烟台市30年巨大胎儿发生率及其相关因素的变化

Study on the trend of changes in fetal macrosomia in Yantai during the past 30 years

目的 探讨巨大胎儿发生率的变化趋势以及发生的相关因素。方法 以 1970年 1月至 1999年 12月分娩的 84 883例新生儿为研究对象 ,分别统计巨大胎儿 (体重≥ 4 0 0 0g)的发生率、平均出生体重、特大胎儿 (体重≥ 4 5 0 0g)所占比例 ,孕龄分布、剖宫产及阴道手术助产率、发生巨大胎儿的相关因素。结果 1970年至 1979年、1980年至 1989年及 1990年至 1999年 3个阶段的巨大胎儿发生率分别为 2 6 %、6 9%和 13 2 % (P <0 0 1) ;剖宫产率分别为 2 3%、2 8 9%和 4 5 3% (P <0 0 1) ;阴道手术助产率分别为 14 7%、35 6 %、4 8% ,经阴道分娩肩难产发生率为 4 3%、5 0 %、1 7% ,而剖宫产孕妇无此并发症发生。特大胎儿所占比例分别为 9 4 %、11 2 %、16 2 % (P <0 0 1)。 3个阶段巨大胎儿平均出生体重分别为 (42 2 0± 2 5 0 )g、(42 2 3± 14 6 )g和 (42 5 3± 2 5 0 )g。孕妇的身高、体重、腹围、糖尿病性巨大胎儿的变化均有统计学意义。结论 30年来 ,烟台市区的巨大胎儿发生率、平均出生体重、特大胎儿所占比例及剖宫产率呈增加趋势。巨大胎儿的发生与孕妇的身高、营养状况、体重、妊娠期糖尿病、孕周等因素有关。

Objective To investigate the changing trend of incidence and the relevant factors in fetal macrosomia. Methods 84 883 newborns during Jan. 1,1970 to Dec. 31,1999 were used to analyze the incidence of fetal macrosomia,the average birth weight,the percentage of superior fetal macrosomia, the distribution of gestational age, the rate of cesarean section and the vaginal delivery, the relevant factors of fetal macrosomia. Results All the cases were divided into 3 groups, one group from 1970 to 1979, the second one from 1980 to 1989, the third one from 1990 to 1999. The incidence of fetal macrosomia for three groups were 2. 6%, 6. 9% and 13 2% ( P <0 01). The rate of cesarean section were 2 3%, 28 9%, 45 3% ( P <0 01). The percentage of superior fecal macrosomia were 9 4%, 11 2%, 16 2% ( P <0 01). The incidence of complications of vaginal delivery such as should dystocia, were 4 3%?5 0%?1 7%, respectively, wheres these complications were not found in cesarean section. The average birth weight of fetal macrosomia were (4 220± 250) g, (4 223± 146) g, (4 253± 250) g in 3 groups. There were signifigant differences maternal height?weight, abdominal perimeter and GDM mac. Conclusions The incidence of fetal macrosomia, the average birth weight, the percentage of superior fetal macrosomia and the rate of cesarean section gradually rose in Yantai in the past 30 years. The occurrence of fetal macrosomia may associate with many factors of pregant women, such as weight, nutrition, diabetes, gestational age and fetal sex. Cesarean section is a relatively safer choice for macrosomia delivery.