TY - JOUR
T1 - Association between fetal sex, birthweight percentile and adverse pregnancy outcome
AU - Voskamp, Bart Jan
AU - Peelen, Myrthe J. C. S.
AU - Ravelli, Anita C. J.
AU - van der Lee, Robin
AU - Mol, Ben W. J.
AU - Pajkrt, Eva
AU - Ganzevoort, Wessel
AU - Kazemier, Brenda M.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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 (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.
AB - 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 (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.
KW - adverse outcome
KW - antepartum death
KW - intrapartum death
KW - neonatal death
KW - sex
KW - small for gestational age
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85071377136&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31424085
UR - http://www.scopus.com/inward/record.url?scp=85071377136&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/aogs.13709
DO - https://doi.org/10.1111/aogs.13709
M3 - Article
C2 - 31424085
SN - 0001-6349
VL - 99
SP - 48
EP - 58
JO - Acta obstetricia et gynecologica Scandinavica
JF - Acta obstetricia et gynecologica Scandinavica
IS - 1
ER -