孕妇体重预测巨大儿发生的临床价值

Clinical value of maternal weight in predicting macrosomia

目的：分析孕妇体重预测巨大儿发生的临床价值。方法：选取2008年1-10月在常州市妇幼保健院进行产前检查并分娩巨大儿的260例孕妇和分娩正常体重儿的270例孕妇分别为研究组和对照组,对比并分析两组孕妇不同妊娠时期体重,建立预测巨大儿的ROC曲线,根据ROC曲线下面积比较孕妇不同妊娠时期体重预测巨大儿的能力。结果：不同妊娠时期孕妇体重的ROC曲线下面积及截断值分别为：孕前体重0.679,截断值55.0 kg;孕27周末体重0.720,截断值65.5 kg;分娩前体重0.730,截断值72.0 kg;孕中期增重0.611,截断值10.5 kg;孕晚期增重0.567,截断值6.5 kg;孕期总增重0.639,截断值17.5 kg。以孕27周末体重作为预测指标,当截断值取≥65.5 kg时,敏感度和特异度分别为66.15%和67.04%;以孕前体重作为预测指标,当取截断值为55.0 kg时,灵敏度和特异度分别为65.77%和65.56%。经多因素Logistic回归分析,控制混杂因素后,孕前体重≥55.0 kg的孕妇发生巨大儿的风险是孕前体重〈55.0 kg孕妇的3.306倍（OR=3.306,95%CI：2.207-4.952）;孕27周末体重≥65.5 kg的孕妇发生巨大儿的风险是孕27周末体重〈65.5 kg孕妇的2.818倍（OR=2.818,95%CI：1.834-4.329）。结论：孕27周末体重可能是一个临床价值较好的预测指标,孕前体重也有一定的预测价值。为提高预测价值,可以结合孕前体重和孕27周末体重两个指标分两个阶段进行巨大儿预测。

Objective： To analyze the clinical value of maternal weight in predicting macrosomia. Methods： A total of 260 women giving birth to macrosomia and 270 women giving birth to normal birth weight infants were selected from this hospital from January to October in 2008 as study group and control group,respectively,all the women received prenatal examination in this hospital. Body weight of the women in the two groups in different gestational periods were compared and analyzed,ROC was established for predicting macrosomia,the abilities of predicting macrosomia by body weight in different gestational periods were compared according to the area under ROC curve. Results： The areas under ROC curve and cut- off values of body weight in different gestational periods were listed as follows： progestational weight（ 0. 679,55. 0 kg）,body weight at the end of the 27 th gestational week（ 0. 720,65. 5 kg）,body weight before delivery（ 0. 730,72. 0 kg）,body weight gain during the second trimester of pregnancy（ 0. 611,10. 5 kg）,body weight gain during the third trimester of pregnancy（ 0. 567,6. 5 kg）,the total body weight gain during pregnancy（ 0. 639,17. 5 kg）. Taking body weight at the end of the 27 th gestational week as predictive index,when the cut- off value was 65. 5 kg or more than 65. 5 kg,the sensitivity and specificity were 66. 15% and67. 04%,respectively; when the cut- off value was 55. 0 kg,the sensitivity and specificity were 65. 77% and 65. 56%,respectively. Multivariate Logistic regression analysis showed that after controlling confounding factors,the risk of macrosomia among the women with progestational weight≥55. 0 kg was 3. 306 times more than the women with progestational weight 〈55. 0 kg（ OR = 3. 306,95% CI： 2. 207-4. 952）; the risk of macrosomia among the women with body weight at the end of the 27 th gestational week≥65. 5 kg was 2. 818 times more than the women with body weight at the end of the 27 th gestational week 〈65. 5 kg（ OR = 2. 818,95% CI： 1. 834- 4. 329）. Conclusion：Body weight at the end of the 27 th gestational week may be a predictive index for macrosomia with high clinical value,progestational weight also has a certain predictive value. In order to improve the predictive value,progestational weight and body weight at the end of the 27 th gestational week can be used in two phases.