Association of abnormal placental perfusion with the risk of male hypospadias: a hospital-based retrospective cohort study

Abstract

Background The effect and extent of abnormal placental perfusion (APP) on the risk of male hypospadias are poorly understood. We compared the prevalence of male hypospadias in the offspring of women with APP and quantify the extent of the APP effect on the anomaly. Methods A hospital-based retrospective analysis of births from 2012 to 2016 was conducted in 2018. Women of singleton pregnancy and male infants born to them were included (N = 21,447). A multivariate analysis was performed to compare the prevalence of male hypospadias in infants exposed to APP with those that were not exposed to APP. Results Compared with the infants of women without APP, infants of women with APP showed an increased risk of male hypospadias (odds ratio, 2.40; 95% confidence interval, 1.09–5.29). The male hypospadias cumulative risk increased with the severity of APP. Infants exposed to severe APP had a significantly higher risk of male hypospadias than those without APP exposure (9.2 versus 1.7 per 1000 infants, P < 0.001). A path analysis indicated that 28.18–46.61% of the risk of hypospadias may be attributed to the effect of APP. Conclusions Male hypospadias risk was associated with APP and increased with APP severity, as measured in the second trimester. APP had an important role in the development of the anomaly.

Abnormal placental perfusion and the risk of stillbirth: a hospital-based retrospective cohort study

“…Details of the design have been mentioned in our previous studies [ 13 , 14 ]. Pregnant women who participated in prenatal examinations at the Obstetrics and Gynaecology Hospital of Fudan University between April 2012 and August 2016 were extracted and followed up till delivery.…”

“…Pregnant women who participated in prenatal examinations at the Obstetrics and Gynaecology Hospital of Fudan University between April 2012 and August 2016 were extracted and followed up till delivery. Basic information (e.g., maternal age at delivery, parity, and residence), pregnancy complications (e.g., gestational diabetes mellitus [GDM] and PE) and outcomes (e.g., foetal sex and stillbirths) was collected during the follow up period [ 14 ]. Women with multiple pregnancies and who were lost to follow-up were excluded from the analysis.…”

“…Placental perfusion of the UtA, including calculation of the left and right UtA pulsatility index (PI), UtA resistance index (RI), and the presence of early diastolic notching (EDN), was measured by sonographers using GE ultrasound devices (GE Healthcare, Zipf, Austria) at 20 to 24 weeks of gestation [ 14 , 15 ]. Women with a gestational age specific percentile of >95th percentile for the UtA-PI and UtA-RI values was classified as abnormal UtA-PI or -RI perfusion (Table S2 ) [ 14 ]. The presence of EDN was identified by the ISUOG practice guidelines [ 15 ].…”

“…The presence of EDN was identified by the ISUOG practice guidelines [ 15 ]. Pregnant women with any abnormality in the right or left UtA-PI, UtA-RI, or presence of EDN markers were defined as the APP group; otherwise, they were classified as the normal placental perfusion group [ 14 ].…”

“…Potential confounders in the study included PE (yes or no), maternal age at delivery (≤ 24, 25–34, and ≥ 35 years), resident location (local or nonlocal), parity (nulliparous or pluriparous), assisted conception (yes or no), GDM (yes or no) and foetal sex (male or female) [ 14 ]. Women who complicated hypertension and proteinuria after 20 weeks of gestation were diagnosed as PE [ 16 ].…”