Association between fetal sex, birthweight percentile and adverse pregnancy outcome

Bart Jan Voskamp*, Myrthe J.C.S. Peelen, Anita C.J. Ravelli, Robin van der Lee, Ben W.J. Mol, Eva Pajkrt, Wessel Ganzevoort, Brenda M. Kazemier

*Corresponding author for this work

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Abstract

Introduction: The objective was to evaluate the association between fetal sex and adverse pregnancy outcome, while correcting for fetal growth and gestational age at delivery. Material and methods: Data from the Netherlands Perinatal Registry (1999-2010) were used. The study population comprised all white European women with a singleton delivery between 25+0 and 42+6 weeks of gestation. Fetuses with structural or chromosomal abnormalities were excluded. Outcomes were antepartum death, intrapartum/neonatal death (from onset of labor until 28 days after birth), perinatal death (antepartum death or intrapartum/neonatal death), a composite of neonatal morbidity (including infant respiratory distress syndrome, sepsis, necrotizing enterocolitis, meconium aspiration, persistent pulmonary hypertension of the newborn, periventricular leukomalacia, Apgar score <7 at 5 minutes, and intracranial hemorrhage) and a composite adverse neonatal outcome (perinatal death or neonatal morbidity). Outcomes were expressed stratified by birthweight percentile (<p10 [small for gestation], p10-90 [normal weight], >p90 [large for gestation]) and gestational age at delivery (25+0-27+6, 28+0-31+6, 32+0-36+6, 37+0-42+6weeks). The association between fetal sex and outcome was assessed using the fetus at risk approach. Results: We studied 1 742 831 pregnant women. We found no increased risk of antepartum, intrapartum/neonatal and perinatal death in normal weight and large-for-gestation males born after 28+0weeks compared with females. We found an increased risk of antepartum death among small-for-gestation males born after 28+0weeks (relative risk [RR] 1.16-1.40). All males born after 32+0 weeks of gestation suffered more neonatal morbidity than females regardless of birthweight percentile (RR 1.07-1.34). Infant respiratory distress syndrome, sepsis, persistent pulmonary hypertension of the newborn, Apgar score <7 at 5 minutes, and intracranial hemorrhage all occurred more often in males than in females. Conclusions: Small-for-gestation males have an increased risk of antepartum death and all males born after 32+0 weeks of gestation have an increased risk of neonatal morbidity compared with females. In contrast to findings in previous studies we found no increased risk of antepartum, intrapartum/neonatal or perinatal death in normal weight and large-for-gestation males born after 28+0 weeks.

Original languageEnglish
Pages (from-to)48-58
Number of pages11
JournalActa Obstetricia et Gynecologica Scandinavica
Volume99
Issue number1
Early online date30 Aug 2019
DOIs
Publication statusPublished - Jan 2020

Keywords

  • adverse outcome
  • antepartum death
  • intrapartum death
  • neonatal death
  • sex
  • small for gestational age
  • MORTALITY
  • PRETERM BIRTH
  • RATIO
  • RISK
  • DELIVERY
  • GESTATIONAL-AGE
  • GENDER
  • NETHERLANDS
  • PROBABILISTIC RECORD LINKAGE

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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  • Cite this

    Voskamp, B. J., Peelen, M. J. C. S., Ravelli, A. C. J., van der Lee, R., Mol, B. W. J., Pajkrt, E., Ganzevoort, W., & Kazemier, B. M. (2020). Association between fetal sex, birthweight percentile and adverse pregnancy outcome. Acta Obstetricia et Gynecologica Scandinavica, 99(1), 48-58. https://doi.org/10.1111/aogs.13709