is Hypospadias A Result From Early Gestational Placental Insufficiency Or Still an Unexplained Malformation?

Tariq O. Abbas; Mazin Mohammed; Mansour Ali

Volume : III, Issue : VI, June - 2014

is Hypospadias A Result From Early Gestational Placental Insufficiency Or Still an Unexplained Malformation?

Tariq O. Abbas, Mazin Mohammed, Mansour Ali

Abstract :

Aim Hypospadias a relatively common male genital anomaly may be caused by different maternal hormone levels, blood glucose levels or nutritional deficiencies that are poorly defined. The association of growth retardation and hypospadias is well established. Fetal testosterone secretion is under the influence of placental human chorionic gonadotropin during first 14 weeks of gestation. We hypothesized that placental insufficiency may disrupt the supply of nutrients and human chorionic gonadotropinto the fetus leading to both growth retardation and hypospadias. To validate this hypothesis, we analyzed placental and birth weight indices in infants with and without hypospadias. Methods We performed a population-based, case control study using linked birth-hospital discharge data from Hamad General Hospital from January 2007 to December 2012. A retrospective cohort analysis of these infants was performed. Infants� growth parameters at birth (weight, head circumference) were analyzed along with maternal risk factors known to be associated with changes in fetal growth, including maternal age, diagnosis of preeclampsia, gestational diabetes as well as placental weight. Results 73 newborn males with a birth were included. Birth body weights were lower in patients with hypospadias compared with those for controls (3096 � 823 vs 3283 � 583 g). Placenta-to- fetal weight ration (0.243 � 0.2 vs 0.211 � 0.04) and gestational age were higher in the patients with hypospadias. There were no differences between singleton and multiple-gestation births. However, the frequency of occurrence was similar among first-born infants compared with all other infants. Conclusion The significant association between the occurrence of hypospadias and early growth retardation with higher placenta-to-fetal ration and placental abnormalities suggest that placental dysfunction in early gestation may play an important role in the development of hypospadias. The increasing frequency of hypospadias and its association with poor intrauterine growth originating in early gestation suggest that common environmental factors that have an impact on both conditions may be involved. Careful evaluation of the genitalia is advised when early-onset placentally mediated IUGR is encountered.