Fetal Growth Restriction and a Single Umbilical Artery are Independent Predictors of Hypospadias During Pregnancy

Objective: To investigate the association between hypospadias (HS) and small fetuses using a database on fetal ultrasound and obstetric events. Methods A cohort of male singleton infants delivered after 22 weeks of gestation at Keio University Hospital between 2013 and 2019 was retrospectively reviewed. Fetal growth restriction (FGR) was defined by the Delphi criteria. Logistic regression analysis was performed to identify the significant predictors of HS. Placental pathology was reviewed in cases with HS. Results 2063 male infants delivered during the study period, 27 had HS. The prevalence of a single umbilical artery (SUA), small for gestational age, maternal hypertensive disorders of pregnancy, and a small placenta, were significantly higher in infants with HS. Multiple logistic regression analysis revealed that the presence of FGR and an SUA were independently and significantly associated with HS. The association of FGR with HS was significant regardless of the time of onset. Moreover, the review of placental histological findings suggested that fetal vascular malperfusion might play a role in HS. Conclusion Our study suggests that FGR and SUAs are independent prenatal predictors for the development of HS and that fetal vascular malperfusion of the placenta may be involved in the etiology of HS.