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Given evidence that maternal blood pressure (BP) may be raised in pregnancies with Beckwith-Wiedemann syndrome (fetal overgrowth), a possible contributor to the association between male sex and term pre-eclampsia is faster male growth (~\u2009130\u00a0g heavier than females). We hypothesized that male sex would be associated with higher maternal BP in a general population sample, explained by birth weight sex differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We tested the association between fetal sex and maternal systolic (SBP) and diastolic blood pressure (DBP), measured at\u2009~\u200928\u00a0weeks gestation, in a meta-analysis of five cohorts of mother\u2013child pairs (\n                      <jats:italic>n<\/jats:italic>\n                      up to 109,842). Maternal BP was analyzed as a continuous and dichotomized (high BP yes\/no) outcome. Linear regression models were constructed with and without adjustment for birth weight to assess whether any difference in maternal BP was explained by birth weight differences between male and female babies. Lastly, we constructed a fetal genetic score for birth weight using 186 own-birth-weight-associated single-nucleotide polymorphisms (SNPs) to test whether fetal birth-weight-raising-alleles were associated with maternal BP in pregnancy (\n                      <jats:italic>n<\/jats:italic>\n                      up to 32,232).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Maternal SBP and DBP were higher in pregnancy when carrying a male compared to a female fetus (mean difference 0.35\u00a0mmHg [95% CI: 0.15\u20130.55] and 0.35\u00a0mmHg [95% CI: 0.21\u20130.49], for SBP and DBP, respectively). An independent effect of fetal sex remained when including birth weight but attenuated slightly (0.22\u00a0mmHg [95% CI: 0.02\u20130.42] and 0.31\u00a0mmHg [95% CI: 0.17\u20130.45], for SBP and DBP, respectively). While there was a positive direction of effect for odds of high maternal BP given pregnancy with a male fetus, confidence intervals included the null (OR 1.05 [95% CI: 0.98\u20131.12]). No evidence for an association was found between a fetal birth weight genetic score and SBP or DBP when conditioned on maternal genotype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found strong evidence to support a small effect of male fetal sex on higher maternal BP in pregnancy, without substantial contribution from larger fetal size at birth. Our findings do not indicate a difference in maternal BP that would warrant changes to routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-025-04432-0","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T12:43:27Z","timestamp":1762346607000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The influence of fetal sex on maternal blood pressure in pregnancy"],"prefix":"10.1186","volume":"23","author":[{"given":"Caitlin S.","family":"Decina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin N.","family":"Beaumont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Juodakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Warrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashyap A.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e5l R.","family":"Nj\u00f8lstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Hattersley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Jacobsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"William L.","family":"Lowe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Freathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"4432_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0220-4","author":"D Mondal","year":"2014","unstructured":"Mondal D, Galloway TS, Bailey TC, Mathews F. 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Informed consent for the use of data collected via questionnaires and clinics was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time. Consent for biological samples has been collected in accordance with the Human Tissue Act (2004). Study participants have the right to withdraw their consent for elements of the study or from the study entirely. Full details of the ALSPAC consent procedures are available on the study website (\n                      \n                      ).Ethics approval was obtained for the main platform study and all of the individual sub-studies from the Bradford Research Ethics Committee.The establishment of MoBa and initial data collection was based on a license from the Norwegian Data Protection Agency and approval from The Regional Committees for Medical and Health Research Ethics. The MoBa cohort is currently regulated by the Norwegian Health Registry Act. The administrative board of MoBa led by the Norwegian Institute of Public Health approved the study protocol and the current study was approved by the Regional Committees for Medical and Health Research Ethics (no. 2012\/67).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate."}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"612"}}