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The placenta and neurodevelopment: sex differences in prenatal vulnerability
Open accessAbstract
Prenatal insults, such as maternal stress, are associated with an increased neurodevelopmental disease risk and impact males significantly more than females, including increased rates of autism, mental retardation, stuttering, dyslexia, and attention deficit/hyperactivity disorder (ADHD). Sex differences in the placenta, which begin with sex chromosomes, are likely to produce sex-specific transplacental signals to the developing brain. Our studies and others have identified X-linked genes that are expressed at higher levels in the female placenta. Through a genome-wide screen after maternal stress in mice, we identified the X-linked gene O-linked N-acetylglucosamine transferase (OGT) and demonstrated its causality in neurodevelopmental programming producing a male-specific stress phenotype. Elucidating the sex-specific molecular mechanisms involved in transplacental signals that impact brain development is key to understanding the sex bias in neurodevelopmental disorders and is expected to yield novel insight into disease risk and resilience.
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“In many studies, male offspring appear to be the most strongly affected. Interestingly, they often present with what is known as a dysmasculinized phenotype (i.e., with behaviors and gene expression patterns most commonly seen in females) (Bale 2016).”
From Prenatal developmental origins of future psychopathology: mechanisms and pathways (2019) · cites this paper as Bale 2016
In the citing paper
“In one elegant model in mice based on the X-linked gene OGT (O-linked N-acetylglucosamine transferase), male placentas with typically lower levels of OGT are poised for epigenetic alterations that appear to produce robust transcriptional responses to maternal prenatal stress that result in increased stress sensitivity as adults (Bale 2016).”
From Prenatal developmental origins of future psychopathology: mechanisms and pathways (2019) · cites this paper as Bale 2016
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“…there is an extended critical period of prenatal vulnerability—as an explanatory model; another lead considers hormone exposure, especially to testosterone, given its role of organizing sexual variation in the developing brain and association with risk of neurodevelopmental disease (Bale 2016).”
BackgroundInfluentialSex and gender differences in developmental programming of metabolism
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Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes
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Parental Advisory: Maternal and Paternal Stress Can Impact Offspring Neurodevelopment
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BackgroundSelf-citationIL-6 and IL-8: An Overview of Their Roles in Healthy and Pathological Pregnancies
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Sex Differences in Immunity to Viral Infections
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“Interestingly, it has been shown that sex chromosome genes mediate transcription regulation, affecting transplacental signalling, resulting in differential responses to maternal insults that can culminate in neurodevelopmental disorders (Bale, 2016).”
BackgroundThe cortisol switch between vulnerability and resilience
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Gender Specific Differences in Disease Susceptibility: The Role of Epigenetics
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“Placenta function is also influenced by fetal sex, and placental sex seems to be a major determinant in the magnitude and functional responses of the placenta to perturbations during pregnancy [101].”
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“Significantly decreased levels ofOGTand its controloverH3K27me3 in themale placenta predisposes male chromatin to be in a reactive state and more vulnerable to maternal stress (Bale, 2016).”
BackgroundPrata, J., Santos, S. G., Almeida, M. I., Coelho, R., & Barbosa, M. A. (2017) · Journal of Neuroinflammation · doi:10.1186/s12974-017-0938-y · Cited by 115
Placental programming of neuropsychiatric disease
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Prenatal environmental risk factors for autism spectrum disorder and their potential mechanisms
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“Mouse and human studies indicate that placental immune responses may occur in a sex-specific manner in response to maternal stressors, potentially mediated by hormonal disruptions and consequently influencing neurodevelopmental outcomes [104, 105].”
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“A dysregulation in CRH production, secondary to various maternal conditions, such as hypoxia, increased inflammatory cytokines and glucocorticoids, stress, preeclampsia, and eclampsia, may lead to altered neurodevelopmental patterns of these fetal structures (Allen, 2001; Bale, 2016; Sheng et al., 2020).”
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Shao, S., Wang, J., Huang, K., Wang, S., Liu, H., Wan, S., Yan, S., Hao, J., Zhu, P., & Tao, F. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104797 · Cited by 50
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“…mechanisms bestowed to the developing fetus to differential responses of the placenta and gonadal hormones during and following puberty, which may all impose lasting epigenetic changes and hormone-driven cellular signaling responses in different organs and physiology between sexes [9, 56].”
