1
|
Peris M, Crompton K, Shepherd DA, Amor DJ. The association between human chorionic gonadotropin and adverse pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:118-184. [PMID: 37572838 DOI: 10.1016/j.ajog.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between human chorionic gonadotropin and adverse pregnancy outcomes. DATA SOURCES Medline, Embase, PubMed, and Cochrane were searched in November 2021 using Medical Subject Headings (MeSH) and relevant key words. STUDY ELIGIBILITY CRITERIA This analysis included published full-text studies of pregnant women with serum human chorionic gonadotropin testing between 8 and 28 weeks of gestation, investigating fetal outcomes (fetal death in utero, small for gestational age, preterm birth) or maternal factors (hypertension in pregnancy: preeclampsia, pregnancy-induced hypertension, placental abruption, HELLP syndrome, gestational diabetes mellitus). METHODS Studies were extracted using REDCap software. The Newcastle-Ottawa scale was used to assess for risk of bias. Final meta-analyses underwent further quality assessment using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. RESULTS A total of 185 studies were included in the final review, including the outcomes of fetal death in utero (45), small for gestational age (79), preterm delivery (62), hypertension in pregnancy (107), gestational diabetes mellitus (29), placental abruption (17), and HELLP syndrome (2). Data were analyzed separately on the basis of categorical measurement of human chorionic gonadotropin and human chorionic gonadotropin measured on a continuous scale. Eligible studies underwent meta-analysis to generate a pooled odds ratio (categorical human chorionic gonadotropin level) or difference in medians (human chorionic gonadotropin continuous scale) between outcome groups. First-trimester low human chorionic gonadotropin levels were associated with preeclampsia and fetal death in utero, whereas high human chorionic gonadotropin levels were associated with preeclampsia. Second-trimester high human chorionic gonadotropin levels were associated with fetal death in utero and preeclampsia. CONCLUSION Human chorionic gonadotropin levels are associated with placenta-mediated adverse pregnancy outcomes. Both high and low human chorionic gonadotropin levels in the first trimester of pregnancy can be early warning signs of adverse outcomes. Further analysis of human chorionic gonadotropin subtypes and pregnancy outcomes is required to determine the diagnostic utility of these findings in reference to specific cutoff values.
Collapse
Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Kylie Crompton
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia.
| |
Collapse
|
2
|
Skogler J, Moberg T, Tancredi L, Styrmisdóttir L, Hedayati E, Alarcon-Ruiz CA, Khamis A, Persad E, Iskandarani G, Hansson SR, Bruschettini M. Association between human chorionic gonadotropin (hCG) levels and adverse pregnancy outcomes: A systematic review and meta-analysis. Pregnancy Hypertens 2023; 34:124-137. [PMID: 37951184 DOI: 10.1016/j.preghy.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/01/2023] [Indexed: 11/13/2023]
Abstract
Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and adverse pregnancy outcomes. We conducted a systematic review including studies measuring hCG blood levels in the first or second trimester, reporting on any of the 12 predefined adverse pregnancy outcomes with logistic regression-adjusted association estimates. The primary outcomes were placenta-associated complications, such as miscarriage, preeclampsia, intrauterine growth restriction, and preterm delivery. We searched PubMed, Embase and CINAHL Complete. The hCG levels were analysed as multiple of the median (MoM). Odds ratio (OR) and 95% confidence interval (CI) were used. Risk of bias and the certainty of evidence were assessed using ROBINS-I and GRADE, respectively. Meta-analysis also showed that hCG levels, reported as MoM ≥2/2.31/2.5, might be associated with an increased risk of preeclampsia (OR 2.08, 95% CI 1.26 to 3.44) and preterm delivery (OR 1.29, 95% CI 1.12 to 1.47), but the evidence is very uncertain. High second trimester hCG levels may be associated with preeclampsia and preterm delivery but confidence in evidence is low.
