足月小于胎龄儿发生的相关因素分析

Analysis of related factors in occurrence of full-term small for gestational age infants

目的分析分娩足月单胎小于胎龄儿(SGA)孕妇的临床资料,探讨足月SGA发生的相关因素。方法选取2020年1—12月在首都医科大学附属北京妇产医院产检、单胎妊娠且分娩孕周在37~41周的孕妇10472例为研究对象,根据分娩的新生儿体重及孕周分布,将纳入对象分为SGA组(n=455)与非SGA组(n=10017)。回顾性分析两组孕妇的相关指标,包括一般情况[年龄、孕产次、孕前体质量指数(BMI)、孕期增重]、合并症/并发症及新生儿性别等。通过单因素分析和多因素Logistic回归分析,探讨足月SGA发生的相关因素。结果纳入研究的10472例孕妇中,分娩SGA共455例,SGA发生率为4.3%。SGA组中孕前体重偏低、孕期增重过少、首次分娩、新生儿女婴、脐带异常的比率显著高于非SGA组(P<0.001);合并糖尿病、IVF-ET助孕比率显著低于非SGA组(P<0.05);两组孕妇的年龄、合并高血压疾病和前置胎盘比率无显著性差异(P>0.05)。多因素Logistic回归分析结果显示孕前体重偏低(OR=2.029)、孕期增重过少(OR=1.645)、首次分娩(OR=1.653)、新生儿女婴(OR=2.075)、脐带异常(OR=1.674)是SGA发生的危险因素(P<0.001);而合并糖尿病和IVF-ET助孕者SGA发生率相对较低(OR<1,P<0.05)。结论孕前体重偏低、孕期增重过少、首次分娩、新生儿女婴及脐带异常是足月单胎SGA发生的危险因素;加强孕期监测和营养管理对减少足月SGA的发生非常重要。

Objective:To explore the related factors in occurrence of full-term small for gestational age infants(SGA) through analyzing the clinical data of the pregnant women delivered SGA.Methods:A total of 10 472 pregnant women with singleton gestation and delivery within 37-41 weeks of pregnancy in the Beijing Obstetrics and Gynecology Hospital from January to December in 2020 were included as the study subjects. They were divided into the SGA group(n=455) and non-SGA group(n=10 017) according to the birth weight of newborns and gestational age. The correlation factors with full-term SGA included the general status[age, gravidity & parity, pre-pregnancy body mass index(BMI),gestational weight gain],complications during pregnancy, and gender of the newborn etc. The related factors of full-term SGA were discussed by univariate analysis and multivariate logistic regression analysis.Results:Of the 10 472 pregnant women included in the study, 455 pregnant women delivered SGA,and the incidence of SGA was 4.3%. In SGA group, the rates of low weight before pregnancy, low weight gain during pregnancy, primipara, female neonatal and umbilical cord abnormalities were significantly higher than those in non-SGA group(P<0.001),and the rates of diabetes mellitus complication and assisted pregnancy of IVF-ET were significantly lower than that in non-SGA group(P<0.05). There were no significant differences in age, hypertension and placenta previa between the two groups(P>0.05). Logistic regression analysis showed that low pre-pregnancy BMI(OR=2.029),inadequate weight gain during pregnancy(OR=1.645),primipara(OR=1.653),female neonatal(OR=2.075),abnormal umbilical cord(OR=1.674) were the risk factors of SGA(P<0.001). However, the incidence of SGA was significantly lower in patients with diabetes mellitus and IVF-ET assisted pregnancy(OR<1,P<0.05).Conclusions:Low pre-pregnancy BMI,inadequate gestational weight gain, primipara, female neonatal and abnormal umbilical cord are the independent risk factors for full-term singleton SGA. Strengthening gestational monitoring and nutritional management is very important to reduce the incidence of full-term SGA.