Mechanistic Insights into the Development of Fetal Growth Restriction Associated with Fetal Sex

Genetic and hormonal determinants not only define male and female fenotypes. Differences that occur from the early stages of embryogenesis can also cause normal and pathological phenotypic manifestations depending on fetal sex, as well as different predispositions to diseases in the future. Fetal growth restriction is one of the most common causes of perinatal mortality and morbidity in newborns that complicates a significant number of pregnancies. In this review, we summarized and analyzed the recent data posted on the eLibrary and PubMed platforms with reference to the relationship between the sex of the fetus and the development of fetal growth restriction. According to the available data, fetal growth restriction occurs more frequently in female fetuses than in male ones. This is because in pregnant women, the sex of the fetus determines its biological susceptibility to such risk factors for fetal growth restriction as gestational diabetes mellitus, gestational hypertension, preeclampsia, asthma, etc. In a male fetus, the developing placenta is primarily aimed at increasing fetal weight; while for a female fetus, the priority is on the multiple mechanisms that regulate immune protection, adaptability, and rapid response to modifiable adverse effects.