Gender Differences of Placental Dysfunction in Severe Prematurity


Background: Several obstetric complications have been reported to be related to fetal gender such as prematurity, preeclampsia and placental abruption. Objective: To investigate whether a sex difference exists in findings at placental histology of extreme prematurity.Design: Cross-sectional.Setting: Gynecology and Obstetrics department, Al-Kadhimyia Teaching Hospital, Baghdad, Iraq Patients and Methods: Fifty deliveries before 32 weeks of gestation of singleton, liveborn, non-anomalous infants were included in the study. Placental histological findings were compared between male (n=25) and female (n=25) neonates.Results: Male fetuses had distributions rate of nulliparity, maternal age , gestational age at delivery as female fetuses , but higher birth weight centiles ([55.09±11.3] vs. [43.09±8.2]). Placental histology showed no association between fetal gender and lesion of acute inflammation (p=0.09) , intraplacental vascular pathology (p=0.2) or uteroplacental vascular pathology (p=0.5).However ,lesion of chronic inflammation had a significantly higher score in male than in female fetuses (p=0.01).when we examined the distribution of chronic placental inflammation ,significantly more severe lesions were noted in male than in female fetuses at the implantation site (i.e the area of interstitial trophoblast invasion of the maternal decidua and maternal endovascular trophoblast remodeling ),than within the placental villi (chronic villitis) or in the amniochorionic membranes (where interstitial trophoblast invasion is minimal). Conclusion: In premature deliveries at <32 weeks ,male fetal gender is associated with placental lesions suggestive of a maternal immune response against the invading interstitial trophoblast .The immunological basis of these findings deserves further studies.Key wards: Gender difference, prematurity, placental histology.