Collapse
Affiliation(s)
| | - Tilda Moberg
- Lund University, Lund, Sweden; Helsingborg Hospital, Helsingborg, Sweden.
| | - Luca Tancredi
- Regiomed Medical School, University of Split School of Medicine, Split, Croatia
| | | | - Ehsan Hedayati
- Nezam Mafi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Assem Khamis
- Wolfson Palliative Care Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Emma Persad
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Evidence-based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria
| | | | - Stefan R Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
3
|
Kasoha M, Takacs Z, Dumé J, Findeklee S, Gerlinger C, Sima RM, Ples L, Solomayer EF, Haj Hamoud B. Postpartum Assessment of the Correlation between Serum Hormone Levels of Estradiol, Progesterone, Prolactin and ß-HCG and Blood Pressure Measurements in Pre-Eclampsia Patients. Diagnostics (Basel) 2022; 12:diagnostics12071700. [PMID: 35885604 PMCID: PMC9316309 DOI: 10.3390/diagnostics12071700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Preeclampsia is a pregnancy-related hypertensive disease. Aberrant hormone levels have been implicated in blood pressure disorders. This study investigated the association of postpartum maternal serum hormone levels of estradiol, progesterone, prolactin, and ß-HCG with poorer PE-related complications including arterial hypertension. Methods: Thirty patient women with preeclampsia, and twenty women with uncomplicated pregnancy were included in this study. Serum levels of estradiol, progesterone, prolactin, and ß-HCG were determined immediately after delivery, and on the first and third postpartum days by means of ECLIA. Results: Compared with normal pregnancy cases, preeclampsia cases had higher serum levels of ß-HCG levels on Day-0 (319%), of progesterone on Day-0 (207%) and Day-1 (178%), and of estradiol on Day-1 (187%) and Day-3 (185%). Increased prolactin levels were positively associated with disease severity and estradiol and progesterone levels were decreased in poorer preeclampsia features including disease onset and IUGR diagnosis. No significant correlation between different hormone levels and blood pressure measurements was reported. Conclusions: This study is the first that detected postpartum maternal serum hormone levels and their correlation with blood pressure measurements in preeclampsia. We believe that the persistent arterial hypertension in the puerperium in preeclampsia as well as poorer disease specifications are most likely not of hormonal origin. Larger, well-defined prospective studies are recommended.
Collapse
Affiliation(s)
- Mariz Kasoha
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
- Correspondence: ; Tel.: +49-(0)-6841-16-28199; Fax: +49-(0)-684-16-28110
| | - Zoltan Takacs
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
| | - Jacob Dumé
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
| | - Christoph Gerlinger
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-M.S.); (L.P.)
| | - Liana Ples
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-M.S.); (L.P.)
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg, Germany; (Z.T.); (J.D.); (S.F.); (C.G.); (E.-F.S.); (B.H.H.)
| |
Collapse
|
4
|
Kim C, Cathey AL, Watkins DJ, Mukherjee B, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD. Maternal blood metal concentrations are associated with matrix metalloproteinases (MMPs) among pregnant women in Puerto Rico. ENVIRONMENTAL RESEARCH 2022; 209:112874. [PMID: 35123972 PMCID: PMC10443181 DOI: 10.1016/j.envres.2022.112874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 06/11/2023]
Abstract
BACKGROUND/AIM Matrix metalloproteinases (MMPs) are important regulators of uterine remodeling, a critical process for healthy pregnancies, and studies have revealed a link between an imbalance in MMPs and adverse birth outcomes. Toxicological studies have indicated that exposure to heavy metals can alter the levels of inflammatory cytokines, including MMPs. Despite growing evidence, the clear association between heavy metal exposure and MMPs has yet to be explored extensively in human populations. To have a better understanding of the association, in this study, we assessed associations between maternal blood metal levels with MMPs among 617 pregnant women in the Puerto Rico PROTECT birth cohort. METHODS We measured blood concentrations for 11 metals in the first and/or second trimester of pregnancy using ICP-MS. MMPs (MMP1, MMP2, and MMP9) were quantified using a customized Luminex assay. Linear mixed effects models (LMEs) were used to regress MMPs on metals and included random intercepts for study participants to account for correlated repeated outcome measures. Fetal sex effects were estimated using interaction terms between metal exposure variables and fetal sex indicators. RESULTS We observed significant associations between cesium, manganese, and zinc with all the MMPs that were measured. We also observed differences in metal-MMPs associations by fetal sex. Cobalt was positively associated with MMP1 only in women with male fetuses, and cesium was negatively associated with MMP1 only in women with female fetuses. MMP2 had significant associations with maternal blood metal concentrations only in women with female fetuses. CONCLUSION Certain metals were significantly associated with MMPs that are responsible for uterine remodeling and healthy pregnancies. Most of these associations differed by fetal sex. This study highlighted significant metal-MMPs associations that may inform research on new avenues for understanding heavy metal-induced adverse birth outcomes and the development of diagnostic tools.
