Sex-specific associations between hypertensive disorders in pregnancy and fetal and placental weight

Document Type

Article

Publication Date

6-20-2025

Publication Title

Pediatr Investig

Abstract

Importance: Hypertensive disorders in pregnancy (HDPs) are common and increase the risk of maternal and fetal morbidity and mortality. HDPs may impact fetal growth; however, sex-specific effects have been understudied.

Objective: To examine whether sex-specific differences exist in the association between HDPs and birthweight and placental weight.

Methods: A birth cohort based in Detroit, Michigan, was utilized (n = 1258). HDPs and birthweight were abstracted from medical records; placental weight was obtained from placental pathology reports. Linear regression was used to model sex-specific associations, after multiple imputation, confounder adjustment, and inverse probability weighting to account for selection bias.

Results: The primary analysis included all pregnancies (n = 853), while the secondary analysis included those sent for placental pathology, reflective of complicated pregnancies (n = 165). In the primary analysis subset, males of mothers with gestational hypertension had birthweight Z-scores that were on average 0.90 standard deviations higher, but this association was not found among females (interaction P = 0.019; male β [95% confidence interval {CI}]: 0.90 [0.28, 1.52]; female β [95% CI]: −0.12 [−0.65, 0.41]). However, in the subset of complicated pregnancies, female mothers with gestational hypertension also had reduced birthweight (interaction P = 0.013; male β [95% CI]: 1.50 [0.15, 2.86]; female β [95% CI]: −1.14 [−2.13, −0.16]). For fetoplacental weight ratio, any HDP was associated with a lower ratio among females only (interaction P = 0.028; male β [95% CI]: −0.04 [−0.71, 0.64]; female β [95% CI]: −0.95 [−1.57, −0.33]).

Interpretation: Male fetuses may prioritize growth, whereas females may prioritize placental development when exposed to HDPs.

Medical Subject Headings

Birthweight; Birth cohort; Hypertension; Placenta; Pregnancy

PubMed ID

Not assigned.

ePublication

ePub ahead of print

First Page

1

Last Page

11

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