Jaskolka D, Retnakaran R, Zinman B, Kramer CK. Fetal sex and maternal risk of pre-eclampsia/eclampsia: a systematic review and meta-analysis.
BJOG 2017;
124:553-560. [PMID:
27315789 DOI:
10.1111/1471-0528.14163]
[Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND
A preponderance of male fetuses in pregnancies complicated by pre-eclampsia was described over 40 years ago. Since then, however, there has been conflicting evidence in the literature, with some studies supporting a male preponderance, some demonstrating no relationship with fetal sex, and others reporting increased risk in pregnancies bearing females.
OBJECTIVES
In this context, we sought to conduct a systematic review and meta-analysis to objectively evaluate the relationship between fetal sex and maternal risk of pre-eclampsia/eclampsia.
SEARCH STRATEGY
Studies from January 1950 to April 2015 were identified from PUBMED and EMBASE.
SELECTION CRITERIA
This systematic review and meta-analysis evaluated 22 articles reporting data on fetal sex and prevalence of pre-eclampsia/eclampsia.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent reviewers. Pooled estimates of the relative risk (RR) were calculated by random-effects model.
MAIN RESULTS
Male fetus was considered the exposure and prevalence of maternal pre-eclampsia/eclampsia was the outcome of interest. We identified 534 studies through electronic searches and three studies through manual searches. Twenty-two studies fulfilled the inclusion criteria, yielding data on 3 163 735 women. Pooled analyses of these studies showed no association between male fetal sex and maternal risk of pre-eclampsia/eclampsia (RR 1.01; 95% confidence interval, 95% CI 0.97-1.05); however, a subgroup analysis including only studies that evaluated the non-Asian population (n = 2 931 771 women) demonstrated that male fetal sex was associated with increased maternal risk of pre-eclampsia/eclampsia (RR 1.05; 95% CI 1.03-1.06; I2 = 10%; P = 0.33).
CONCLUSION
Male fetal sex is associated with maternal risk of pre-eclampsia/eclampsia in the non-Asian population.
TWEETABLE ABSTRACT
Fetal sex is associated with maternal risk of pre-eclampsia/eclampsia in the non-Asian population.
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