Collapse
Affiliation(s)
- Christine Kim
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States
| | - Amber L Cathey
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States
| | - Deborah J Watkins
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States
| | - Bhramar Mukherjee
- University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, MI, United States
| | - Zaira Y Rosario-Pabón
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, PR, USA
| | - Carmen M Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, PR, USA
| | | | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - John D Meeker
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States.
| |
Collapse
|
5
|
Dos Santos Fagundes I, Brendler EP, Nunes Erthal I, Eder Ribeiro RJ, Caron-Lienert RS, Machado DC, Pinheiro da Costa BE, Poli-de-Figueiredo CE. Total Th1/Th2 cytokines profile from peripheral blood lymphocytes in normal pregnancy and preeclampsia syndrome. Hypertens Pregnancy 2021; 41:15-22. [PMID: 34812111 DOI: 10.1080/10641955.2021.2008424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To evaluate total Th1/Th2 cytokines in CD3+ cells (immunocompetent T-lymphocytes) and peripheral blood lymphocytes, mostly CD4+ (T helper cells) and CD8+ (T-cytotoxic cells) subpopulations in preeclampsia. Total blood leukocytes and lymphocytes counts, percent cells: CD3+, INF-g+/CD3+, IL-4+/CD3+, and IL-10+/CD3+, CD4+/CD8+ were determined by flow-cytometry. Preeclampsia (n= 26) and normal pregnancy (n= 25) participants were age and gestational age matched. CD4+ lymphocytes count was higher in preeclampsia, compared with normal pregnancy (43.6 ± 5.8 vs 37.6 ± 5.6%; P< 0.001). CD3+ cells Th1/Th2 shift was not detected in preeclampsia, yet may be present in other cell types, such as CD4+ and CD3 - lymphocytes.
Collapse
Affiliation(s)
- Iara Dos Santos Fagundes
- Serviço de Imunologia Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Eduardo Pletsch Brendler
- School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Pucrs, Porto Alegre, Brazil
| | - Isadora Nunes Erthal
- School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Pucrs, Porto Alegre, Brazil
| | | | | | - Denise Cantarelli Machado
- School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Pucrs, Porto Alegre, Brazil
| | | | | |
Collapse
|
6
|
Griffin A, Spencer SK, Bowles T, Solis L, Robinson R, Ramarao S, Wallace K. Male HELLP pups experience sensorimotor delays and reduced body weight. Physiol Behav 2021; 241:113567. [PMID: 34474060 DOI: 10.1016/j.physbeh.2021.113567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/12/2023]
Abstract
Offspring of Preeclampsia (PreE) and HELLP Syndrome are at an increased risk of developing neurodevelopmental disorders. In the current study we sought to determine if offspring from experimental models of PreE and HELLP had evidence of early onset neurodevelopmental delay. Offspring from PreE, HELLP and normal pregnant dams were assessed in a battery of sensorimotor tests beginning on postnatal day (PND) 3. Male HELLP offspring showed altered behavior in the surface righting reflex on PND 3 and cliff avoidance task from PND 3-6 relative to other groups. Results suggest that there are sex differences in offspring born to dams with PreE and HELLP.
