nach oben

Erschienen in:

04.03.2023 | Maternal-Fetal Medicine

Association between foetal sex and adverse neonatal outcomes in women with gestational diabetes

verfasst von: Catarina Cidade-Rodrigues, Catarina Chaves, Anabela Melo, Alexandra Novais-Araújo, Odete Figueiredo, Vânia Gomes, Ana Morgado, M. Céu Almeida, Mariana Martinho, Margarida Almeida, Filipe M. Cunha

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 4/2024

Einloggen, um Zugang zu erhalten

Abstract

Aims

Foetal male sex is associated with adverse perinatal outcomes. However, studies evaluating the impact of foetal sex on perinatal outcomes in women with gestational diabetes (GDM) are scarce. We studied whether male new-born sex is associated with neonatal outcomes, in women with GDM.

Methods

This is a retrospective study based on the national Portuguese register of GDM. All women with live-born singleton pregnancies between 2012 and 2017 were eligible for study inclusion. Primary endpoints under analysis were neonatal hypoglycaemia, neonatal macrosomia, respiratory distress syndrome (RDS) and neonatal intensive care unit (NICU) admission. We excluded women with missing data on the primary endpoint. Pregnancy data and neonatal outcomes between female and male new-borns were compared. Multivariate logistic regression models were built.

Results

We studied 10,768 new-borns in mothers with GDM, 5635 (52.3%) male, 438 (4.1%) had neonatal hypoglycaemia, 406 (3.8%) were macrosomic, 671 (6.2%) had RDS, and 671 (6.2%) needed NICU admission. Male new-borns were more frequently small or large for gestational age. No differences were observed on maternal age, body mass index, glycated haemoglobin, anti-hyperglycaemic treatment, pregnancy complications or gestational age at delivery. In the multivariate regression analysis, male sex was independently associated with neonatal hypoglycaemia [OR 1.26 (IC 95%: 1.04–1.54), p = 0.02], neonatal macrosomia [1.94 (1.56–2.41), p < 0.001], NICU admission [1.29 (1.07–1.56), p = 0.009], and RDS [1.35 (1.05–1.73, p = 0.02].

Conclusions

Male new-borns have an independent 26% higher risk of neonatal hypoglycaemia, 29% higher risk of NICU admission, 35% higher risk of RDS, and almost twofold higher risk of macrosomia, compared to female new-borns.

Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, Hoegfeldt CA, Elise Powe C, Immanuel J, Karuranga S, Divakar H, Levitt N, Li C, Simmons D, Yang X, Group IDFDACHiPSI (2022) IDF diabetes atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by international association of diabetes in pregnancy study group’s criteria. Diabetes Res Clin Pract 183:109050. https://doi.org/10.1016/j.diabres.2021.109050CrossRefPubMed

Kim SY, Sharma AJ, Callaghan WM (2012) Gestational diabetes and childhood obesity: what is the link? Curr Opin Obstet Gynecol 24(6):376–381. https://doi.org/10.1097/GCO.0b013e328359f0f4CrossRefPubMedPubMedCentral

Saravanan P, Diabetes in Pregnancy Working G, Maternal Medicine Clinical Study G, Royal College of O, Gynaecologists UK (2020) Gestational diabetes: opportunities for improving maternal and child health. Lancet Diabetes Endocrinol 8(9):793–800. https://doi.org/10.1016/S2213-8587(20)30161-3CrossRefPubMed

Di Renzo GC, Rosati A, Sarti RD, Cruciani L, Cutuli AM (2007) Does fetal sex affect pregnancy outcome? Gend Med 4(1):19–30. https://doi.org/10.1016/s1550-8579(07)80004-0CrossRefPubMed

Sheiner E, Levy A, Katz M, Hershkovitz R, Leron E, Mazor M (2004) Gender does matter in perinatal medicine. Fetal Diagn Ther 19(4):366–369. https://doi.org/10.1159/000077967CrossRefPubMed

Al-Qaraghouli M, Fang YMV (2017) Effect of Fetal Sex on Maternal and Obstetric Outcomes. Front Pediatr 5:144. https://doi.org/10.3389/fped.2017.00144CrossRefPubMedPubMedCentral

Lorente-Pozo S, Parra-Llorca A, Torres B, Torres-Cuevas I, Nunez-Ramiro A, Cernada M, Garcia-Robles A, Vento M (2018) Influence of Sex on Gestational Complications, Fetal-to-Neonatal Transition, and Postnatal Adaptation. Front Pediatr 6:63. https://doi.org/10.3389/fped.2018.00063CrossRefPubMedPubMedCentral

Naeye RL, Burt LS, Wright DL, Blanc WA, Tatter D (1971) Neonatal mortality, the male disadvantage. Pediatrics 48(6):902–906CrossRefPubMed

Simchen MJ, Weisz B, Zilberberg E, Morag I, Weissmann-Brenner A, Sivan E, Dulitzki M (2014) Male disadvantage for neonatal complications of term infants, especially in small-for-gestational age neonates. J Matern Fetal Neonatal Med 27(8):839–843. https://doi.org/10.3109/14767058.2013.845658CrossRefPubMed

10.

