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Does a Woman’s Risk of Developing GDM Depend on the Gender of the Child?

Evidence may show an increased risk of maternal GDM whether you have a girl or a boy…

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In various studies, the presence of a male fetus was associated with an increased risk of adverse outcomes. Some of these include preterm delivery, premature rupture of membranes, umbilical cord prolapse, true umbilical cord knot, failure to progress in the first and second stages of labor, non-reassuring fetal heart rate patterns, Cesarean delivery, and lower Apgar scores.

Researchers analyzed perinatal databases to identify whether there is a possibility of an increased risk of gestational diabetes mellitus (GDM) in women carrying a male fetus, and also to determine whether previous results were falsely associated. They also evaluated the relationship between fetal sex and maternal glucose metabolism in a cohort of women reflecting the full spectrum of gestational glucose tolerance from normal to mildly abnormal to GDM.

All pregnant women were screened for GDM by 50g glucose challenge test (GCT) in late second trimester, followed by referral for diagnostic oral glucose tolerance test (OGTT) if the GCT was abnormal (blood glucose ≥140mg/dL. or 7.8 mmol/L at 1-hour post-challenge). For the cohort study, women were recruited either before or after the GCT, and all participants then underwent a 3-hour 100g OGTT for determination of GDM status (regardless of the GCT result). A total of 1,074 pregnant women underwent metabolic characterization, oral glucose tolerance test (OGTT), at mean 29.5 weeks gestation. The prevalence of GDM, its pathophysiologic factors (b-cell function and insulin sensitivity or resistance), and its clinical risk factors were compared between women carrying a female fetus (n = 534) and those carrying a male fetus (n = 540). All analyses were conducted using SAS 9.2 (SAS Institute, Cary, NC). Insulin resistance was assessed with HOMA (HOMA-IR) and pancreatic b-cell function was assessed with the insulinogenic index divided by HOMA-IR (insulinogenic index/HOMA-IR).

Results showed no significant differences between the groups with respect to the major clinical risk factors for GDM: maternal age, ethnicity, family history of diabetes, and maternal weight (pre-pregnancy BMI and weight gain in pregnancy). Women who were carrying a male fetus had lower mean adjusted b-cell function (insulinogenic index divided by HOMA of insulin resistance: 9.4 vs. 10.5, P = 0.007) and higher mean adjusted blood glucose at 30 min (P = 0.025), 1 hour (P = 0.004) and 2 hour (P = 0.02) during the OGTT, as compared with those carrying a female fetus. Women carrying a male fetus also had higher odds of developing GDM (odds ratio 1.39 [95% CI 1.01–1.90]). The male fetus was also shown to increase the relative risk of GDM which was conferred by the classical risk factors of maternal age >35 years and non-white ethnicity by 47 and 51%, respectively.

In conclusion, this study demonstrates that the presence of a male fetus is associated with higher postprandial glycemia and an increased risk of GDM in the mother. Although the exact mechanism is not fully understood, the male fetus appears to be associated with poorer maternal b-cell function. Results demonstrate an independent association between fetal sex and maternal glucose homeostasis, which suggest that the fetus may affect glucose metabolism in the mother.

Practice Pearls:

  • Although the male fetus was independently associated with higher odds of GDM after adjustment for classical risk factors, the increased risk was shown to be moderate.
  • Women with pre-pregnancy BMI >25kg/m2 and a male fetus had no increase in relative risk with these factors combined.
  • Presence of maternal age >35 years of age and a male fetus combined displayed a relative excess risk of GDM compared to other individual risk observed.

Ravi Retnakaran, Caroline K. Kramer, Chang Ye. et al. "Fetal Sex and Maternal Risk of Gestational Diabetes Mellitus: The Impact of Having a Boy" Diabetes Care. 2015 Feb18