Collapse
Affiliation(s)
- Ashley Griffin
- Program in Neuroscience, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Shauna-Kay Spencer
- Department of Obstetrics and Gynecology, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Teylor Bowles
- Department of Obstetrics and Gynecology, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Lucia Solis
- Department of Obstetrics and Gynecology, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Reanna Robinson
- Department of Obstetrics and Gynecology, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Sumana Ramarao
- Department of Pediatrics, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Kedra Wallace
- Department of Obstetrics and Gynecology, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States; Department of Neurobiology and Anatomical Sciences, 2500 North State Street, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| |
Collapse
|
7
|
Al Khalaf SY, O'Reilly ÉJ, McCarthy FP, Kublickas M, Kublickiene K, Khashan AS. Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study. Am J Obstet Gynecol 2021; 225:298.e1-298.e20. [PMID: 33823152 DOI: 10.1016/j.ajog.2021.03.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Maternal chronic kidney disease and chronic hypertension have been linked with adverse pregnancy outcomes. We aimed to examine the association between these conditions and adverse pregnancy outcomes over the last 3 decades. OBJECTIVE We conducted this national cohort study to assess the association between maternal chronic disease (CH, CKD or both conditions) and adverse pregnancy outcomes with an emphasis on the effect of parity, maternal age, and BMI on these associations over the last three decades. We further investigated whether different subtypes of CKD had differing effects. STUDY DESIGN We used data from the Swedish Medical Birth Register, including 2,788,490 singleton births between 1982 and 2012. Women with chronic kidney disease and chronic hypertension were identified from the Medical Birth Register and National Patient Register. Logistic regression models were performed to assess the associations between maternal chronic disease (chronic hypertension, chronic kidney disease, or both conditions) and pregnancy outcomes, including preeclampsia, in-labor and prelabor cesarean delivery, preterm birth, small for gestational age, and stillbirth. RESULTS During the 30-year study period, 22,397 babies (0.8%) were born to women with chronic kidney disease, 13,279 (0.48%) to women with chronic hypertension and 1079 (0.04%) to women with both conditions. Associations with chronic hypertension were strongest for preeclampsia (adjusted odds ratio, 4.57; 95% confidence interval, 4.33-4.84) and stillbirth (adjusted odds ratio, 1.65; 95% confidence interval, 1.35-2.03) and weakest for spontaneous preterm birth (adjusted odds ratio, 1.07; 95% confidence interval, 0.96-1.20). The effect of chronic kidney disease varied from (adjusted odds ratio, 2.05; 95% confidence interval, 1.92-2.19) for indicated preterm birth to no effect for stillbirth (adjusted odds ratio, 1.16; 95% confidence interval, 0.95-1.43). Women with both conditions had the strongest associations for in-labor cesarean delivery (adjusted odds ratio, 1.86; 95% confidence interval, 1.49-2.32), prelabor cesarean delivery (adjusted odds ratio, 2.68; 95% confidence interval, 2.18-3.28), indicated preterm birth (adjusted odds ratio, 9.09; 95% confidence interval, 7.61-10.7), and small for gestational age (adjusted odds ratio, 4.52; 95% confidence interval, 3.68-5.57). The results remained constant over the last 3 decades. Stratified analyses of the associations by parity, maternal age, and body mass index showed that adverse outcomes remained independently higher in women with these conditions, with worse outcomes in multiparous women. All chronic kidney disease subtypes were associated with higher odds of preeclampsia, in-labor cesarean delivery, and medically indicated preterm birth. Different subtypes of chronic kidney disease had differing risks; strongest associations of preeclampsia (adjusted odds ratio, 3.98; 95% confidence interval, 2.98-5.31) and stillbirth (adjusted odds ratio, 2.73; 95% confidence interval, 1.13-6.59) were observed in women with congenital kidney disease, whereas women with diabetic nephropathy had the most pronounced increase odds of in-labor cesarean delivery (adjusted odds ratio, 3.54; 95% confidence interval, 2.06-6.09), prelabor cesarean delivery (adjusted odds ratio, 7.50; 95% confidence interval, 4.74-11.9), and small for gestational age (adjusted odds ratio, 4.50; 95% confidence interval, 2.92-6.94). In addition, women with renovascular disease had the highest increased risk of preterm birth in both spontaneous preterm birth (adjusted odds ratio, 3.01; 95% confidence interval, 1.57-5.76) and indicated preterm birth (adjusted odds ratio, 8.09; 95% confidence interval, 5.73-11.4). CONCLUSION Women with chronic hypertension, chronic kidney disease, or both conditions are at an increased risk of adverse pregnancy outcomes which were independent of maternal age, body mass index, and parity. Multidisciplinary management should be provided with intensive clinical follow-up to support these women during pregnancy, particularly multiparous women. Further research is needed to evaluate the effect of disease severity on adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Sukainah Y Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
| | - Éilis J O'Reilly
- School of Public Health, University College Cork, Cork, Ireland; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Marius Kublickas
- Department of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
| |
Collapse
|
8
|
Zhang X, Huangfu Z, Shi F, Xiao Z. Predictive Performance of Serum β-hCG MoM Levels for Preeclampsia Screening: A Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:619530. [PMID: 34177797 PMCID: PMC8223748 DOI: 10.3389/fendo.2021.619530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the predictive value of using the multiple of the median (MoM) of β-human chorionic gonadotropin (β-hCG) levels in patients with preeclampsia (PE) and healthy pregnant women. METHODS Electronic databases including PubMed, EBSCO, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, Wangfang and the Weipu Journal were searched up to May 31, 2020. Two reviewers independently selected the articles and extracted data on study characteristics, quality and results. A random-effects model was employed, and standardized mean difference and 95% confidence intervals were calculated. Twenty-one case-control studies were analyzed in the present meta-analysis, including a total of 2,266 cases and 25,872 healthy controls. RESULTS Women who were diagnosed with PE were found to have higher early second-trimester levels of serum β-hCG MoM compared with healthy controls, although the levels in the first trimester were not significantly different. Ethnicity subgroup analysis demonstrated that the MoM of β-hCG serum levels was significantly higher in PE patients in both Asian and Caucasian populations during the early second trimester. CONCLUSION The MoM of β-hCG serum levels was found to be a valuable clinical indicator for predicting PE in the early second trimester, but had little predictive value in the first trimester. However, further assessment of the predictive capacity of β-hCG within larger, diverse populations is required.
