title: Role of fetal sex in the outcome of antenatal glucocorticoid treatment to prevent respiratory distress syndrome: systematic review and meta-analysis.
abstract: BACKGROUND
  Antenatal glucocorticoid (AGC) therapy has been associated with a decrease in respiratory distress syndrome (RDS). While preterm males remain at greater risk of RDS than females, the role of fetal sex in AGC response is not well known.
  
  
  OBJECTIVE
  To review the available evidence regarding the effect of fetal sex in the prevention of RDS using AGC.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of RCTs to compare the effect of AGC in male and female infants with regard to the rates of RDS, intra-ventricular hemorrhage (IVH) grades III and IV, and neonatal mortality. Random effects with 95% confidence intervals were assessed in both groups and relative risks were compared using mixed regression.
  
  
  RESULTS
  From 248 potentially eligible articles, we included eight in the analysis for a total of 1109 male and 968 female infants. Both male and female infants had a significant decrease in the risks, but no difference between the sexes was observed in terms of reduction in RDS (RR 0.50; 95% CI 0.33 to 0.77 for males, and RR 0.57; 95% CI 0.43 to 0.75 for females, P = 0.99), reduction in IVH (P = 0.98), and reduction in neonatal mortality (P = 0.43). In a sub-analysis, use of betamethasone was associated with a significant decrease in the rate of RDS in males (RR 0.29; 95% CI 0.15 to 0.57) but dexamethasone was not (RR 0.78; 95% CI 0.57 to 1.07). Conversely, dexamethasone use was significantly helpful in females (RR 0.51; 95% CI 0.32 to 0.81) but betamethasone was not (RR 0.62; 95% CI 0.38 to 1.00).
  
  
  CONCLUSIONS
  The effect of AGC for prevention of RDS is similar in females and males. However, futures studies should investigate the type of AGC according to fetal/neonatal sex.
authors: Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC.
authors: Stéphanie
authors: S
authors: Roberge
authors: Yves
authors: Y
authors: Lacasse
authors: Sylvie
authors: S
authors: Tapp
authors: Yves
authors: Y
authors: Tremblay
authors: Anneli
authors: A
authors: Kari
authors: Jing
authors: J
authors: Liu
authors: Myriam
authors: M
authors: Fekih
authors: Hussein S
authors: HS
authors: Qublan
authors: Melania M
authors: MM
authors: Amorim
authors: Emmanuel
authors: E
authors: Bujold
mesh_terms: D005260:Female; D046128:Fetal Therapies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D047928:Premature Birth; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*; D012737:Sex Factors
chemical_list: D005938:Glucocorticoids