Fetal growth restriction but not preterm birth is a risk factor for severe hypospadias

• Published in: Pediatrics international 2016-07, Vol.58 (7), p.573-577
• Main Authors: Hashimoto, Yukiko, Kawai, Masahiko, Nagai, Sizuyo, Matsukura, Takashi, Niwa, Fusako, Hasegawa, Takeshi, Heike, Toshio
• Format: Article
• Language: English
• Subjects: Adolescent; Birth weight; Blood flow; Child; Chorionic gonadotropin; Cryptorchidism; fetal growth restriction; Fetal Growth Retardation; Fetuses; Follow-Up Studies; Genitalia; Gestational Age; Gonadotropins; Health risk assessment; Histopathology; human chorionic gonadotropin; Humans; hypospadias; Hypospadias - diagnosis; Hypospadias - epidemiology; Hypospadias - etiology; Incidence; Infant, Newborn; Infant, Very Low Birth Weight; Infants; Infarction; Japan - epidemiology; Male; Pediatrics; Pituitary (anterior); Placenta; placental insufficiency; Premature birth; Prenatal development; Retrospective Studies; Risk Factors; Scrotum; Secretion; Severity of Illness Index
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.12864

Background Hypospadias has multifactorial causes and occurs at a high frequency among very low‐birthweight infants. Placental insufficiency is hypothesized to be one cause of hypospadias; that is, decreased human chorionic gonadotropin (hCG) secretion caused by placental insufficiency is suspected to result in abnormal male external genitalia, but there is little direct evidence to support this. The aim of this study was therefore to identify the features of hypospadias and to clarify the male genital abnormalities caused by fetal growth restriction (FGR). Methods We reviewed the clinical data of boys who underwent hypospadias repair between 2005 and 2011 at Kyoto University Hospital. Results Twenty boys were included in this study. Fifteen (75%) of the subjects were preterm or low‐birthweight infants. Thirteen (65%) had FGR, 60% of whom had severe hypospadias regardless of gestational age. In addition, 92% of the FGR infants also had other genital anomalies, such as cryptorchidism, bifid scrotum, or micropenis. In contrast, only 14% and 43% of the non‐FGR infants had severe hypospadias or genital anomalies other than hypospadias, respectively. Placental histopathology was available in eight FGR infants, in seven of whom it was suggestive of blood flow deficiency such as infarction and single umbilical artery. Conclusions Infants with FGR have a high incidence of hypospadias. FGR caused by placental dysfunction, but not low birthweight, is a risk factor for severe hypospadias associated with multiple genital anomalies.