Collapse
Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhao Huangfu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fangxin Shi
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Fangxin Shi, ; Zhen Xiao,
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute of High Altitude Medicine, People’s Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
- *Correspondence: Fangxin Shi, ; Zhen Xiao,
| |
Collapse
|
9
|
Salem NA, Mahnke AH, Wells AB, Tseng AM, Yevtushok L, Zymak-Zakutnya N, Wertlecki W, Chambers CD, Miranda RC. Association between fetal sex and maternal plasma microRNA responses to prenatal alcohol exposure: evidence from a birth outcome-stratified cohort. Biol Sex Differ 2020; 11:51. [PMID: 32912312 PMCID: PMC7488011 DOI: 10.1186/s13293-020-00327-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
Most persons with fetal alcohol spectrum disorders (FASDs) remain undiagnosed or are diagnosed in later life. To address the need for earlier diagnosis, we previously assessed miRNAs in the blood plasma of pregnant women who were classified as unexposed to alcohol (UE), heavily exposed with affected infants (HEa), or heavily exposed with apparently unaffected infants (HEua). We reported that maternal miRNAs predicted FASD-related growth and psychomotor deficits in infants. Here, we assessed whether fetal sex influenced alterations in maternal circulating miRNAs following prenatal alcohol exposure (PAE). To overcome the loss of statistical power due to disaggregating maternal samples by fetal sex, we adapted a strategy of iterative bootstrap resampling with replacement to assess the stability of statistical parameter estimates. Bootstrap estimates of parametric and effect size tests identified male and female fetal sex-associated maternal miRNA responses to PAE that were not observed in the aggregated sample. Additionally, we observed, in HEa mothers of female, but not male fetuses, a network of co-secreted miRNAs whose expression was linked to miRNAs encoded on the X-chromosome. Interestingly, the number of significant miRNA correlations for the HEua group mothers with female fetuses was intermediate between HEa and UE mothers at mid-pregnancy, but more similar to UE mothers by the end of pregnancy. Collectively, these data show that fetal sex predicts maternal circulating miRNA adaptations, a critical consideration when adopting maternal miRNAs as diagnostic biomarkers. Moreover, a maternal co-secretion network, predominantly in pregnancies with female fetuses, emerged as an index of risk for adverse birth outcomes due to PAE.
Collapse
Affiliation(s)
- Nihal A Salem
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Medical Research and Education Bldg., Texas A&M University Health Science Center, 8447 Riverside Parkway, Bryan, TX, 77807-3260, USA.,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, USA
| | - Amanda H Mahnke
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Medical Research and Education Bldg., Texas A&M University Health Science Center, 8447 Riverside Parkway, Bryan, TX, 77807-3260, USA.,Women's Health in Neuroscience Program, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Alan B Wells
- Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California San Diego, 9500 Gilman Drive MC 0828, La Jolla, San Diego, CA, 92093, USA
| | - Alexander M Tseng
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Medical Research and Education Bldg., Texas A&M University Health Science Center, 8447 Riverside Parkway, Bryan, TX, 77807-3260, USA
| | - Lyubov Yevtushok
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine.,Lviv National Medical University, Lviv, Ukraine.,OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine.,Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Wladimir Wertlecki
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive MC 0828, La Jolla, San Diego, CA, 92093, USA.,OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine
| | - Christina D Chambers
- Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, USA. .,Department of Pediatrics, University of California San Diego, 9500 Gilman Drive MC 0828, La Jolla, San Diego, CA, 92093, USA.
