Sex-specific adverse neonatal outcomes and umbilical cord arterial ph at birth: a population-based cohort…

Abstract

Background: Biological sex may influence neonatal vulnerability to adverse perinatal outcomes, but sex-related differences in these outcomes remain underexplored. Male neonates may be more susceptible to perinatal asphyxia, metabolic acidosis, preterm birth, and morbidity, possibly due to sex-specific placental differences and inflammatory responses. Umbilical cord arterial pH (UApH) < 7.05 is used in Sweden to define neonatal acidemia, associated with poor outcomes. This study aimed to investigate the association between neonatal sex and adverse outcomes, focusing on UApH.

Methods: This retrospective multicenter cohort study used data from the Swedish Perinatal Revision South Register (1995–2015). The cohort included live-born, singleton, vaginal births. Neonatal and maternal data were extracted, and logistic regression models compared outcomes between male and female neonates, adjusting for maternal age, gestational age, and birth weight.

Results: Among 87 840 neonates, 51.6% were male. Male neonates had significantly higher adjusted odds of adverse outcomes compared with females: UApH < 7.05 (OR 1.18, 95% CI 1.07–1.30; P < 0.001), Apgar score < 7 at 5 min (OR 1.33, 95% CI 1.14–1.56; P < 0.001), CPAP use (OR 1.66, 95% CI 1.46–1.87; P < 0.001), NICU admission (OR 1.51, 95% CI 1.43–1.60; P < 0.001), hypoxic-ischemic encephalopathy (OR 2.24, 95% CI 1.29–3.90; P = 0.002) and central nervous system disease (OR 1.52, 95% CI 1.30–1.76; P < 0.001).

Conclusions: Male neonatal sex was associated with several adverse perinatal outcomes, including acidemia and neurological complications. These findings contribute to the understanding of sex-related differences in neonatal vulnerability and warrant further investigation.

Trial registration: Not applicable.

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BibTeX RIS

BibTeX

@article{akel2026sexspecific,
  title = {{Sex-specific adverse neonatal outcomes and umbilical cord arterial ph at birth: a population-based cohort study}},
  author = {Wazhma Nassery Akel and Sara Abdulilah and Mehreen Zaigham},
  journal = {BMC Pediatrics},
  year = {2026},
  month = oct,
  doi = {10.1186/s12887-026-07865-5},
  url = {https://doi.org/10.1186/s12887-026-07865-5},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Sex-specific adverse neonatal outcomes and umbilical cord arterial ph at birth: a population-based cohort study
AU  - Wazhma Nassery Akel
AU  - Sara Abdulilah
AU  - Mehreen Zaigham
PY  - 2026
DA  - 2026/10/27
JO  - BMC Pediatrics
DO  - 10.1186/s12887-026-07865-5
UR  - https://doi.org/10.1186/s12887-026-07865-5
AB  - Background: Biological sex may influence neonatal vulnerability to adverse perinatal outcomes, but sex-related differences in these outcomes remain underexplored. Male neonates may be more susceptible to perinatal asphyxia, metabolic acidosis, preterm birth, and morbidity, possibly due to sex-specific placental differences and inflammatory responses. Umbilical cord arterial pH (UApH) < 7.05 is used in Sweden to define neonatal acidemia, associated with poor outcomes. This study aimed to investigate the association between neonatal sex and adverse outcomes, focusing on UApH.  Methods: This retrospective multicenter cohort study used data from the Swedish Perinatal Revision South Register (1995–2015). The cohort included live-born, singleton, vaginal births. Neonatal and maternal data were extracted, and logistic regression models compared outcomes between male and female neonates, adjusting for maternal age, gestational age, and birth weight.  Results: Among 87 840 neonates, 51.6% were male. Male neonates had significantly higher adjusted odds of adverse outcomes compared with females: UApH < 7.05 (OR 1.18, 95% CI 1.07–1.30; P < 0.001), Apgar score < 7 at 5 min (OR 1.33, 95% CI 1.14–1.56; P < 0.001), CPAP use (OR 1.66, 95% CI 1.46–1.87; P < 0.001), NICU admission (OR 1.51, 95% CI 1.43–1.60; P < 0.001), hypoxic-ischemic encephalopathy (OR 2.24, 95% CI 1.29–3.90; P = 0.002) and central nervous system disease (OR 1.52, 95% CI 1.30–1.76; P < 0.001).  Conclusions: Male neonatal sex was associated with several adverse perinatal outcomes, including acidemia and neurological complications. These findings contribute to the understanding of sex-related differences in neonatal vulnerability and warrant further investigation.  Trial registration: Not applicable.
SN  - 1471-2431
ER  -

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