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“…in-utero developmental perturbations than females (Clifton, 2010; Eriksson et al., 2010) could be because their brain develops more slowly than that of females, placing them at increased vulnerability to adverse challenges over a relatively longer period than females during gestation (Bale, 2016).”
BackgroundMaternal oxycodone treatment causes pathophysiological changes in the mouse placenta
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“We, and others, have shown that by mounting robust placental gene expression changes in response to maternal challenges, including high fat diet or stress, females demonstrate later resistance to behavioral changes relative to male counterparts [12, 26, 64-66].”
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Maternal Stress and Coping Strategies in Developmental Dyslexia: An Italian Multicenter Study
Carotenuto, M., Messina, A., Monda, V., Precenzano, F., Iacono, D., Verrotti, A., Piccorossi, A., Gallai, B., Roccella, M., Parisi, L., et al. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00295 · Cited by 33
Chen, Z., Xiong, C., Liu, H., Duan, J., Kang, C., Yao, C., Chen, K., Chen, Y., Liu, Y., Liu, M., et al. (2022) · BMC Pediatrics · doi:10.1186/s12887-022-03312-3 · Cited by 33
“Prior studies have shown that fetal gender may play an essential role in regulating the influence of prenatal exposure on neurodevelopment [41, 42].”
BackgroundThe Prenatal Hormone Milieu in Autism Spectrum Disorder
Worsham, W., Dalton, S., & Bilder, D. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.655438 · Cited by 29
“, hyperglycemia, insulin insensitivity) could influence the sex-differential observed in ASD (20).”
BackgroundBabineau, V., Fonge, Y. N., Miller, E. S., Grobman, W. A., Ferguson, P. L., Hunt, K. J., Vena, J. E., Newman, R., Guille, C., Tita, A., et al. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.03.021 · Cited by 31
“In addition to finding associations between prenatal stress and depressive symptoms with multiple interrelated domains of child neurobehavior, we also corroborate prior evidence of biological male vulnerability to prenatal adversity.(31,50) Prenatal depressive symptoms, but not prenatal stress, were associated with ob…”
ResultO-GlcNAc: Regulator of Signaling and Epigenetics Linked to X-linked Intellectual Disability
Konzman, D., Abramowitz, L. K., Steenackers, A., Mukherjee, M., Na, H., & Hanover, J. A. (2020) · Frontiers in Genetics · doi:10.3389/fgene.2020.605263 · Cited by 31
“Interestingly, a recent hypothesis to explain the malebiased presentation of neurodevelopmental diseases focuses on sex differences in the placenta in relaying signals to the developing brain regarding maternal perturbations (Charil et al., 2010; Howerton and Bale, 2012, 2014; Gabory et al., 2013; Howerton et al., 201…”
BackgroundHuman Placental Adaptive Changes in Response to Maternal Obesity: Sex Specificities
Santos, E. D., Hernández, M. H., Serazin-Leroy, V., Vialard, F., & Dieudonné, M. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24119770 · Cited by 29
“More specifically, reduced OGT expression could result in male placentas having less of the histone repressive mark H3K2me3 and, thus, being more vulnerable to modifications of the maternal environmental [92,93].”