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Medical Research and Education Bldg., Texas A&M University Health Science Center, 8447 Riverside Parkway, Bryan, TX, 77807-3260, USA. .,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, USA. .,Women's Health in Neuroscience Program, Texas A&M University Health Science Center, Bryan, TX, USA.
| | | |
Collapse
|
10
|
Hou YP, Lommel L, Wiley J, Zhou XH, Yao M, Liu S, Peng JL. Influencing factors for placenta accreta in recent 5 years: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 35:2166-2173. [PMID: 32552190 DOI: 10.1080/14767058.2020.1779215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Assess influencing factors for placenta accreta in pregnant women documented in recent literature.Methods: A systematic review and meta-analysis were conducted based on English- and Chinese-language articles published from January 2014 to June 2019. Articles were retrieved from the following Chinese databases, CNKI, Wanfang Data, China Science and Technology Journal Database, CBM and English databases, PubMed, Web of Science, the Cochrane Library and Embase.Results: Eleven studies with 2,152,014 cases were included in the meta-analysis. The odds ratios of influencing factors were as follows: hypertension 2.51 (95% CI, 1.50-4.20), multifetal gestations 1.90 (95% CI, 1.26-2.88), male fetus 0.79 (95% CI, 0.74-0.84), and low socioeconomic status 0.51 (95% CI, 0.37-0.71).Conclusion: Evidence from English- and Chinese-language literature indicates that hypertension and multifetal gestations are risk factors for placenta accreta, while male fetus and low socioeconomic status are protective factors.
Collapse
Affiliation(s)
- Yi-Ping Hou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
| | - Lisa Lommel
- School of Nursing, University of California, San Francisco, CA, USA
| | - James Wiley
- Philip R. Lee Institute for Health Policy Studies and Department of Family and Community Medicine School of Medicine, University of California, San Francisco, CA, USA
| | - Xi-Hong Zhou
- Clinical Nursing Teaching and Research Section and Department of Obstetrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Yao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
| | - Sai Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
| | - Jin-Li Peng
- Clinical Nursing Teaching and Research Section and Department of Obstetrics, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
11
|
Broere-Brown ZA, Adank MC, Benschop L, Tielemans M, Muka T, Gonçalves R, Bramer WM, Schoufour JD, Voortman T, Steegers EAP, Franco OH, Schalekamp-Timmermans S. Fetal sex and maternal pregnancy outcomes: a systematic review and meta-analysis. Biol Sex Differ 2020; 11:26. [PMID: 32393396 PMCID: PMC7216628 DOI: 10.1186/s13293-020-00299-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
Background Since the placenta also has a sex, fetal sex–specific differences in the occurrence of placenta-mediated complications could exist. Objective To determine the association of fetal sex with multiple maternal pregnancy complications. Search strategy Six electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Web-of-Science, PubMed, and Google Scholar were systematically searched to identify eligible studies. Reference lists of the included studies and contact with experts were also used for identification of studies. Selection criteria Observational studies that assessed fetal sex and the presence of maternal pregnancy complications within singleton pregnancies. Data collection and analyses Data were extracted by 2 independent reviewers using a predesigned data collection form. Main results From 6522 original references, 74 studies were selected, including over 12,5 million women. Male fetal sex was associated with term pre-eclampsia (pooled OR 1.07 [95%CI 1.06 to 1.09]) and gestational diabetes (pooled OR 1.04 [1.02 to 1.07]). All other pregnancy complications (i.e., gestational hypertension, total pre-eclampsia, eclampsia, placental abruption, and post-partum hemorrhage) tended to be associated with male fetal sex, except for preterm pre-eclampsia, which was more associated with female fetal sex. Overall quality of the included studies was good. Between-study heterogeneity was high due to differences in study population and outcome definition. Conclusion This meta-analysis suggests that the occurrence of pregnancy complications differ according to fetal sex with a higher cardiovascular and metabolic load for the mother in the presence of a male fetus. Funding None.
