巨大儿的相关危险因素及其对妊娠结局的影响

Related risk factors of macrosomia and its influence on pregnancy outcome

目的探讨巨大儿的相关危险因素及其对妊娠结局的影响。方法选择2013年1月~2014年12月于北京市第六医院（以下简称＂我院＂）妇产科分娩巨大儿（胎儿出生体重≥4000 g）的产妇100例为研究对象,设为巨大儿组;随机选择同期分娩正常足月儿（2500 g≤出生体重〈4000 g）的产妇100例为对照,设为非巨大儿组。回顾性分析两组年龄、文化程度、孕龄、孕次、孕前体重指数（BMI）、产前BMI、妊娠期糖尿病（GDM）等一般资料及妊娠结局,采用非条件多因素Logistic回归分析巨大儿的高危因素。结果两组年龄、产次、孕前BMI比较差异无统计学意义（P〉0.05）;两组孕龄、产前BMI、GDM、羊水过多、巨大儿分娩遗传史、文化程度、定期产检、胎儿性别比较,差异均有统计学意义（P〈0.05或P〈0.01）。非条件多因素Logistic回归分析结果显示,孕龄〉40周（OR=1.543,95%CI：1.132~1.993,P〈0.05）、产前超重（OR=1.321,95%CI：1.352~1.546,P〈0.05）、GDM（OR=1.532,95%CI：1.496~1.834,P〈0.01）、文化程度高中以下（OR=1.499,95%CI：1.401~1.635,P〈0.01）、羊水过多（OR=1.135,95%CI：1.424~1.752,P〈0.05）是巨大儿的危险因素。巨大儿组胎膜早破、剖宫产、肩难产、新生儿窒息、会阴裂伤、产后出血的发生率均明显高于非巨大儿组,差异有统计学意义（P〈0.05或P〈0.01）。结论巨大儿的发生与多种因素有关,应加强产前检查、孕期教育、孕期血糖检测,并准确评估胎儿体重,选择合理分娩方式,从而降低巨大儿发生率,并改善妊娠结局。

Objective To explore the related risk factors of macrosomia and its influence on pregnancy outcome.Methods 100 cases of maternal with macrosomia delivery（fetal birth weight≥4000 g） from January 2013 to December2014 in Department of Obstetrics and Gynecology in Beijing NO.6 Hospital（＂our hospital＂ for short） were selected as the macrosomia group, and 100 cases of normal term infant（fetal birth weight between 2500 g and 3999 g） in our hospital at the same period were randomly selected as the non-macrosomia group. The general information such as age,degree of education, gestational age, pregnant times, pre-pregnancy weight, prenatal weight and pregnancy outcomes of two groups were retrospectively analyzed. High risk factors of macrosomia were analyzed by unconditioned multiariable Logistic regression analysis. Results Age, production time and pre-pregnancy BMI of two groups had no statistically significant differences（P〉0.05）; gestational age, prenatal BMI, GDM, hereditary history of macrosomia, degree of education, hydramnios, regular prenatal of two groups had statistically significant differences（P〈0.05 or P〈0.01）. Unconditioned multiariable Logistic regression analysis showed that, gestational age〉 40 weeks（OR =1.543, 95% CI：1.132-1.993, P 1.132）, prenatal overweight（OR=1.321, 95%CI： 1.352-1.546, P〈0.05）, gestational diabetes mellitus（GDM）（OR=1.532, 95%CI： 1.496-1.834, P〈0.01）, degree of education lower than senior school（OR=1.499, 95%CI：1.401-1.635, P〈0.01）, hydramnios（OR=1.135, 95%CI： 1.424-1.752, P〈0.05） were the dangerous factors of macrosomia. The incidences of premature rupture of menmbrane,cesarean delivery, shoulder dystocia, neonatal asphyxia, perineal laceration, postpartum hemorrhage of macrosomia group were significantly higher than those of non-macrosomia group, the difference were statistically significant（P〈0.05 or P〈0.01）. Conclusion The occurrence of macrosomia is associated with a variety of factors, and should strengthen antenatal examination, prenatal education, detection of blood glucose and accurately evaluate fetal weight, choose reasonable way of delivery, so as to reduce the incidence of macrosomia and improve pregnancy outcome.