BackgroundFish Oil Supplementation in Pregnancy and Neurodevelopment in Childhood—A Randomized Clinical Trial
Sass, L., Bjarnadóttir, E., Stokholm, J., Chawes, B., Vinding, R., Mora‐Jensen, A. C., Thorsen, J., Nørgaard, S. K., Ebdrup, B. H., Jepsen, J. R. M., et al. (2021) · Child Development · doi:10.1111/cdev.13541 · Cited by 29
Christians, J. K., Ahmadzadeh-Seddeighi, S., Bilal, A., Bogdanovic, A., Ho, R., Leung, E. V., MacGregor, M. A., Nadasdy, N. M., & Principe, G. M. (2023) · Biology of Sex Differences · doi:10.1186/s13293-023-00532-9 · Cited by 34
“Some studies have suggested increased male vulnerability in long-term behavioral and cognitive outcomes [15, 19, 20, 22, 23], and so we focused on such outcomes measured at 1 year of age or older, including assessments of abilities relating to language (including reading and speech), behaviour, memory, learning, think…”
BackgroundBoerma, T., ter Haar, S. M., Ganga, R., Wijnen, F. N. K., Blom, E., & Wierenga, C. J. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105398 · Cited by 36
“…at greater risk for neurodevelopmental cognitive deficits, including (persisting) language delays and being diagnosed with DLD, compared to females (Bale, 2016; Cheuk and Wong, 2005; Dale et al., 2003; Harrison and McLeod, 2010; Law et al., 2009; Mossabeb et al., 2012; Prathanee et al., 2007;…”
Maternal Lifetime Trauma and Birthweight: Effect Modification by In Utero Cortisol and Child Sex
Flom, J. D., Chiu, Y.-H. M., Hsu, H. L., Devick, K. L., Brunst, K. J., Campbell, R. K., Enlow, M. B., Coull, B. A., & Wright, R. J. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.07.069 · Cited by 31
“Our results are consistent with literature showing that males are more susceptible to effects of in utero stress and stress correlates on fetal growth.(31,57) For example, Thayer et al found that elevated maternal cortisol levels assessed before conception disproportionately impacted fetal growth in boys.”
The Placenta’s Role in Sexually Dimorphic Fetal Growth Strategies
Christians, J. K. (2021) · Reproductive Sciences · doi:10.1007/s43032-021-00780-3 · Cited by 31
Bulka, C. M., Everson, T. M., Burt, A., Marsit, C. J., Karagas, M. R., Boyle, K. E., Niemiec, S., Kechris, K. J., Davidson, E., Yang, I. V., et al. (2023) · Epigenetics · doi:10.1080/15592294.2023.2179726 · Cited by 29
“After birth, male infants are also more likely than females to exhibit morbidities, including respiratory distress and neurological impairments [32–35]; it has been posited that the pathogenesis of these conditions originates in utero and is influenced by the placenta [36, 37].”
BackgroundBraithwaite, E., Hill, J., Pickles, A. R., Glover, V. A. S., O’Donnell, K. J., & Sharp, H. M. (2018) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174418000181 · Cited by 28
“Fetal sex is a key determinant in the functional responses of the placenta to maternal perturbations during pregnancy.(51) Sex differences in placental mechanisms are evident throughout gestation, and therefore could provide a plausible mechanism by which the maternal milieu could have sexdependent effects on fetal gr…”
BackgroundSex differences in early and term placenta are conserved in adult tissues
Olney, K. C., Plaisier, S. B., Phung, T. N., Silasi, M., Perley, L. E., O’Bryan, J., Ramirez, L., Kliman, H. J., & Wilson, M. A. (2022) · Biology of Sex Differences · doi:10.1186/s13293-022-00470-y · Cited by 27
“…genes such as O-linked N-acetylglucosamine transferase (OGT), which is expressed at a higher level in XX females because it escapes X chromosome inactivation, leading to increased histone methylation and decreased gene expression thought to provide a neuroprotective state in females (Bale, 2016).”
BackgroundRam, S., Howland, M. A., Sandman, C. A., Davis, E. P., & Glynn, L. M. (2018) · Clinical Psychological Science · doi:10.1177/2167702618811079 · Cited by 28
Ryva, B. A., Pacyga, D. C., Anderson, K. Y., Calafat, A. M., Whalen, J., Aung, M. T., Gardiner, J. C., Braun, J. M., Schantz, S. L., & Strakovsky, R. S. (2024) · Environment International · doi:10.1016/j.envint.2024.108433 · Cited by 27
“Additionally, other studies have shown that male placentas are more responsive to stressors than female placentas (Bale, 2016; Bronson and Bale, 2016; Eriksson et al., 2010).”
ResultBabineau, V., McCormack, C. A., Feng, T., Lee, S., Berry, O. O., Knight, B. T., Newport, D. J., Stowe, Z. N., & Monk, C. E. (2022) · Bipolar Disorders · doi:10.1111/bdi.13207 · Cited by 26
“54 Evidence for intergenerational transmission of maternal CM via prenatal programming was specific to birth outcomes only.”
