Effect of Gender on Perinatal Outcome in Pregnancies Complicated by Diabetes

Abstract

The aim of this study was to determine whether there is a gender-related difference in the morbidity and mortality of infants of diabetic mothers. We also wanted to identify risk factors associated with adverse pregnancy outcome, and create a perinatal morbidity index. We performed a retrospective review of 107 women whose pregnancies were singleton and complicated by diabetes. The subjects were divided according to the gender of the infant. The morbidity, mortality and confounding variables between the two groups were compared. Logistic regression analysis was used to identify the independent factors associated with an adverse pregnancy outcome. The male group (n = 62) had higher morbidity than the female group (n = 45). This was due to a higher incidence of hypoglycemia (relative risk = 3.9, 95% CI 1.2-12.5, p = 0.011) and need to stay in the neonatal intensive care unit 2 or more days (relative risk = 1.8, 95% CI 1.1-2.9, p = 0.015). There was one female stillbirth due to an episode of ketoacidosis in the mother. Male gender (relative risk = 1.8,95% CI 1.2-2.7, p = 0.002) was one of three independent predictors of poor outcome. There is a male disadvantage in infants of diabetic mothers with regards to perinatal morbidity. Advanced White’s classification, male gender, and third trimester mean glucose > 110 mg% identify the pregnancies at risk for diabetes-related morbidity.

Sex and gender differences in newborn infants: why are boys at increased risk?

“…Male fetal and newborn sex is an independent predictor of poor outcome in pregnancies affected by maternal diabetes [81]. One study showed newborn boys to have a higher risk for developing hypoglycemia and to need on average 2 days longer stays when admitted to the neonatal intensive care unit [81].…”

“…One study showed newborn boys to have a higher risk for developing hypoglycemia and to need on average 2 days longer stays when admitted to the neonatal intensive care unit [81]. The investigators speculated that an explanation for the neonatal hypoglycemia could be related to the increased levels of human chorionic gonadotropine levels in diabetic mothers.…”

Perinatal Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus According to Fetal Sex

“…[3][4][5][6] It is well known that male sex is a risk factor for worse perinatal outcomes in the general obstetric population, 7 with increased risk of preterm delivery, 8 labor dystocia, 9 cord problems, 10 instrumental vaginal deliveries or cesarean section (CS), 10,11 macrosomia, 10 low Apgar scores, 10 major birth defects, 1 and perinatal mortality. 2,8,12 In relation to diabetic pregnancy, fetal sex has been considered only occasionally.…”

Management of Infants of Diabetic Mothers

“…[3][4][5] Suboptimal prenatal care along with poor maternal glycemic control, vasculopathy, infection, and pregnancy-induced hypertension are factors associated with poor perinatal outcome. 1,6,7 Congenital malformations, [8][9][10] macrosomia, 3,11,12 respiratory distress syndrome (RDS), 13,14 hypoglycemia, 3,[15][16][17] hyperbilirubinemia 18 and hypocalcemia 19 are some of the conditions most frequently diagnosed in the offspring of diabetic women.…”