Fetal Medicine Unit, Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
British Columbia Women's Hospital, 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada.
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:9-13. doi: 10.1016/j.ejogrb.2020.03.004. Epub 2020 Mar 6.
The aim of this study is to evaluate whether markers of intrapartum hypoxia differ according to sex, and if this could explain the increased risk of adverse perinatal outcomes in males.
This is a retrospective observational cohort study of non-anomalous, singleton deliveries >36 completed weeks' gestation at a UK teaching hospital over a 4.5 year period. Absent or incomplete cord gas results were excluded and the remaining data were validated according to an established method. The relations between sex and both arterial pH and a composite variable, 'fetal distress' (cases in which operative delivery or caesarean section were undertaken for presumed fetal compromise), were examined using independent samples t-test and Chi-square test. Odds ratios with 95 % confidence intervals were calculated to describe the relation between fetal sex and intermediate-term adverse outcomes. Binary logistic regression was performed to generate odds ratios (with 95 % confidence intervals) adjusted for arterial pH and fetal distress. This was repeated to adjust for labor and induction of labor.
There were eligible 8758 cases, of which 4655 were male and 4103 female, from a total of 39,148 deliveries during the study period. Neonatal unit admission (OR 1.54, 95 % CI; 1.31-1.80), renal impairment (OR 1.63, 95 % CI; 1.15-2.32), neurological impairment (OR 1.73, 95 % CI; 1.06-2.84) and a composite adverse outcome (OR 1.73, 95 % CI; 1.29-2.33) were all more likely in males, even after adjusting for labor and induction of labor, both of which were more likely males. The mean cord arterial pH of males was lower (7.23 vs 7.24, P = 0.019) although they were not more likely to be acidemic with a pH <7.0 (males 43 (0.92 %) vs females 41 (1.00 %), P = 0.717), and males were also more likely to have fetal distress (834 (17.9 %) vs 588 (14.3 %), P = <0.001). Being male remained associated with adverse outcomes despite adjustment for arterial pH and fetal distress.
Despite a lower mean cord arterial pH and greater incidence of fetal distress in males, intrapartum hypoxia does not account for their worse neonatal outcomes.
本研究旨在评估产时缺氧的标志物是否因性别而异，如果是，这是否可以解释男性围产儿不良结局风险增加的原因。
这是一项在英国一所教学医院进行的回顾性观察性队列研究，纳入了 4.5 年期间胎龄超过 36 周的非畸形、单胎分娩。排除了无或不完整的脐带血气结果，并根据既定方法验证了其余数据。使用独立样本 t 检验和卡方检验检查了性别与动脉 pH 以及“胎儿窘迫”（因疑似胎儿窘迫而行剖宫产或剖宫产的病例）复合变量之间的关系。使用 95%置信区间计算比值比（OR）来描述胎儿性别与中期不良结局之间的关系。进行二元逻辑回归以生成动脉 pH 和胎儿窘迫调整后的 OR（95%置信区间）。为了调整分娩和引产，再次进行了二元逻辑回归。
在研究期间，共有 39148 例分娩，其中有 8758 例符合条件，包括 4655 例男性和 4103 例女性。新生儿入住新生儿病房（OR 1.54，95%CI：1.31-1.80）、肾功能损害（OR 1.63，95%CI：1.15-2.32）、神经功能损害（OR 1.73，95%CI：1.06-2.84）和复合不良结局（OR 1.73，95%CI：1.29-2.33）的可能性在男性中更高，即使在调整了分娩和引产的情况下也是如此，而这两者在男性中更常见。男性的平均脐带动脉 pH 较低（7.23 对 7.24，P=0.019），尽管他们酸中毒的可能性（pH<7.0）并不更高（男性 43 例（0.92%）vs 女性 41 例（1.00%），P=0.717），而且男性发生胎儿窘迫的可能性也更高（834 例（17.9%）vs 588 例（14.3%），P<0.001）。尽管调整了动脉 pH 和胎儿窘迫，男性仍然与不良结局相关。
尽管男性的平均脐带动脉 pH 较低，胎儿窘迫的发生率较高，但产时缺氧并不能解释他们较差的新生儿结局。
