巨大儿发生危险因素的病例对照研究及预测模型

Case-control study on the risk factors for the occurrence of the macrosomia and the prediction model of macrosomia

目的探讨影响巨大儿的危险因素,建立巨大儿发生的预测模型,为预防巨大儿的干预措施提供参考依据。方法选择2017年10月-2018年10月于广西壮族自治区妇幼保健院住院分娩巨大儿的产妇262例为病例组,同期分娩正常体质量儿的产妇293例为对照组,分析两组产妇年龄、孕前体质指数(BMI)、孕期总增重以及是否患妊娠期糖尿病等差异,找出巨大儿的危险因素并建立巨大儿发生的预测模型。结果根据多因素Logistic回归分析,身高≥160cm,孕早期BMI≥24 kg/m^2、产次≥2次,孕期体质量增长≥16kg,患妊娠期糖尿病,男性胎儿,分娩孕周M39周均为巨大儿发生的危险因素。筛选身高、孕早期BMI、产次、孕期总增重、患妊娠期糖尿病5个因素建立巨大儿发生的预测模型,差异有统计学意义(P<0.05),且准确度为73.2%。结论根据巨大儿的危险因素和建立的预测模型,采取有针对性的预防措施,关注孕前超重或肥胖及高龄孕妇,监测并管理孕期体质量增长,防治妊娠期糖尿病,以降低巨大儿发生率。

Objective To explore the risk factors of macrosomia and establish a prediction model for macrosomia. Methods From October 2017 to October 2018,262 cases of pregnant women who delivered macrosomia in our hospital were selected as case group and 293 cases of maternal with normal bodyweight infants in the same period as the control group. The differences of age,body mass index( BMI) of first-trimester,weight gain during the whole pregnancy and gestational diabetes mellitus between the two groups were analyzed. To find the risk factors and establish a prediction model for macrosomia. Results According to multivariate Logistic regression analysis,height over160 cm,the first-trimester BMI over 24 kg/m2,multigravida,weight gain over 16 kg during pregnancy,gestational diabetes mellitus,male fetus and gestational weeks over 39 weeks were the risk factors of macrosomia. Five factors including height,the first-trimester BMI,parity,weight gain during pregnancy and gestational diabetes mellitus were screened to establish a predictive model for macrosomia. The model had statistical significance( P<0. 05),and the accuracy rate was 73. 2%. Conclusion Based on the established prediction model of macrosomia,we should focus on the pre-pregnancy overweightor obesewomen and the pregnantwomen who with advanced maternal age,monitor and manage the weight gain during pregnancy,prevent gestational diabetes mellitus and take targeted preventive measures to reduce the incidence of macrosomia.