Reemst, K., Ruigrok, S. R., Bleker, L. S., Naninck, E. F. G., Ernst, T. R., Kotah, J. M., Lucassen, P. J., Roseboom, T. J., Pollux, B. J. A., de Rooij, S. R., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104627 · Cited by 26
Nitschke, A. S., do Valle, H. A., Vallance, B. A., Bickford, C., Ip, A., Lanphear, N. E., Lanphear, B. P., Weikum, W., Oberlander, T. F., & Hanley, G. E. (2023) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12972 · Cited by 28
Scarborough, J., Mueller, F. S., Weber‐Stadlbauer, U., Mattei, D., Opitz, L., Cattaneo, A., & Richetto, J. (2021) · Molecular Psychiatry · doi:10.1038/s41380-021-01145-7 · Cited by 25
“The sex-specific programming of behavioral abnormalities observed here is in line with the findings from other rodent models of gestational stress exposure [86] and may be explained by a differential susceptibility of male and female placental functions to prenatal perturbations, with male placentas being more vulnera…”
ResultTung, P. W., Burt, A., Karagas, M. R., Jackson, B. P., Punshon, T., Lester, B. M., & Marsit, C. J. (2021) · Environmental Research · doi:10.1016/j.envres.2021.111939 · Cited by 26
Firestein, M. R., Romeo, R. D., Winstead, H., Goldman, D. A., Grobman, W. A., Haas, D., Mercer, B., Parker, C., Parry, S., Reddy, U., et al. (2022) · Hormones and Behavior · doi:10.1016/j.yhbeh.2022.105125 · Cited by 22
“…Robinson et al., 1977; Rodeck et al., 1985), and the observed sex bias in the prevalence of neurodevelopmental disorders (Al-Zaid, 2017; Constantino and Charman, 2012; Werling and Geschwind, 2013), we hypothesized that male vulnerability (Bale, 2016) would be reflected in sex-specific associations.”
BackgroundMiller, C. N., Dye, J. A., Henriquez, A. R., Stewart, E. J., Lavrich, K. S., Carswell, G. K., Ren, H., Freeborn, D. L., Snow, S. J., Schladweiler, M. C. J., et al. (2020) · Molecular Metabolism · doi:10.1016/j.molmet.2020.101094 · Cited by 24
Kowash, H. M., Potter, H. G., Woods, R. M., Ashton, N., Hager, R., Neill, J. C., & Glazier, J. D. (2022) · Clinical Science · doi:10.1042/cs20220245 · Cited by 23
Profiling placental DNA methylation associated with maternal SSRI treatment during pregnancy
Inkster, A. M., Konwar, C., Peñaherrera, M. S., Brain, U. M., Khan, A., Price, E. M., Schuetz, J. M., Portales-Casamar, É., Burt, A., Marsit, C. J., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-26071-8 · Cited by 24
Hsu, C., Lee, S.-Y., & Wang, L. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1242-9 · Cited by 23
Hendrix, C. L., Srinivasan, H., Feliciano, I., Carré, J. M., & Thomason, M. E. (2022) · Life · doi:10.3390/life12070943 · Cited by 21
“Well-replicated preclinical studies in mouse models have isolated sexual dimorphisms in the placenta that lead to this strengthened effect on male neurodevelopment [16,16].”
BackgroundGonzález, A., & Valencia, M. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25073632 · Cited by 22
“Moreover, their findings identified the brain as being structurally sexually dimorphic and vascularly dimorphic, as other authors have described [91,189,190].”
ResultBoots, A., Wiegersma, A. M., Vali, Y., den Hof, M. V., Langendam, M. W., Limpens, J., Backhouse, E. V., Shenkin, S. D., Wardlaw, J. M., Roseboom, T. J., et al. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.105019 · Cited by 22
“For instance, prenatal exposure to alcohol or tobacco restricts fetal brain growth, mostly observed as reduced whole brain and regional brain volumes (e.g. Banderali et al., 2015; Caputo et al., 2016; Ekblad et al., 2015; Popova et al., 2021).”
