队列研究巨大儿发生的危险因素及预测

Risk factors of macrosomia in a cohort study and prediction

目的:探讨巨大儿发生的危险因素,预测发生巨大儿的风险,以降低巨大儿的发生。方法:选取在上海市嘉定区妇幼保健院与浦东新区妇幼保健院建卡且符合纳入标准的孕妇2 063例作为研究对象,根据新生儿的出生体重将其分为巨大儿组(新生儿体重≥4 000 g,n=125)与正常婴儿组(2 500 g≤新生儿体重<4 000 g,n=1 938)。比较两组年龄、孕次、孕前BMI、妊娠期糖尿病、糖耐量、孕期增重、分娩体重、分娩孕周等一般资料。采用多因素Logistic回归分析巨大儿发生的危险因素。结果:⑴两组孕妇孕前BMI、糖耐量空腹血糖、孕中期体重增长、孕晚期体重增长、分娩体重和分娩孕周等指标差异有统计学意义(P<0.05)。⑵单因素分析显示,孕前BMI、初诊孕周、糖耐量空腹血糖、孕中期增重、孕晚期增重、分娩孕周和分娩体重是孕妇妊娠可能是巨大儿发生的影响因素(P<0.05)。⑶多因素分析显示,分娩孕周、妊娠期糖尿病、糖耐量空腹血糖和孕中期体重增长是影响巨大儿产生的主要因素,其中妊娠期糖尿病是保护性因素,而分娩孕周、糖耐量空腹血糖和孕中期体重增长是危险因素。结论:巨大儿发生的高危因素为分娩孕周、糖耐量空腹血糖和孕中期体重增长;应加强定期产检、孕期保健、合理膳食及适量运动,并严格控制孕中期体重增长,同时也要及时监测血糖,从而降低巨大儿的发生率。

Objective:To explore the risk factors of macrosomia and predict the risk of macrosomia in order to reduce the incidence of macrosomia.Methods:Two hundred and sixty-three pregnant women who had established cards in Jiading District Maternal and Child Health Hospital and Pudong New District Maternal and Child Health Hospital from February 2016 to April 2017 were selected as the study subjects.According to the birth weight of newborns,they were divided into two groups:the macrosomia group(newborn weight>4 000 g,n=125)and normal infant group(2 500 g<newborn body).Weight<4 000 g,n=1 938.The general data of age,gestational times,BMI before pregnancy,gestational diabetes mellitus,glucose tolerance,weight gain during pregnancy,birth weight and gestational weeks were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors of macrosomia.Results:(1)There were significant differences in BMI,glucose tolerance(fasting blood sugar),weight gain in the second trimester,weight gain in the third trimester,birth weight and gestational weeks between the two groups(P<0.05).(2)Univariate analysis showed that BMI before pregnancy,gestational weeks at first diagnosis,fasting glucose tolerance,mid-pregnancy weight gain,late pregnancy weight gain,gestational weeks and birth weight were the influencing factors of macrosomia(P<0.05).(3)Multivariate analysis showed that gestational weeks,gestational diabetes mellitus,fasting glucose tolerance and mid-pregnancy weight gain were the main factors affecting macrosomia,of which gestational diabetes mellitus was the protective factor,while gestational weeks,glucose tolerance(fasting blood sugar)and mid-pregnancy weight gain were the risk factors.Conclusion:The high risk factors for macrosomia are gestational weeks,fasting glucose tolerance and mid-pregnancy weight gain.Regular obstetric examination,pregnant health care,reasonable diet and proper exercise should be strengthened,and the mid-pregnancy weight gain should be strictly controlled.At the same time,blood sugar should be monitored in time to reduce the incidence of macrosomia.