Fetal sex modifies effects of prenatal stress exposure and adverse birth outcomes

Tamar Wainstock*, Ilana Shoham-Vardi, Saralee Glasser, Eyal Anteby, Liat Lerner-Geva

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Prenatal maternal stress is associated with pregnancy complications, poor fetal development and poor birth outcomes. Fetal sex has also been shown to affect the course of pregnancy and its outcomes. The aim of this study was to evaluate whether fetal sex modifies the association between continuous exposure to life-threatening rocket attack alarms and adverse pregnancy outcomes. A retrospective cohort study was conducted in which the exposed group was comprised of 1846 women exposed to rocket-attack alarms before and during pregnancy. The unexposed group, with similar sociodemographic characteristics, delivered during the same period of time at the same medical center, but resided out of rocket-attack range. Multivariable models for each gender separately, controlling for possible confounders, evaluated the risk associated with exposure for preterm births (PTB), low birthweight (LBW), small for gestational age and small head circumference (HC). In both univariable and multivariable analyses exposure status was a significant risk factor in female fetuses only: PTB (adj. OR=1.43; 1.04-1.96), LBW (adj. OR=1.41; 1.02-1.95) and HC<31cm (adj. OR=1.78; 1.11-2.88). In addition, regarding all adverse outcomes, the male-to-female ratio was higher in the exposed group than in the unexposed group. The findings support the hypothesis that male and female fetuses respond differentially to chronic maternal stress.

Original languageEnglish
Pages (from-to)49-56
Number of pages8
Issue number1
StatePublished - 1 Jan 2015


  • Chronic stress
  • Cohort study
  • Fetal growth
  • Low birthweight
  • Preterm birth
  • Secondary sex ratio


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