Fetal sex as a risk factor for fetal growth restriction or small for gestational age

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Аннотация

Objective: To evaluate the association between fetal sex and insufficient fetal growth (IFG), including fetal growth restriction (FGR) and small for gestational age (SGA).

Materials and methods: A prospective cohort study was conducted at N.A. Semashko Republican Clinical Hospital from 2018 to 2023. A total of 611 women with singleton pregnancies diagnosed with IFG were included in the study, with FGR (n = 435) and SGA (n = 176).

Results: Fetal sex in patients with IFG was associated with various factors, including parental age, age at menarche, maternal BMI, weight gain, blood pressure, hemoglobin levels, leukocyte counts, ALT and AST levels, blood creatinine, Doppler data of uteroplacental blood flow, CTG results, IFG variant (FGR or SGA), causes of IFG, prematurity, low birth weight (LBW), and the need for intensive care (IC) for the newborn. FGR, compared to SGA, was characterized by (p < 0.05–0.001) a younger age of both parents, earlier age at menarche, greater weight gain, lower systolic and diastolic blood pressure in the first trimester, lower CTG indicators, lower hemoglobin levels, but higher creatinine, ALT, and AST levels, and an earlier gestational age at delivery. Female fetuses are more commonly associated with FGR, impaired blood flow in the uterine and middle cerebral arteries, LBW, severe preeclampsia (PE), and gestational arterial hypertension as causes of IFG as well as a higher need for IC in newborns. Male fetuses are more often linked to unknown causes of IFG, chronic arterial hypertension, moderate PE, and prematurity. Decision tree analysis revealed that the IFG variant is associated with fetal sex, parental age, the cause of IFG, LBW, and the need for IC.

Conclusion: Fetal sex is interconnected with the IFG variant and numerous factors that contribute to or result from this condition. The specific nature of this relationship is influenced by the IFG variant (FGR or SGA), parental age, maternal and fetoplacental hemodynamics, and the maternal hemic, hepatic, and renal responses to pregnancy complicated by IFG. It is advisable to implement individualized centile tables adjusted for fetal sex during ultrasound monitoring.

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Авторлар туралы

Arsen Ziyadinov

Semashko Republican Clinical Hospital; Georgievsky Medical Institute of the Vernadsky Crimean Federal University; Patrice Lumumba Peoples' Friendship University of Russia

Хат алмасуға жауапты Автор.
Email: ars-en@yandex.ru

PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology No. 1; Obstetrician-Gynecologist; Doctoral Student at the Department of Obstetrics and Gynecology with the Course of Perinatology of the Medical Institute 

Ресей, 8, Semashko St., Simferopol, Republic of Crimea, 295017; Bldg. 7, 5, Lenin Blvd., Simferopol, Republic of Crimea, 295006; 8, Miklukho-Maklay St., Moscow, 117198

Vladislava Novikova

Patrice Lumumba Peoples' Friendship University of Russia

Email: vladislavan@mail.ru

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology with the Course of Perinatology of the Medical Institute

Ресей, 8, Miklukho-Maklay St., Moscow, 117198

Victor Radzinsky

Patrice Lumumba Peoples' Friendship University of Russia

Email: kafedra-aig@mail.ru

Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of the Department of Obstetrics and Gynecology with the Course of Perinatology of the Medical Institute

Ресей, 8, Miklukho-Maklay St., Moscow, 117198

Әдебиет тізімі

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2. Fig. 1. Variants of NPD (a), low birth weight (b), cause of NPD (c), prematurity (d) and need for IT in newborns (e) depending on the sex of the foetus

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3. Fig. 2. Ultrasound Doppler imaging of uteroplacental blood flow in foetuses of different sexes: uterine arteries (a), umbilical artery (b), middle cerebral artery (c) and cerebral-placental index (d)

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4. Fig. 3. Decision tree showing the probability of one of the NPD options (dependent variable) in conjunction with the cause of NPD, foetal sex, foetal NMT, and the newborn's need for IT

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5. Fig. 4. Decision tree (classifications) demonstrating the probability of one of the NHR options (dependent variable) in conjunction with the age of the mother and oiца of the foetus, causes of NHR, sex of the foetus, its NMT, volume of IT

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6. Fig. 5. Decision tree (classifications) demonstrating the probability of foetal sex (dependent variable) taking into account the age of the mother and father of the foetus and the NHR option

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7. Fig. 6. Decision tree (classification) demonstrating the relationship between foetal sex and the cause of IUGR, Doppler ultrasound parameters of uteroplacental blood flow, type of IUGR, and the need for and extent of IT in newborns

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8. Fig. 7. Interactive risk factors for ZRP or MGV, including foetal sex and outcome for the foetus

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