三省六县农村地区巨大儿影响因素研究

Risk factors of fetal macrosomia in rural China

目的探讨中国三省六县农村地区巨大儿发生率的影响因素。方法采用分层整群随机抽样相结合的方法 ,抽取三省六县25个医疗卫生机构2008年入院分娩的活产儿病案进行病历摘录。结果共摘录17805份合格病案,其中巨大儿1765例,巨大儿发生率为9.91%(95%CI:9.47～10.35)。单因素分析显示,新生儿性别、产妇分娩年龄、职业、孕次、产次、孕周、孕前体质指数(BMI)、孕期增重、首次产检孕周、产前检查次数可能是发生巨大儿的影响因素。非条件Lo-gistic回归分析显示,发生巨大儿的风险,男婴是女婴的1.81倍,过期产是非过期产的1.91倍,孕前超重和肥胖的妇女分别是正常者的1.98倍和3.20倍,孕期增重超过18kg的妇女是正常者的1.80倍,孕13～20周和孕20周以后才进行首次产前检查的妇女分别是孕早期开始产检的2.72倍和3.60倍。结论三省六县农村地区巨大儿发生率较高,新生儿性别、妇女分娩年龄、孕周、孕前BMI指数、孕期增重、首次产检孕周是巨大儿的影响因素。

Objective To identify risk factors of fetal macrosomia in 6 counties of 3 provinces in rural China.Methods Stratified random cluster sampling were used to investigate the medical records of all live births in 2008 in 25 research medical institutions.Results We collected 17 805 eligible data,1765 of them were fetal macrosomia.The fetal macrosomia incidence in rural China was 9.91%（95%CI：9.47-10.35）.Chisquare tests suggested the risk factors of macrosomia included：gender of infants,delivery age,occupation,parity,gestation week,pre-pregnancy body mass index（BMI）,weight gain in gestation period and prenatal care.Logistic regression analysis suggested the odds ratio（OR）of male infants was 1.81;1.91 for post term delivery;1.98 for pre-pregnancy overweight;3.20 for pre-pregnancy obesity;1.80 for weight gain over 18kg in gestation period;2.72 for first prenatal care during 13 to 20 weeks and 3.60 for first prenatal care after 20 weeks.Conclusions The macrosomia incidence in rural China has reached to a high level.The risk factors of macrosomia are gender of infants,delivery age,gestation week,pre-pregnancy body mass index（BMI）,weight gain in gestation period and gestational week of first prenatal care.