Abstract
BackgroundFetal sex is known to modify the course and complications of pregnancy, with recent evidence of sex-differential fetal influences on the maternal immune and endocrine systems. In turn, heightened inflammation and surges in reproductive hormone levels associated with pregnancy and parturition have been linked with the development of perinatal depression. Here, we examined whether there is an association between fetal sex and maternal depression assessed during the prenatal and postnatal periods.MethodsThe study included two multi-ethnic, prospective pregnancy cohorts that enrolled women from prenatal clinics in the Northeastern United States between 2001 and 2018. Maternal depressive symptoms were measured during the prenatal and postnatal periods using the Edinburgh Postpartum Depression Scale (EPDS), and newborn sex was reported by the mother following delivery. We used logistic regression to examine associations between fetal sex and maternal depressive symptoms (EPDS > 10) during the prenatal period only, postnatal period only, or both periods versus no depressive symptoms during either period. We considered both unadjusted models and models adjusted for a core set of sociodemographic and lifestyle variables.ResultsIn adjusted models using PRISM data (N = 528), women pregnant with a male versus female fetus had significantly greater odds of depressive symptoms during the postnatal period compared to women without depressive symptoms during either period (odds ratio [OR] = 5.24, 95% confidence interval [CI] = 1.93, 14.21). The direction of results was consistent in the ACCESS cohort, although the findings did not reach statistical significance (OR = 2.05, 95% CI = 0.86, 4.93). Significant associations were not observed in either cohort among women with prenatal symptoms only or women with prenatal and postnatal symptoms.ConclusionsMale fetal sex was associated with the onset of depressive symptoms during the postnatal period.
Highlights
Fetal sex is known to modify the course and complications of pregnancy, with recent evidence of sex-differential fetal influences on the maternal immune and endocrine systems
Given that risk factors related to the onset of perinatal depression, such as shifts in hormone levels [26, 27] and immune activity [29], may vary across the course of gestation and into the postpartum period, we considered the importance of timing by examining depressive symptomology measured during both the prenatal and postnatal periods
In the PRISM cohort, n = 104 (20%) babies were born premature and/or admitted to the Neonatal Intensive Care Unit (NICU); we did not detect an association between fetal sex and these outcomes (odds ratio (OR) = 1.11, 95% confidence interval (CI) 0.72, 1.71). In this prospective study, we found that women giving birth to a male versus a female infant were more likely to develop depressive symptoms during the postnatal period
Summary
Fetal sex is known to modify the course and complications of pregnancy, with recent evidence of sex-differential fetal influences on the maternal immune and endocrine systems. Heightened inflammation and surges in reproductive hormone levels associated with pregnancy and parturition have been linked with the development of perinatal depression. Research studies estimate approximately 10–19% of (2021) 12:6 obstetric complications [4], restricted fetal growth [5], altered neurodevelopmental programming [6], and impaired infant bonding [3]. The microRNAs and other signals carried by these vesicles interact with distal recipient cells to modify maternal metabolism and physiology and have been associated with a range of reproductive- and obstetric-related disorders [10, 11]
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