Maternal and Fetal Risk Factors Associated with Hypospadias in a Sample of Iraqi Boys

Abstract

Background: Hypospadias is one of the most common congenital anomalies among boys. The exact causes of this anomaly are not clearlydefined yet. However, many of the risk factors have been identified in different ethnic groups. Objective: The objectives of this study are toevaluate the maternal‑ and fetal‑related risk factors for hypospadias in a sample of Iraqi patients. Materials and Methods: This case–controlstudy included 42 boys with hypospadias cases and other 42 age‑matched boys free from any genital anomalies as a control group. Maternaldata, including age, parity, body mass index, hypertension, diabetes mellitus (DM), the use of assisted reproduction techniques (ART), levelof education, consanguinity, and residence; and infant‑related factors. Logistic regression analysis was used to predict the risk of each variablethrough the calculation of odds ratio (OR) and its corresponding 95% of confidence interval (CI). Results: Three maternal factors were found tobe associated significantly with increased risk of hypospadias. These were maternal age >33 years (OR = 3.08, 95% CI = 1.02–9.26, P = 0.045),consanguineous marriage (OR = 3.0, 95% CI = 1.02–8.8, P = 0.045), and rural residence (OR = 2.64, 95% CI = 1.04–6.73, P = 0.041).Hypertension, DM, and using ART were more frequent among mothers of cases than controls; however, the differences were not significant.For fetal‑related factors, infants with low‑birth weight (LBW) were more frequent among cases than controls (40.48% vs. 19.05%), with astatistically significant difference (OR = 2.89, 95% CI = 1.08–7.75, P =0.035). Of note, twins were more frequent among cases than controls;however, this difference was not statistically significant (P = 0.074). Conclusions: These results highly suggest the critical role of advancedmaternal age, consanguinity, rural residence, and infant LBW, as predisposing factors for the occurrence of hypospadias among Iraqi boys.