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Systematic Review

Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression

1
Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), 6229HA Maastricht, The Netherlands
2
Statistics Netherlands, 6412HX Heerlen, The Netherlands
*
Author to whom correspondence should be addressed.
Academic Editors: Julia Kuligowski and Máximo Vento
Antioxidants 2021, 10(9), 1490; https://doi.org/10.3390/antiox10091490
Received: 30 August 2021 / Accepted: 14 September 2021 / Published: 18 September 2021
A widely accepted concept is that boys are more susceptible than girls to oxidative stress-related complications of prematurity, including bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL). We aimed to quantify the effect size of this male disadvantage by performing a systematic review and meta-analysis of cohort studies exploring the association between sex and complications of prematurity. Risk ratios (RRs) and 95% CIs were calculated by a random-effects model. Of 1365 potentially relevant studies, 41 met the inclusion criteria (625,680 infants). Male sex was associated with decreased risk of hypertensive disorders of pregnancy, fetal distress, and C-section, but increased risk of low Apgar score, intubation at birth, respiratory distress, surfactant use, pneumothorax, postnatal steroids, late onset sepsis, any NEC, NEC > stage 1 (RR 1.12, CI 1.06–1.18), any IVH, severe IVH (RR 1.28, CI 1.22–1.34), severe IVH or PVL, any BPD, moderate/severe BPD (RR 1.23, CI 1.18–1.27), severe ROP (RR 1.14, CI 1.07–1.22), and mortality (RR 1.23, CI 1.16–1.30). In conclusion, preterm boys have higher clinical instability and greater need for invasive interventions than preterm girls. This leads to a male disadvantage in mortality and short-term complications of prematurity. View Full-Text
Keywords: preterm birth; oxidative stress; sex differences; male disadvantage; female advantage; bronchopulmonary dysplasia; retinopathy of prematurity; necrotizing enterocolitis; intraventricular hemorrhage; periventricular leukomalacia; mortality preterm birth; oxidative stress; sex differences; male disadvantage; female advantage; bronchopulmonary dysplasia; retinopathy of prematurity; necrotizing enterocolitis; intraventricular hemorrhage; periventricular leukomalacia; mortality
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MDPI and ACS Style

van Westering-Kroon, E.; Huizing, M.J.; Villamor-Martínez, E.; Villamor, E. Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression. Antioxidants 2021, 10, 1490. https://doi.org/10.3390/antiox10091490

AMA Style

van Westering-Kroon E, Huizing MJ, Villamor-Martínez E, Villamor E. Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression. Antioxidants. 2021; 10(9):1490. https://doi.org/10.3390/antiox10091490

Chicago/Turabian Style

van Westering-Kroon, Elke, Maurice J. Huizing, Eduardo Villamor-Martínez, and Eduardo Villamor. 2021. "Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression" Antioxidants 10, no. 9: 1490. https://doi.org/10.3390/antiox10091490

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