分娩前后巨大儿对母婴的影响研究

Study on the impact of macrosomia on their mothers and themselves around childbirth

目的探讨分娩前后巨大儿对母婴结局的影响。方法利用北京市通州区妇幼保健院2013年1月至2017年12月期间分娩的医院电子信息系统,构建回顾性队列,共收集76 045例孕妇的分娩情况,其中活产75 894个,死胎死产151个。排除出生体重低于1 000克或高于6 000克的异常数据,最终纳入分析75 874例活产。采用分层分析和卡方检验比较不同出生体重与母婴结局的关系,并采用Logistic回归定量分析巨大儿对母婴结局的影响。结果 2013年到2017年期间北京市通州区妇幼保健院巨大儿发生过期产的风险比正常出生体重儿高80%,其剖宫产风险比正常出生体重儿高135%。与正常出生体重儿相比,扣除分娩方式的影响,巨大儿母亲会阴侧切风险增加了近20%(OR=1.20,95%CI:1.09～1.32)。与正常出生体重儿相比,巨大儿母亲产后2 h出血风险增加超过80%(OR=1.87,95%CI:1.67～2.09),扣除分娩方式的影响后仍增加25%多(OR=1.26,95%CI:1.45～1.52)。但不同分娩方式,巨大儿产后窒息比例与正常出生体重儿比较,差异无统计学意义。结论巨大儿会产生较多的不良母婴结局,因此需要研究巨大儿的产前预测方法,正确处理产程问题,从而改善母婴结局。

Objective The aim is to explore the impact of macrosomia on their mothers and themselves around childbirth. Methods Data on childbirth information during January 2013 to December 2017 from electronic information system in maternal and child care service center, Tongzhou district, Beijing are used in this study to construct a retrospective cohort. A total of 76,045 pregnant women were collected, including 75,894 live births and 151 stillbirths. Excluding fetuses with birth weights below 1 000 g or above 6 000 g, 75 874 live births were eventually included. Stratification analyses and Chi-square test were used to compare the differences among different birth weight groups, and logistic regression analyses was used to assess the impact of macrosomia on maternal and fetal outcomes. Results From 2013 to 2017, the risk to be post-term infant of macrosomia was 80% higher than that of normal birth weight in Tongzhou district maternal and child health hospital of Beijing, and the risk of cesarean section was 135% higher than that of normal birth weight. Compared with the mothers of the infants with normal birth weight, the risk of lateral episiotomy increased by nearly 20 percent for the mothers of the macrosomia, excluding the effects of delivery modes. However, there was no statistically significant differences on the rate of postpartum asphyxiation between macrosomia and the infants with normal birth weight ( P >0.05) by different delivery modes. Conclusion There are more adverse maternal and infant outcomes in macrosomia. It is necessary to study and improve the methods of prenatal prediction for macrosomia, and correctly handle the delivery process so as to improve maternal and infant outcomes.