BackgroundShort, A. K., Weber, R., Kamei, N., Thai, C. W., Arora, H., Mortazavi, A., Stern, H. S., Glynn, L. M., & Baram, T. Z. (2024) · Neurobiology of Stress · doi:10.1016/j.ynstr.2024.100652 · Cited by 21
“Initially detected in experimental animal models of early-life adversity (Molet et al., 2014, 2016; Rice et al., 2008), unpredictable sequences of parental care behaviors have emerged as an important potential predictor of susceptibility to later cognitive and emotional deficits (Groh et al., 2012).”
BackgroundUtility of DNA methylation to assess placental health
Wilson, S. L., & Robinson, W. P. (2017) · Placenta · doi:10.1016/j.placenta.2017.12.013 · Cited by 24
The genetics of autism and steroid-related traits in prenatal and postnatal life
Tsompanidis, A., Warrier, V., & Baron‐Cohen, S. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1126036 · Cited by 21
Preeclampsia promotes autism in offspring via maternal inflammation and fetal NFκB signaling
Liu, X., Liu, H., Gu, N.-H., Pei, J., Lin, X.-H., & Zhao, W. (2023) · Life Science Alliance · doi:10.26508/lsa.202301957 · Cited by 19
“Prior works have suggested that female hormones or placental sex differences might in fl uence the development and (68).”
BackgroundFowler, S. P., Gimeno, D., Swartz, M. D., Granados, P. S., Heilbrun, L. P., & Palmer, R. F. (2023) · Nutrients · doi:10.3390/nu15173772 · Cited by 19
Cissé, Y. M., Montgomery, K. R., Zierden, H. C., Hill, E. M., Kane, P. J., Huang, W., Kane, M. A., & Bale, T. L. (2023) · Biology of Reproduction · doi:10.1093/biolre/ioad156 · Cited by 19
“Consistent with other models examining effects of prenatal insults, preconception stress was associated with sex-specific effects on gene expression in the placenta [26, 56–58].”
Self-citationExploring sex differences in fetal programming for childhood emotional disorders
Galbally, M., Watson, S., Lappas, M., de Kloet, E. R., Wyrwoll, C. S., Mark, P. J., & Lewis, A. J. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105764 · Cited by 19
“Prenatal stress may produce sex-dependent signals via the placenta to the developing brain, underpinning sex differences in child mental health outcomes (Bale, 2016; Clifton, 2010; Mueller and Bale, 2007, 2008).”
BackgroundHoluka, C., Grova, N., Charalambous, E. G., Cléac`H, J. L., Turner, J. D., & Mposhi, A. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105785 · Cited by 18
“Subsequent reprogramming events then establish new methylation marks that direct the cells to follow specific developmental pathways. influence foetal development through placenta (Bale, 2016).”
Human Umbilical Cord: Information Mine in Sex-Specific Medicine
Campesi, I., Franconi, F., Montella, A., Dessole, S., & Capobianco, G. (2021) · Life · doi:10.3390/life11010052 · Cited by 18
Metadata
- Authors
- Bale, T. L.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Bale, Tracy L.
- ORCID
- Bale, Tracy L.
- Venue
- Dialogues in Clinical Neuroscience
- Publisher
- Informa UK Limited
- Published
- 2016-12-31
- Volume
- 18
- Issue
- 4
- Pages
- 459-464
- ISSN
- 1294-8322 (ISSN-L)
- 1958-5969
- PMC
- PMC5286731
- OpenAlex
- W2988356887
- Cited by
- 236
- References
- 86
- Citations by year
- 2026: 23 · 2025: 29 · 2024: 23 · 2023: 35 · 2022: 30 · 2021: 32 · 2020: 20 · 2019: 17 · 2018: 20 · 2017: 7
- FWCI
- 11.85
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Dialogues in Clinical Neuroscience (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh091258-05)
- National Institute of Mental Health (P50MH099910, R37MH108286, R33MH104184, R01 MH-091258, R01MH087597)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- placenta, sex differences, brain development, prenatal stress, maternal stress, neurodevelopmental disorders, autism spectrum disorder, attention deficit hyperactivity disorder, X-linked genes, O-GlcNAc transferase, sex bias
- MeSH terms
- Animals, Female, Humans, Male, Placenta, Pregnancy, Prenatal Exposure Delayed Effects, Sex Characteristics, Stress, Physiological, Stress, Psychological, Neurodevelopmental Disorders
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