Sex differences in fetal heart rate and variability assessed by antenatal computerized cardiotocography

Acta Obstet Gynecol Scand. 2018 Dec;97(12):1486-1490. doi: 10.1111/aogs.13437. Epub 2018 Sep 14.


Introduction: The aim of the current study is to explore the effect of fetal sex on the fetal heart rate and variability.

Material and methods: This is a retrospective cross-sectional study. We analyzed fetal heart rate (FHR) traces of pregnant women that were recorded antenatally using a commercially available computerized cardiotocograph (cCTG; Oxford system). Fetal sex was ascertained after birth. Baseline FHR and short-term heart rate variation (STV) were compared between male and female fetuses. Expected mean values for baseline FHR and STV were computed and multiples of the mean (MOMean) of males and females were compared.

Results: Information on 9259 cases is reported in this study. Baseline FHR of female fetuses was significantly higher (P < 0.001) and STV lower (P < 0.001) than that of male fetuses. This difference remained even after the effects of gestational age and diurnal variation were eliminated by computation of MOMean, but the absolute differences in the baseline FHR (0.9 beats/min [bpm]) and STV (0.246 ms) between male and female fetuses were small. A significant negative correlation was found between baseline FHR and STV (r = -0.518, P < 0.001). Similarly, a significant negative correlation was found between the MoMean of baseline FHR and MoMean STV (r = -0.481, P < 0.001).

Conclusions: Using the Oxford cCTG, male fetuses show a significantly lower baseline FHR and greater variability as compared with female fetuses. However, the absolute differences are small and may not be of major clinical significance.

Keywords: computerized cardiotocograph fetal monitoring; high-risk pregnancy; prenatal care.

MeSH terms

  • Cardiotocography / methods*
  • Cross-Sectional Studies
  • Female
  • Gestational Age
  • Heart Rate, Fetal / physiology*
  • Humans
  • Male
  • Pregnancy
  • Retrospective Studies
  • Sex Factors