Liliya Tamayev MD1, Letizia Schreiber MD2, Jacob Bar MD1, Michal Kovo MD, PhD1
Depts. Obstetrics and Gynecology 1 & Pathology 2, Wolfson Medical Center, Holon, all affiliated with Sackler School of medicine, Tel-Aviv University, Tel-Aviv, Israel
Objectives: Adaptations to a pathological intrauterine environment might differ in relation to fetal gender. Therefor we aimed to study if there are sex-specific differences in placental pathology of pregnancies complicated by small for gestational age (SGA).
Materials & Methods: The medical records and placental histology reports of all neonates with a birth-weight (BW) ≤10th percentile, born between 24-42 weeks of gestation, during 2010-2015, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions, maternal and fetal inflammatory responses (MIR and FIR) and villitis of unknown etiology (VUE). Composite neonatal outcome was defined as one or more of early complications. Results were compared between the male and female group of neonates.
Results: The male group included 263 neonates that were compared with 240 female neonates (female group). There were no between group differences regard maternal age, BMI, maternal smoking, associated pregnancy complications as hypertensive disorders, or diabetes and mode of delivery. The female group had a slightly higher duration of pregnancy as compared with the male group (38.0±2.27 vs. 37.4±3.14 weeks, p=0.089 respectively). There was no significant difference in neonatal BW between the males and females groups, 2170±531, 2171±531, respectively, p=0.086. The rate of placental lesions: MVM, FVM, MIR, FIR and VUE lesions did not differ between the groups. By multivariate logistic regression analysis, male gender (aOR 3.36, 95% CI, 1.64-6.91, p=0.001), gestational age ( aOR 0.52, 95% CI 0.42-0.65, p<0.001), MIR (aOR 4.0, 95% CI , 1.21-13.21, p=0.023) and VUE (aOR 5.74, 95% CI , 1.77-18.59, p=0.004), were found to be independently associated with adverse composite neonatal outcome.
Conclusion: Placental pathology lesions are similar between male and female neonates complicate by SGA. Nonetheless, placental MIR and VUE as well as male gender and gestational age, were independently associated with adverse neonatal outcome.