巨大儿发生的相关危险因素及其对妊娠结局的影响

Risk factors associated with 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2016年1月至2017年1月在我院分娩巨大儿(胎儿出生体重≥4 000 g)的产妇170例为研究组,同期选择在我院分娩正常新生儿(2 500 g≤出生体重<4 000 g)的产妇170例作为对照组。对340例产妇的一般资料、疾病史、遗传史及母婴并发症等临床资料进行回顾性分析。结果单因素分析结果显示,两组年龄、营养状况、活动情况、文化程度、定期产检、产次、GDM、产前BMI、巨大儿分娩史、肥胖家族史及过期妊娠情况比较,差异具有统计学意义(P<0.05);两组的胎儿性别及孕产妇孕早期BMI比较,差异无统计学意义(P>0.05)。多因素非条件Logistic分析显示,年龄、营养状况、产次、产前BMI、巨大儿分娩史、肥胖家族史、GDM及过期妊娠是巨大儿发生的影响因素(P<0.05),而经常活动、文化程度高中及以上、定期产检是巨大儿发生的保护因素(P<0.05)。研究组剖宫产、产道裂伤、肩难产、新生儿窒息及产后出血发生率明显高于对照组(P<0.05)。结论巨大儿的发生与多种因素有关,应指导合理的孕期营养,适当运动,加强产前检查、孕期教育、孕期血糖监测,避免孕期体重增加过快,并准确评估胎儿体重,选择合适的分娩方式,以降低母婴并发症发生率。

Objective To explore the risk factors associated with macrosomia and its influence on pregnancy outcome.Methods From January 2016 to January 2017,170 cases of maternal with macrosomia delivery(fetal birth weight>4 000 g)in our hospital were selected as the study group,and 170 cases of maternal with normal term infant(fetal birth weight between 2 500 g and 3 999 g)at the same period were selected as the control group.The general data,disease history,genetic history and maternal and infant complications of 340 cases of parturient were analyzed retrospectively.Results The results of univariate analysis showed that there were significant differences between the two groups in age,nutritional status,activity,education level,regular birth check-up,delivery times,GDM,prenatal BMI,history of macrosomia delivery,family history of obesity and overdue pregnancy(P<0.05);but there were no significant differences in fetal sex and early pregnancy BMI between the two groups(P>0.05).Multivariate non conditional Logistic analysis showed that age,nutritional status,delivery times,prenatal BMI,history of macrosomia delivery,family history of obesity,GDM and overdue pregnancy were the influencing factors of macrosomia(P<0.05),while frequent activity,high school education and above regular birth examination were the protective factor of macrosomia(P<0.05).The rates of cesarean section,laceration of the birth canal,shoulder dystocia,neonatal asphyxia and postpartum hemorrhage in the study group were higher than those in the control group(P<0.05).Conclusion The occurence of macrosomia is associated with a variety of factors.We should guide reasonable nutrition during pregnancy,exercise properly,strengthen antenatal examination and education during pregnancy,monitor blood sugar during pregnancy,avoid excessive weight gain during pregnancy,evaluate fetal weight accurately,select appropriate delivery mode,so as to reduce the incidence of maternal and infant complications.