Collapse
Affiliation(s)
- Zoe A Broere-Brown
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maria C Adank
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laura Benschop
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Myrte Tielemans
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Taulant Muka
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Romy Gonçalves
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Hogeschool van Amsterdam (HvA), Amsterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sarah Schalekamp-Timmermans
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands. .,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
12
|
Impact of gestational hypertension and preeclampsia on fetal gender: A large prospective cohort study in China. Pregnancy Hypertens 2019; 18:132-136. [PMID: 31610399 DOI: 10.1016/j.preghy.2019.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent studies suggested an association between fetal sex preponderance and hypertensive disorders during pregnancy, but the conclusions were inconsistent. Our objective was to investigate whether the occurrence of gestational hypertensive disorders would affect the possibility of delivering boys. METHODS Data were obtained from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. We included participants who were registered in 2 southern Chinese provinces, and whose information of blood pressure and sex delivery were recorded in detailed. Blood pressure was measured during pregnancy by trained health care workers and other health-related information was recorded prospectively. We used log-binomial regression to evaluate the association between gestational hypertension or preeclampsia and the chance of male delivery. RESULTS Among 205,605 singleton pregnancy women, the overall incidences of gestational hypertension and preeclampsia were 9.5% and 2.4%, respectively. The prevalence of male delivery was 51.1% and 50.2% in the groups of gestational hypertension and preeclampsia, while in the normotension group was 52.0%. After adjustment for the effects of the main potential confounders, women with gestational hypertension and preeclampsia both showed significantly decreased probability of giving birth to a boy. The adjusted risk ratios (RRs) were 0.98 (95% confidence interval (CI): 0.97-0.99) and 0.96 (95% CI: 0.94-0.99), respectively. CONCLUSIONS Our results support a slight but significant association between gestational hypertension or preeclampsia and decreased likelihood of male delivery.
Collapse
|
13
|
Osborne LM. Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers. Obstet Gynecol Clin North Am 2019; 45:455-468. [PMID: 30092921 DOI: 10.1016/j.ogc.2018.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Postpartum psychosis is a psychiatric emergency that affects 1 to 2 per 1000 women. Key clinical features include mood fluctuation, abnormal thoughts or behaviors, and confusion. Women with a history of bipolar disorder are at heightened risk, as are first-time mothers; current research on the causes focuses on biological triggers, such as immune dysregulation. Women with postpartum psychosis require inpatient hospitalization and should be treated with lithium, antipsychotics, and benzodiazepines.
Collapse
Affiliation(s)
- Lauren M Osborne
- Departments of Psychiatry & Behavioral Sciences and Gynecology & Obstetrics, Women's Mood Disorders Center, Johns Hopkins University School of Medicine, 550 North Broadway, Suite 305, Baltimore, MD 21205, USA.
| |
Collapse
|
14
|
Tosun G, İnan AH, Kanmaz AG, Biler A, İleri A, Beyan E, Ertas IE. Does fetal sex affect placental delivery times? A prospective observational study. J Matern Fetal Neonatal Med 2018; 33:217-221. [PMID: 29886800 DOI: 10.1080/14767058.2018.1488163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: The aim of this study was to determine the potential effect of fetal sex on placental delivery times.Study design: This was a prospective observational study of term, singleton, and primiparous pregnant women who underwent vaginal delivery and subsequently delivered a phenotypically normal live infant. Women with labor or pregnancy complications and comorbid diseases were excluded. Women with factors who could lengthen the placental delivery time were also excluded. The cohort was divided into two groups according to fetal sex. A total of 299 vaginal deliveries were included, and placental delivery times were analyzed in both groups.Results: There were 3938 vaginal deliveries during the study period. Of these, 150 male-bearing pregnant women and 149 female-bearing pregnant women who met the inclusion criteria were included in the analysis. The mean placental delivery time was significantly longer in the male-bearing group than the female-bearing group (12.20 versus 8.21 min, p = .01). Birth weight was significantly greater in the male-bearing group than the female-bearing group (3194 versus 3059 g, p = .004). There was no significant between-group difference in maternal age, gestational age, and preconception body mass index (BMI).Conclusion: Fetal sex had a significant effect on the placental delivery time in the present study. Fetal sex should be considered in future clinical trials of placental delivery times.
