Fetal sex and risk of preeclampsia: Dose maternal race matter?

Abstract

Objective

To examine whether maternal race could affect the relationship between fetal sex and preeclampsia.

Material and methods

This study was a cohort analysis using prospectively collected data from pregnant women who participated in the Vitamin Antenatal Asthma Reduction Trial (VDAART). Preeclampsia was the secondary outcome of VDAART. We examined the association of fetal sex with preeclampsia and its potential interaction with maternal race in 813 pregnant women (8% with preeclampsia) in logistic regression models with adjustment for preterm birth (<37 weeks of gestation), maternal age, education, and body mass index at enrollment and clinical center. We further conducted a race stratified analysis and also examined whether any observed association was dependent on the gestational age at delivery and prematurity.

Results

In an analysis of all races combined, preeclampsia was not more common among pregnant women with a male fetus compared to those with a female fetus (odds ratio [OR] = 1.3, 95% CI = 0.81, 2.24). There was an interaction between African American race and fetal sex in association with preeclampsia after adjustment for preterm delivery and other potential confounders (p = .014). In race stratified analyses, we observed higher odds of preeclampsia among African American pregnant women who carried male fetuses after adjustment for preterm delivery and other potential confounders (adjusted OR = 2.4, 95% CI = 1.12, 5.60).

Conclusion

We observed fetal sexual dimorphic differences in the occurrence of preeclampsia in African American women, but not in Whites. Information on fetal sex may ultimately improve the prediction of pre-eclampsia in African American mothers, who might be at higher risk for this adverse condition in pregnancy.

Keywords:

• Fetal sex
• maternal race
• pregnancy
• preeclampsia

Acknowledgments

The authors thank the women and their children who participated in the trial and all the study staff for their contributions to the trial and ancillary investigations.

Contribution to authorship

HM conceptualized, designed the study, performed statistical analysis drafted the initial manuscript and revised the manuscript. STW conceptualized the study, designed, and conducted the VDAART, coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content.

VDAART registration

This study is a secondary analysis from the VDAART with the registration identification number of NCT00902621 on “ClinicalTrials.gov” (https://clinicaltrials.gov/ct2/show/NCT00920621).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study is a secondary analysis of data from the Vitamin D Antenatal Asthma Reduction Trial (VDAART). VDAART was supported by NIH grant [#R01 HL091528 and U01 HL091528] from NHLBI to STW. HM has received support from NIH NHLBI [through, U01 HL091528, L30 HL129467 and 1 K01HL146977 01A1].