Jaskolka D, Retnakaran R, Zinman B, Kramer CK (2017) Fetal sex and maternal risk of pre-eclampsia/eclampsia: a systematic review and meta-analysis. BJOG 124(4):553–560. https://doi.org/10.1111/1471-0528.14163CrossRefPubMed

11.

Hu J, Ge Z, Xu Q, Shen S, Wang Y, Zhu D, Bi Y (2020) Influence of fetal sex on perinatal outcomes in women with gestational diabetes mellitus. Diabetes Metab Res Rev 36(3):3245. https://doi.org/10.1002/dmrr.3245CrossRef

12.

Retnakaran R, Kramer CK, Ye C, Kew S, Hanley AJ, Connelly PW, Sermer M, Zinman B (2015) Fetal sex and maternal risk of gestational diabetes mellitus: the impact of having a boy. Diabetes Care 38(5):844–851. https://doi.org/10.2337/dc14-2551CrossRefPubMed

13.

Geng X, Geng L, Zhang Y, Lu H, Shen Y, Chen R, Fang P, Tao M, Wang C, Jia W (2017) Fetal sex influences maternal fasting plasma glucose levels and basal beta-cell function in pregnant women with normal glucose tolerance. Acta Diabetol 54(12):1131–1138. https://doi.org/10.1007/s00592-017-1055-1CrossRefPubMed

14.

Giannubilo SR, Pasculli A, Ballatori C, Biagini A, Ciavattini A (2018) Fetal sex, need for insulin, and perinatal outcomes in gestational diabetes mellitus: an observational cohort study. Clin Ther 40(4):587–592. https://doi.org/10.1016/j.clinthera.2018.02.015CrossRefPubMed

15.

Jaskolka D, Retnakaran R, Zinman B, Kramer CK (2015) Sex of the baby and risk of gestational diabetes mellitus in the mother: a systematic review and meta-analysis. Diabetologia 58(11):2469–2475. https://doi.org/10.1007/s00125-015-3726-1CrossRefPubMed

16.

Seghieri G, Di Cianni G, Gualdani E, De Bellis A, Franconi F, Francesconi P (2022) The impact of fetal sex on risk factors for gestational diabetes and related adverse pregnancy outcomes. Acta Diabetol 59(5):633–639. https://doi.org/10.1007/s00592-021-01836-1CrossRefPubMed

17.

Tundidor D, Garcia-Patterson A, Maria MA, Ubeda J, Ginovart G, Adelantado JM, de Leiva A, Corcoy R (2012) Perinatal maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex. Gend Med 9(6):411–417. https://doi.org/10.1016/j.genm.2012.09.002CrossRefPubMed

18.

International Association of D, Pregnancy Study Groups Consensus P, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682. https://doi.org/10.2337/dc09-1848CrossRef

19.

Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline (2014). Diabetes Res Clin Pract 103 (3): 341–363. https://doi.org/10.1016/j.diabres.2013.10.012

20.

Ingemarsson I (2003) Gender aspects of preterm birth. BJOG 110(Suppl 20):34–38. https://doi.org/10.1016/s1470-0328(03)00022-3CrossRefPubMed

21.

Bracero LA, Cassidy S, Byrne DW (1996) Effect of gender on perinatal outcome in pregnancies complicated by diabetes. Gynecol Obstet Invest 41(1):10–14. https://doi.org/10.1159/000292026CrossRefPubMed

22.

Persson M, Fadl H (2014) Perinatal outcome in relation to fetal sex in offspring to mothers with pre-gestational and gestational diabetes–a population-based study. Diabet Med 31(9):1047–1054. https://doi.org/10.1111/dme.12479CrossRefPubMed

23.

Wilkin TJ, Voss LD, Metcalf BS, Mallam K, Jeffery AN, Alba S, Murphy MJ (2004) Metabolic risk in early childhood: the earlybird study. Int J Obes Relat Metab Disord 28(Suppl 3):S64-69. https://doi.org/10.1038/sj.ijo.0802807CrossRefPubMed

24.

Barbieri RL, Saltzman D, Phillippe M, Torday JS, Randall R, Frigoletto FD, Ryan KJ (1985) Elevated beta-human chorionic gonadotropin and testosterone in cord serum of male infants of diabetic mothers. J Clin Endocrinol Metab 61(5):976–979. https://doi.org/10.1210/jcem-61-5-976CrossRefPubMed

25.

Zondek LH, Zondek T (1967) Leydig cells of the foetus and newborn in various complications of pregnancy. Acta Obstet Gynecol Scand 46(3):392–413. https://doi.org/10.3109/00016346709158642CrossRefPubMed

26.

Polderman KH, Gooren LJ, Asscheman H, Bakker A, Heine RJ (1994) Induction of insulin resistance by androgens and estrogens. J Clin Endocrinol Metab 79(1):265–271. https://doi.org/10.1210/jcem.79.1.8027240CrossRefPubMed

27.

