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Published on: January 12, 2018
Sex differences in fetal growth and immediate birth outcomes in a low-risk Caucasian population
Sander Galjaard1,2, Lieveke Ameye3, Christoph C Lees4,5
1KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. s.galjaard@erasmusmc.nl.
Insights
Gender-specific fetal growth curves reveal boys exhibit larger head measurements from 20 weeks and poorer birth outcomes compared to girls, impacting fetal assessment and management.
Area of Science:
- Obstetrics and Gynecology
- Fetal Development
- Neonatal Health
Background:
- Postnatal growth trajectories differ between genders per WHO recommendations.
- Intrauterine growth may also exhibit gender-specific patterns.
Purpose of the Study:
- To develop gender-specific fetal growth curves in a low-risk population.
- To compare immediate birth outcomes between genders.
Main Methods:
- Longitudinal fetal ultrasound data from 12,368 uncomplicated singleton pregnancies (2002-2012).
- Generalized Additive Model for Location, Scale and Shape (GAMLSS) used for curve derivation.
- Analysis of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL).
Main Results:
- Gender-specific curves derived for BPD, HC, AC, and FL.
- Boys showed significantly larger HC and BPD from 20 weeks gestation (p < 0.001).
- At birth, boys were significantly larger and had lower Apgar scores and arterial cord pH (p < 0.01).
Conclusions:
- Novel fetal growth curves integrate with WHO postnatal gender-specific data.
- Distinct gender differences in fetal growth impact clinical estimations and dating.
- Findings suggest implications for early fetal and neonatal management.
Background:
According to the WHO Multicentre Growth Reference Study Group recommendations, boys and girls have different growth trajectories after birth. Our aim was to develop gender-specific fetal growth curves in a low-risk population and to compare immediate birth outcomes.
Methods:
First, second, and third trimester fetal ultrasound examinations were conducted between 2002 and 2012. The data was selected using the following criteria: routine examinations in uncomplicated singleton pregnancies, Caucasian ethnicity, and confirmation of gestational age by a crown-rump length (CRL) measurement in the first trimester. Generalized Additive Model for Location, Scale and Shape (GAMLSS) was used to align the time frames of the longitudinal fetal measurements, corresponding with the methods of the postnatal growth curves of the WHO MGRS Group.
Results:
A total of 27,680 complete scans were selected from the astraia© ultrasound database representing 12,368 pregnancies. Gender-specific fetal growth curves for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were derived. The HC and BPD were significantly larger in boys compared to girls from 20 weeks of gestation onwards (p < 0.001) equating to a 3-day difference at 20-24 weeks. Boys were significantly heavier, longer, and had greater head circumference than girls (p < 0.001) at birth. The Apgar score at 1 min (p = 0.01) and arterial cord pH (p < 0.001) were lower in boys.
Conclusions:
These longitudinal fetal growth curves for the first time allow integration with neonatal and pediatric WHO gender-specific growth curves. Boys exceed head growth halfway of the pregnancy, and immediate birth outcomes are worse in boys than girls. Gender difference in intrauterine growth is sufficiently distinct to have a clinically important effect on fetal weight estimation but also on the second trimester dating. Therefore, these differences might already play a role in early fetal or immediate neonatal management.
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