Association between fetal sex, birthweight percentile and adverse pregnancy outcome

Introduction The objective was to evaluate the association between fetal sex and adverse pregnancy outcome, while correcting for fetal growth and gestational age at delivery. Material and methods Data from the Netherlands Perinatal Registry (1999-2010) were used. The study population comprised all white European women with a singleton delivery between 25(+0) and 42(+6) weeks of gestation. Fetuses with structural or chromosomal abnormalities were excluded. Outcomes were antepartum death, intrapartum/neonatal death (from onset of labor until 28 days after birth), perinatal death (antepartum death or intrapartum/neonatal death), a composite of neonatal morbidity (including infant respiratory distress syndrome, sepsis, necrotizing enterocolitis, meconium aspiration, persistent pulmonary hypertension of the newborn, periventricular leukomalacia, Apgar score <7 at 5 minutes, and intracranial hemorrhage) and a composite adverse neonatal outcome (perinatal death or neonatal morbidity). Outcomes were expressed stratified by birthweight percentile ( p90 [large for gestation]) and gestational age at delivery (25(+0)-27(+6), 28(+0)-31(+6), 32(+0)-36(+6), 37(+0)-42(+6 )weeks). The association between fetal sex and outcome was assessed using the fetus at risk approach. Results We studied 1 742 831 pregnant women. We found no increased risk of antepartum, intrapartum/neonatal and perinatal death in normal weight and large-for-gestation males born after 28(+0 )weeks compared with females. We found an increased risk of antepartum death among small-for-gestation males born after 28(+0 )weeks (relative risk [RR] 1.16-1.40). All males born after 32(+0) weeks of gestation suffered more neonatal morbidity than females regardless of birthweight percentile (RR 1.07-1.34). Infant respiratory distress syndrome, sepsis, persistent pulmonary hypertension of the newborn, Apgar score <7 at 5 minutes, and intracranial hemorrhage all occurred more often in males than in females. Conclusions Small-for-gestation males have an increased risk of antepartum death and all males born after 32(+0) weeks of gestation have an increased risk of neonatal morbidity compared with females. In contrast to findings in previous studies we found no increased risk of antepartum, intrapartum/neonatal or perinatal death in normal weight and large-for-gestation males born after 28+0( )weeks.