title: Fetal sex modifies effects of prenatal stress exposure and adverse birth outcomes.
abstract: Prenatal maternal stress is associated with pregnancy complications, poor fetal development and poor birth outcomes. Fetal sex has also been shown to affect the course of pregnancy and its outcomes. The aim of this study was to evaluate whether fetal sex modifies the association between continuous exposure to life-threatening rocket attack alarms and adverse pregnancy outcomes. A retrospective cohort study was conducted in which the exposed group was comprised of 1846 women exposed to rocket-attack alarms before and during pregnancy. The unexposed group, with similar sociodemographic characteristics, delivered during the same period of time at the same medical center, but resided out of rocket-attack range. Multivariable models for each gender separately, controlling for possible confounders, evaluated the risk associated with exposure for preterm births (PTB), low birthweight (LBW), small for gestational age and small head circumference (HC). In both univariable and multivariable analyses exposure status was a significant risk factor in female fetuses only: PTB (adj. OR = 1.43; 1.04-1.96), LBW (adj. OR = 1.41; 1.02-1.95) and HC < 31 cm (adj. OR = 1.78; 1.11-2.88). In addition, regarding all adverse outcomes, the male-to-female ratio was higher in the exposed group than in the unexposed group. The findings support the hypothesis that male and female fetuses respond differentially to chronic maternal stress.
authors.affiliation: Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel .
authors.forename: Tamar
authors.initials: T
authors.lastname: Wainstock
authors.forename: Ilana
authors.initials: I
authors.lastname: Shoham-Vardi
authors.forename: Saralee
authors.initials: S
authors.lastname: Glasser
authors.forename: Eyal
authors.initials: E
authors.lastname: Anteby
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007230:Infant, Low Birth Weight; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects*; D015999:Multivariate Analysis; D009622:Noise / Q000009:adverse effects*; D016017:Odds Ratio; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology* / Q000523:psychology; D011297:Prenatal Exposure Delayed Effects; D012189:Retrospective Studies; D012307:Risk Factors; D012732:Sex Determination Analysis; D012737:Sex Factors; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology; D055815:Young Adult
keywords: Chronic stress; cohort study; fetal growth; low birthweight; preterm birth; secondary sex ratio