Fetal sex as a risk factor for gestational diabetes: A literature review
DOI:
https://doi.org/10.37800/RM.2.2026.629Keywords:
gestational diabetes, fetal sex, pregnancy, placenta, insulin resistanceAbstract
Relevance: Gestational diabetes mellitus (GDM) remains one of the most common endocrine pathologies of pregnancy, affecting the health of the mother and fetus both in the short and long term. In recent years, the role of not only maternal but also fetal factors in the pathogenesis of GDM has been actively studied. One of the factors discussed is the sex of the fetus. This paper summarizes current data on the relationship between fetal sex and the risk of developing GDM, possible pathophysiological mechanisms, and the clinical significance of this phenomenon.
The study aimed to explore the nature of obstetric pathology and birth outcomes in pregnant women with gestational diabetes mellitus, depending on the sex of the fetus being carried.
Materials and Methods: This review analyzed publications from 2015-2025 indexed in PubMed, Scopus, and eLibrary. The inclusion criteria were studies published in English or Russian over the past 10 years that included data on gestational diabetes mellitus, fetal sex, the placenta, and maternal metabolism. The review included 22 studies: 7 cohort, 9 cross-sectional, and 6 meta-analytical.
Results: The placentas of male fetuses show increased expression of genes related to insulin resistance and stress response, which increases the metabolic burden on the mother. Fetal macrosomia, cesarean section, and persistence of insulin resistance after childbirth are more common in women carrying boys. Thus, the male sex of the fetus is an independent modifying risk factor for GDM and can be used for personalized monitoring of pregnant women with a predisposition to metabolic disorders.
Conclusion: The fetal sex is an important, albeit moderate, biological factor affecting the risk of developing gestational diabetes and the nature of pregnancy. Pregnancy with a male fetus is more often accompanied by more pronounced insulin resistance, increased placental hormonal activity, and an increased risk of macrosomia.
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