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.
Highlights
Human sex is the result of a complex prenatal interaction of genetic, gonadal, and hormonal factors; and establishment of gender involves additional postnatal phenotypic and psychological factors
Based on a review of current literature published in English language from around the world, this review summarizes the specific differences in pregnancies and postpartum outcome based on the fetal sex
Because of the well-known oxidative damage to fetal tissues and organs at critical developmental windows represents a common underlying mechanism connecting both fetal programming and subsequent health outcomes [49], this study has suggested that such sex-specific dimorphic responses of fetal cells to early exposure to oxidative stress might be involved in the sex-related difference in fetal development that may have long-term influence on offspring [48]
Summary
Human sex is the result of a complex prenatal interaction of genetic, gonadal, and hormonal factors; and establishment of gender involves additional postnatal phenotypic and psychological factors. The prenatal sex-specific interactions between the mother, the placenta, and the fetus have and influence on intrauterine life of the fetus and the health of the pregnant mother but. Fetal Sex, Maternal and Obstetrical Outcomes may have significant postpartum effects on the mother’s future health and well-being. Most important of these may be the hormonal factor from the fetus that have a major impact on obstetrical outcomes and differences between male and female fetus pregnancies. Based on a review of current literature published in English language from around the world, this review summarizes the specific differences in pregnancies and postpartum outcome based on the fetal sex
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