title: Neonatal outcomes in relation to sex differences: a national cohort survey in Taiwan.
abstract: BACKGROUND
  An extensive assessment investigating the association between sex differences and neonatal outcomes is lacking. In the current study, we estimated the correlation of gender with adverse birth outcomes in a large cohort population.
  
  
  METHODS
  National population-based data containing maternal and neonatal information in 2001 to 2010 were derived from the Health Promotion Administration, Taiwan. Singletons without high-risk pregnancy were further analyzed for the sex ratio of live births in relation to neonatal outcomes-including preterm birth, birth weight, neonatal death, delivery mode, and congenital anomaly. A multivariate logistic regression model was used to adjust for possible confounders.
  
  
  RESULTS
  In total, 2,123,100 births were valid for the analysis. Overall, the sex ratio at birth (male/female) was 1.096. Compared to multiple births, the sex ratio was significantly higher with singleton births (p < 0.001). Among multiple births, the incidence of stillbirths was significantly higher in males than in females (p < 0.05). The sex ratio at gestational age (GA) <37 weeks was 1.332, and it declined proportionally with a rise in the GA to 0.899 at GA of ≥41 weeks. In contrast, the sex ratio was 0.850 at birth weight <3000 g, and it rose proportionally with a rise in the birth weight to 1.902 at birth weight ≥4000 g (macrosomia). Operative delivery was more common in males than in females (p < 0.001). The regression analysis showed greater risks of preterm birth, macrosomia, operative delivery, neonatal death, and congenital anomaly among male newborns.
  
  
  CONCLUSIONS
  Male gender carried higher risks of adverse neonatal outcomes, including preterm birth, macrosomia, operative delivery, neonatal death, and congenital anomaly. The data have clinical implications on health surveillance for plotting strategies in response to the unbalanced sex ratio in relation to the boy preference.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Dunhua North Road, Taipei, 105 Taiwan.
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Weng
authors.affiliation: Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung, 80708 Taiwan.
authors.forename: Chun-Yuh
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Master Program in Global Health and Development, Health Policy and Care Research Center, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110 Taiwan.
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Chiu
keywords: Birth outcome; Birth weight; Cesarean section; Congenital anomaly; Gender; Gestational age; Sex ratio