Fetal sex as a risk factor for fetal growth restriction or small for gestational age

DOI

https://dx.doi.org/10.18565/aig.2025.164

Ziyadinov A.A., Novikova V.A., Radzinsky V.E.
1) N.A. Semashko Republican Clinical Hospital, Simferopol, Russia; 2) S.I. Georgievsky Medical Institute of V.I. Vernadsky Crimean Federal University, Simferopol, Russia; 3) Patrice Lumumba Peoples' Friendship University of Russia, Moscow, Russia

Objective: To evaluate the association between fetal sex and insufficient fetal growth (IFG), including fetal growth restriction (FGR) and small for gestational age (SGA).
Materials and methods: A prospective cohort study was conducted at N.A. Semashko Republican Clinical Hospital from 2018 to 2023. A total of 611 women with singleton pregnancies diagnosed with IFG were included in the study, with FGR (n=435) and SGA (n=176).
Results: Fetal sex in patients with IFG was associated with various factors, including parental age, age at menarche, maternal BMI, weight gain, blood pressure, hemoglobin levels, leukocyte counts, ALT and AST levels, blood creatinine, Doppler data of uteroplacental blood flow, CTG results, IFG variant (FGR or SGA), causes of IFG, prematurity, low birth weight (LBW), and the need for intensive care (IC) for the newborn. FGR, compared to SGA, was characterized by (p<0.05–0.001) a younger age of both parents, earlier age at menarche, greater weight gain, lower systolic and diastolic blood pressure in the first trimester, lower CTG indicators, lower hemoglobin levels, but higher creatinine, ALT, and AST levels, and an earlier gestational age at delivery. Female fetuses are more commonly associated with FGR, impaired blood flow in the uterine and middle cerebral arteries, LBW, severe preeclampsia (PE), and gestational arterial hypertension as causes of IFG as well as a higher need for IC in newborns. Male fetuses are more often linked to unknown causes of IFG, chronic arterial hypertension, moderate PE, and prematurity. Decision tree analysis revealed that the IFG variant is associated with fetal sex, parental age, the cause of IFG, LBW, and the need for IC.
Conclusion: Fetal sex is interconnected with the IFG variant and numerous factors that contribute to or result from this condition. The specific nature of this relationship is influenced by the IFG variant (FGR or SGA), parental age, maternal and fetoplacental hemodynamics, and the maternal hemic, hepatic, and renal responses to pregnancy complicated by IFG. It is advisable to implement individualized centile tables adjusted for fetal sex during ultrasound monitoring.

Authors' contributions: Ziyadinov A.A. – conception and design of the study, data analysis, drafting and editing of the manuscript, interpretation of results, approval of the manuscript for submission; Novikova V.A. – conception and design of the study, statistical analysis and interpretation of results; Radzinsky V.E. – conception and design of the study, editing of the manuscript, approval of the manuscript for submission.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Patrice Lumumba Peoples' Friendship University of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator. For citation: Ziyadinov A.A., Novikova V.A., Radzinsky V.E. Fetal sex as a
risk factor for fetal growth restriction or small for gestational age.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (8): 109-122 (in Russian)
https://dx.doi.org/10.18565/aig.2025.164

pregnancy

fetal growth restriction

small for gestational age fetus

fetal sex

low birth weight

parental age

classification trees

Full text (in Russian)

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Received 20.06.2025

Accepted 12.08.2025

Arsen A. Ziyadinov, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology No. 1, S.I. Georgievsky Medical Institute of V.I. Vernadsky Crimean Federal University; Obstetrician-Gynecologist, Perinatal Center of N.A. Semashko Republican Clinical Hospital, 295017, Russia, Republic of Crimea, Simferopol, Semashko str., 8; Doctoral student at the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute of Patrice Lumumba Peoples’ Friendship University of Russia, ars-en@yandex.ru
Vladislava A. Novikova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute of Patrice Lumumba Peoples’ Friendship University of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, vladislavan@mail.ru
Victor E. Radzinsky, Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute of Patrice Lumumba Peoples’ Friendship University of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, kafedra-aig@mail.ru

Fetal sex as a risk factor for fetal growth restriction or small for gestational age

Ziyadinov A.A., Novikova V.A., Radzinsky V.E.

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