糖代谢正常孕妇分娩巨大儿的相关因素分析

Related factors of delivery macrosomia in pregnant women with normal glycometabolism

目的 探讨糖代谢正常孕妇孕期体重增长速度及相关因素与分娩巨大儿的关系,以期早期警戒巨大儿的发生,减少巨大儿的出现,改善围产结局。方法 回顾分析2014年11月1日至2015年12月1日于我院住院分娩的糖代谢正常且分娩新生儿体重≥4 000g的孕妇94例作为研究组,同期住院分娩新生儿体重〈4 000g孕妇90例作为对照组,比较两组孕妇年龄、孕产次、孕前体重指数、孕期体重增长速度、孕期体重增长总量及分娩孕周对妊娠结局的影响。结果 研究组与对照组比较,平均年龄、身高、孕产次及妊娠并发症均无统计学差异（P〉0.05）;研究组孕前体重指数显著高于对照组[（22.89±3.27）vs.（21.53±3.81）kg/m2],且研究组超重者比例（23.40%）显著高于对照组（6.67%）（P〈0.05）;研究组孕期体重增加显著高于对照组[（17.49±5.13）vs.（15.30±4.58）kg]（P〈0.05）,尤其在孕第12~20周以及36周至分娩期两个时段,两组体重增加的差异尤为显著[分别为（4.93±2.21）vs.（3.73±1.66）kg、（2.18±1.56）vs.（1.65±1.29）kg]（P〈0.05）;研究组剖宫产率（56.38%）、产后出血率（20.21%）、胎儿窘迫发生率（14.89%）均显著高于对照组（分别为40.00%、6.67%、6.67%）（P〈0.05）。结论 孕前体重超重及孕期增重过多是分娩巨大儿的高危因素,注意控制妊娠12~20周及36周至分娩前两个时段的体重增长,可以减少巨大儿的发生,改善母胎结局。

Objective： To explore the relationship between the weight gain and related factors of pregnant women with normal glycometabolism and delivery macrosomia, in order to early alert the occurrence of macrosomia and improve perinatal outcome. Methods： Ninety four pregnancy women with normal glycometabolism,who gave birth in our hospital and whose newborn＇ weight was≥4 000 g,from November 1,2014 to December 1,2015,were included in the study group. Meanwhile,90 normal pregnancy women whose newborn＇ weight was less than 4 000 g were as the control group. The age, gravidity and parity, body weight index （BMI） before pregnancy, weight gain during pregnancy,total weight gain during pregnancy,and the gestational age at delivery were compared between the two groups. Results： The average age, height, gravidity and parity, pregnancy complications had no significant differences between the two groups （P〉0.05）. Pre-pregnancy BMI [（22.89±3.27） vs. （21. 53± 3. 81） kg/m2]and the proportion of overweight pregnancy women （23. 40% vs. 6. 67%） in the study group was significantly higher than those in the control group （P〈0. 05）. The weight gain during pregnancy [ （17. 49 ±5.13） vs. （15.30±4.58） kg]in the study group was significantly more than that in the control 0.05）,especially 12 to 20 gestational weeks [（4. 93±2. 21） vs. （3. 73±1. 66） kg]or 36 weeks todelivery [（2. 18± 1.56） vs. （1.65 ± 1.29） kg] （P〈0.05）. The cesarean delivery rate （56. 38% vs. 40.00%）, postpartum hemorrhage rate （20.21% vs. 6.67%）,the incidence of fetal distress （14. 89% vs. 6.67%） in the study group were significantly higher than those in the control group （all P〈0.05）. Conclusions： The overweight before pregnancy and weight gain during pregnancy are the high risk factors of delivery of macrosomia. The best way is to control the weight gain during pregnancy,especially 12 to 20 gestational weeks or 36 weeks to delivery, which can reduce the occurrence macrosomia and improve the outcome of pregnancy.