Collapse
Affiliation(s)
- Gökhan Tosun
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Abdurrahman Hamdi İnan
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ahkam Göksel Kanmaz
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alper Biler
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alper İleri
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Emrah Beyan
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Egemen Ertas
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
15
|
Lorente-Pozo S, Parra-Llorca A, Torres B, Torres-Cuevas I, Nuñez-Ramiro A, Cernada M, García-Robles A, Vento M. Influence of Sex on Gestational Complications, Fetal-to-Neonatal Transition, and Postnatal Adaptation. Front Pediatr 2018; 6:63. [PMID: 29740570 PMCID: PMC5924769 DOI: 10.3389/fped.2018.00063] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/02/2018] [Indexed: 12/19/2022] Open
Abstract
Fetal sex is associated with striking differences during in utero development, fetal-to-neonatal transition, and postnatal morbidity and mortality. Male sex fetuses are apparently protected while in utero resulting in a higher secondary sex rate for males than for females. However, during fetal-to-neonatal transition and thereafter in the newborn period, female exhibits a greater degree of maturation that translates into a better capacity to stabilize, less incidence of prematurity and prematurity-associated morbidities, and better long-term outcomes. The present review addresses the influence of sex during gestation and postnatal adaptation that includes the establishment of an adult-type circulation, the initiation of breathing, endurance when confronted with perinatal hypoxia ischemia, and a gender-related different response to drugs. The intrinsic mechanisms explaining these differences in the perinatal period remain elusive and further experimental and clinical research are therefore stringently needed if an individual oriented therapy is to be developed.
Collapse
Affiliation(s)
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Begoña Torres
- Neonatal Research Group, Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Antonio Nuñez-Ramiro
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Cernada
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana García-Robles
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
16
|
Al-Qaraghouli M, Fang YMV. Effect of Fetal Sex on Maternal and Obstetric Outcomes. Front Pediatr 2017; 5:144. [PMID: 28674684 PMCID: PMC5476168 DOI: 10.3389/fped.2017.00144] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/07/2017] [Indexed: 11/25/2022] Open
Abstract
Fetal sex plays an important role in modifying the course and complications related to pregnancy and may also have an impact on maternal health and well-being both during and after pregnancy. The goal of this article is to review and summarize the findings from published research on physiologic and pathologic changes that may be affected by fetal sex and the effect of these changes on the maternal and obstetrical outcomes. This will help create awareness that fetal sex is not just a random chance event but an interactive process between the mother, the placenta, and the fetus. The reported effects of male sex on the course of pregnancy and delivery include higher incidence of preterm labor in singletons and twins, failure of progression in labor, true umbilical cord knots, cord prolapse, nuchal cord, higher cesarean section rate, higher heart rate variability with increased frequency, and duration of decelerations without acidemia and increased risk of gestational diabetes mellitus through the poor beta cells function. Similarly, female fetal sex has been reported to modify pregnancy and delivery outcomes including altered fetal cardiac hemodynamics, increased hypertensive diseases of pregnancy, higher vulnerability of developing type 2 DM after pregnancy possibly because of influences on increased maternal insulin resistance. Placental function is also influenced by fetal sex. Vitamin D metabolism in the placenta varies by fetal sex; and the placenta of a female fetus is more responsive to the relaxing action of magnesium sulfate. Male and female feto-placental units also vary in their responses to environmental toxin exposure. The association of fetal sex with stillbirths is controversial with many studies reporting higher risk of stillbirth in male fetuses; although some smaller and limited studies have reported more stillbirths with female fetus pregnancies. Maternal status such as BMI may in turn also affect the fetus and the placenta in a sex-specific manner. There is probably a sex-specific maternal-placental-fetal interaction that has significant biological implications of which the mechanisms may be genetic, epigenetic, or hormonal. Determination of fetal sex may therefore be an important consideration in management of pregnancy and childbirth.
Collapse
Affiliation(s)
- Mohammed Al-Qaraghouli
- Department Obstetrics and Gynecology, Division Maternal-Fetal Medicine, UConn Health John Dempsey Hospital, Farmington, CT, United States
| | - Yu Ming Victor Fang
- Department Obstetrics and Gynecology, Division Maternal-Fetal Medicine, UConn Health John Dempsey Hospital, Farmington, CT, United States
| |
Collapse
|