江阴城区巨大儿发生情况及其影响因素分析

Analysis of the occurrence of fetal macrosomia and its influencing factors in Jiangyin urban area

目的通过对单胎足月孕产妇包括早孕期体脂测定和腰围等多项临床资料的分析,探讨江阴城区巨大儿发生情况及其相关影响因素。方法选取2018年4月至2019年4月在江阴市妇幼保健院常规产检及分娩的1255名孕产妇为研究对象,分析孕产妇及新生儿的一般资料,并以Logistic回归分析影响巨大儿发生的因素。结果2018—2019年,1255名孕产妇分娩巨大儿共100例,占比7.97%。以体质量指数(BMI)为依据,产妇孕前营养不良者占比为14.7%(184/1255)、营养正常者占比为66.6%(836/1255)、超重和肥胖者占比18.7%(235/1255)。以体脂为依据,早孕期体脂率≥30%占比60.0%(753/1255),早孕期腰围≥85 cm占比25.4%(319/1255),平均孕期增重(13.8±4.7)kg。巨大儿组和非巨大儿组孕产妇的孕次、产次、GDM及分娩方式占比比较,差异无统计学意义(P>0.05);巨大儿组和非巨大儿组孕产妇的年龄、身高、孕前BMI、高大高体脂、高大高BMI、早孕期腰围、分娩孕周、孕期增重、新生儿性别比较,差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄≥35岁、孕前BMI≥26 kg/m2、高大高体脂、早孕期腰围≥85 cm、分娩孕周≥40周、孕期增重≥14.5 kg均为巨大儿发生的独立危险因素(P<0.05)。结论孕妇年龄、孕前BMI、高大高体脂、早孕期腰围、分娩孕周、孕期增重均为巨大儿发生的影响因素,基层医疗保健机构应对此引起充分重视,加强孕前及孕期全程管理,关注体重增长及体脂分布,以降低本地区巨大儿发生率。

Objective To investigate the occurrence of fetal macrosomia and its related influencing factors in Jiangyin urban area by analyzing the clinical data of singleton and full term pregnant women including body fat measurement and waist circumference in the first trimester.Methods From April 2018 to April 2019,1255 pregnant women who underwent routine obstetric examination and delivery in Jiangyin Maternal and Child Health Care Hospital were selected as the research objects.The general data of pregnant women and newborns were analyzed,and the Logistic regression analysis was used to analyze the factors affecting the occurrence of fetal macrosomia.Results From 2018 to 2019,1255 pregnant women delivered 100 cases of fetal macrosomia,accounting for 7.97%.According to body mass index(BMI),the proportion of malnutrition of pregnant women before pregnancy was 14.7%(184/1255),the proportion of normal nutrition was 66.6%(836/1255),and the proportion of overweight and obesity was 18.7%(235/1255).According to body fat,the proportion of body fat≥30%in the first trimester was 60.0%(753/1255),the proportion of waist circumference≥85 cm in the first trimester was 25.4%(319/1255),and the average weight gain during pregnancy was(13.8±4.7)kg.There were no significant differences between fetal macrosomia group and non-fetal macrosomia group in the proportions of times of pregnancy,the number of previous births,gestational diabetes mellitus(GDM)and delivery mode(P>0.05);there were statistically significant differences in the age,height,pre-pregnancy BMI,tall and high body fat,tall and high BMI,waist circumference in early pregnancy,gestational weeks of delivery,gestational weight gain and newborn gender between the fetal macrosomia group and the non-fetal macrosomia group(P<0.05).Logistic regression analysis results showed that age≥35 years,pre-pregnancy BMI≥26 kg/m2,tall and high body fat,waist circumference in early pregnancy≥85 cm,gestational weeks of delivery≥40 weeks and gestational weight gain≥14.5 kg were independent risk factors for fetal macrosomia(P<0.05).Conclusion The age of pregnant women,pre-pregnancy BMI,tall and high body fat,waist circumference in early pregnancy,gestational weeks of delivery and gestational weight gain are all factors affecting the occurrence of fetal macrosomia.Primary health care institutions should pay full attention to this issue,strengthen the whole process management before pregnancy and during pregnancy,and pay attention to weight gain and body fat distribution,so as to reduce the incidence of fetal macrosomia in this area.