Mitanchez D, Yzydorczyk C, Simeoni U (2015) What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes? World J Diabetes 6(5):734–743. https://doi.org/10.4239/wjd.v6.i5.734CrossRefPubMedPubMedCentral

28.

Svensson K, Just AC, Fleisch AF, Sanders AP, Tamayo-Ortiz M, Baccarelli AA, Wright RJ, Tellez-Rojo MM, Wright RO, Burris HH (2019) Prenatal salivary sex hormone levels and birth-weight-for-gestational age. J Perinatol 39(7):941–948. https://doi.org/10.1038/s41372-019-0385-yCrossRefPubMedPubMedCentral

29.

de Zegher F, Francois I, Boehmer AL, Saggese G, Muller J, Hiort O, Sultan C, Clayton P, Brauner R, Cacciari E, Ibanez L, Van Vliet G, Tiulpakov A, Saka N, Ritzen M, Sippell WG (1998) Androgens and fetal growth. Horm Res 50(4):243–244. https://doi.org/10.1159/000023284CrossRefPubMed

30.

Miles HL, Gidlof S, Nordenstrom A, Ong KK, Hughes IA (2010) The role of androgens in fetal growth: observational study in two genetic models of disordered androgen signalling. Arch Dis Child Fetal Neonatal Ed 95(6):F435-438. https://doi.org/10.1136/adc.2009.173575CrossRefPubMed

31.

Group HSCR (2009) Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes 58(2):453–459. https://doi.org/10.2337/db08-1112CrossRef

32.

Oliva M, Munoz-Aguirre M, Kim-Hellmuth S, Wucher V, Gewirtz ADH, Cotter DJ, Parsana P, Kasela S, Balliu B, Vinuela A, Castel SE, Mohammadi P, Aguet F, Zou Y, Khramtsova EA, Skol AD, Garrido-Martin D, Reverter F, Brown A, Evans P, Gamazon ER, Payne A, Bonazzola R, Barbeira AN, Hamel AR, Martinez-Perez A, Martinez-Perez A, Soria JM, Pierce BL, Stephens M, Eskin E, Dermitzakis ET, Segre AV, Im HK, Engelhardt BE, Ardlie KG, Montgomery SB, Battle AJ, Lappalainen T, Guigo R, Stranger BE (2020) The impact of sex on gene expression across human tissues. Science. https://doi.org/10.1126/science.aba3066CrossRefPubMedPubMedCentral

33.

Ponsuksili S, Murani E, Hadlich F, Perdomo-Sabogal A, Trakooljul N, Oster M, Reyer H, Wimmers K (2022) Genetic regulation and variation of expression of miRNA and mRNA transcripts in fetal muscle tissue in the context of sex, dam and variable fetal weight. Biol Sex Differ 13(1):24. https://doi.org/10.1186/s13293-022-00433-3CrossRefPubMedPubMedCentral

34.

Antoniou MC, Gilbert L, Gross J, Rossel JB, Fumeaux CJF, Vial Y, Puder JJ (2022) Sex-dependent influence of maternal predictors on fetal anthropometry in pregnancies with gestational diabetes mellitus. BMC Pregnancy Childbirth 22(1):460. https://doi.org/10.1186/s12884-022-04767-zCrossRefPubMedPubMedCentral

35.

Yildiz Atar H, Baatz JE, Ryan RM (2021) Molecular mechanisms of maternal diabetes effects on fetal and neonatal surfactant. Children 8(4):281. https://doi.org/10.3390/children8040281CrossRefPubMedPubMedCentral

36.

Papageorgiou AN, Colle E, Farri-Kostopoulos E, Gelfand MM (1981) Incidence of respiratory distress syndrome following antenatal betamethasone: role of sex, type of delivery, and prolonged rupture of membranes. Pediatrics 67(5):614–617CrossRefPubMed

37.

Tremblay Y, Provost PR (2006) 17Beta-HSD type 5 expression and the emergence of differentiated epithelial Type II cells in fetal lung: a novel role for androgen during the surge of surfactant. Mol Cell Endocrinol 248(1–2):118–125. https://doi.org/10.1016/j.mce.2005.10.015CrossRefPubMed

Titel: Association between foetal sex and adverse neonatal outcomes in women with gestational diabetes
verfasst von: Catarina Cidade-Rodrigues
Catarina Chaves
Anabela Melo
Alexandra Novais-Araújo
Odete Figueiredo
Vânia Gomes
Ana Morgado
M. Céu Almeida
Mariana Martinho
Margarida Almeida
Filipe M. Cunha
Publikationsdatum: 04.03.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 4/2024
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-023-06979-w

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

28.05.2024 Kinder- und Jugendgynäkologie Nachrichten

Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Internistische Arzneimitteltherapie Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

26.05.2024 Mammakarzinom Nachrichten

Frauen, die zum Zeitpunkt der Brustkrebsdiagnose eine hohe mammografische Brustdichte aufweisen, haben ein erhöhtes Risiko für ein baldiges Rezidiv, legen neue Daten nahe.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Association between foetal sex and adverse neonatal outcomes in women with gestational diabetes

Abstract