{"doi":"10.1111/jmwh.13663","title":"Gender and Sex Inclusive Approaches for Discussing Predicted Fetal Sex: A Call for Reflection and Research","abstract":"Technology has rapidly transformed the centuries-old practice of fetal sex prediction, and significant social and medical progress is changing the way prenatal health care providers (HCPs) address the often-asked question, “Am I having a boy or a girl?” Access to prenatal cell-free fetal DNA (cfDNA) screening is expanding broadly, and medical societies recommend cfDNA screening for all pregnancies.1, 2 Prenatal cfDNA screening offers sex chromosome assessment for sex chromosome aneuploidy (sex chromosome complements other than XX or XY), along with other aneuploidy screening (for trisomies 13, 18, and 21), as early as 10 weeks’ gestation. Patients may have a limited understanding of the prevalence of aneuploidy in the general population, the implications of these differences, and the purpose of screening for them. This gap in understanding could lead patients to believe the test is solely about gender determination. There is increased awareness that gender and sex diversity are essential components of health, health care, and social reality.3 In this commentary, we posit that many prenatal HCPs are currently underprepared to talk to parents about fetal sex prediction and sex chromosome variation during the course of prenatal care in a manner that is accurate and inclusive of gender and sex diversity, which would promote family function and individual well-being for gender- and sex-diverse children and adults. This skill is relevant to midwives, nurses, genetic counselors, physicians, physician associates, radiologists, and radiology technicians. Of note, in this commentary, we have largely chosen to use the term parents to align with the focus on childhood gender socialization, presupposing a context of desired pregnancies leading to birth and parenting. Radiology and prenatal HCPs have examined the morphology of the fetal genitals by ultrasound and then predicted whether parents should expect a girl or a boy for the past 50 years. More recently, fetal diagnostic testing through amniocentesis or chorionic villus sampling enabled specialized HCPs, including perinatologists and genetic counselors, to report fetal sex chromosomes to parents before 20 weeks’ gestation. Currently, increasing access to clinical grade cfDNA screening in the first trimester means that the primary prenatal provider is often responsible for communicating results from sex chromosome screening to patients with limited knowledge or familiarity with sex chromosome variations. Prenatal HCPs are a trusted source of some of the earliest information parents receive. They interpret information obtained by advanced technologies that provide images of fetal genital morphology and detect fetal sex chromosomes. However, the practice of fetal sex prediction has the potential to erase gender and sex diversity if not handled with care. Continuing education (CE) is available for this article. To obtain CE online, please visit http://www.jmwhce.org. A CE form that includes the test questions is available in the print edition of this issue. When prenatal HCPs tell patients, “It's a girl!” or “It's a boy!” they reinforce an erroneous bioessentialist framework: people with XX chromosomes or an apparent vulva are assigned female and socialized as girls, and people with XY chromosomes or an apparent penis are assigned male and socialized as boys. (See Table 1 for relevant terms and definitions.) However, a person's own construct of gender identity is the result of interactions between biological and social factors and relies on cognitive development across the life span. Misconceptions about both sex and gender that are often enacted during the prenatal period among HCPs and pregnant people include: (1) sex and gender are determined by sex chromosomes alone, (2) a person's sex chromosomes can only be XX or XY, and that sex is strictly binary, and (3) there are only 2 gender categories: boy or girl.4, 5 These incorrect assumptions jeopardize the child's autonomy6 and contribut","journal":"Journal of Midwifery & Women s Health","year":2024,"id":458022,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9533,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1283947,"name":"Tiffany Lundeen","orcid":"0000-0002-7039-6253","position":1,"is_corresponding":false},{"id":961465,"name":"Elizabeth Collins","orcid":"0000-0002-2117-6967","position":2,"is_corresponding":false},{"id":727477,"name":"Claudia Geist","orcid":"0000-0003-1901-3429","position":3,"is_corresponding":false},{"id":727478,"name":"Kyl Myers","orcid":"0000-0002-5793-669X","position":4,"is_corresponding":false},{"id":1114622,"name":"Susanna R. Cohen","orcid":"0000-0002-9198-8610","position":5,"is_corresponding":false},{"id":1283948,"name":"Kimberly Zayhowski","orcid":"0000-0003-1712-6403","position":6,"is_corresponding":false},{"id":1283946,"name":"Hannah Llorin","orcid":"0000-0002-2599-6209","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-19T02:03:46.117860Z","pmid":"39023042","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}