妊娠期糖尿病患者分娩巨大儿的危险因素分析

Analysis of risk factors of macrosomia in gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)患者分娩巨大儿的危险因素,为预防巨大儿的发生提供科学依据。方法选取669例分娩的GDM患者,根据新生儿体重分为巨大儿组(100例)与非巨大儿组(569例)。回顾性分析患者的临床资料,采用多因素Logistic回归分析GDM患者分娩巨大儿发生的危险因素。结果两组患者的孕前体重、分娩孕周、胎儿体重、口服葡萄糖耐量试验(OGTT)、糖化血红蛋白(HbA1c)、分娩方式、孕前体质量指数(BMI)、孕期体重增长比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示孕前超重、肥胖、孕期增重过多、孕期HbA1c≥5.5%是分娩巨大儿的危险因素(P<0.05)。结论GDM患者孕前超重肥胖、孕期体重增长过多及HbA1c控制不理想均可增加分娩巨大儿的风险,临床中应采取针对性的预防措施以降低巨大儿发生率。

Objective To investigate the risk factors of macrosomia in gestational diabetes mellitus(GDM),and to provide a scientifi c basis for the prevention of macrosomia.Methods 669 patients with GDM during delivery were divided into macrosomia group(100 cases)and non-macrosomia group(569 cases)according to neonatal weight.The clinical data of the patients were analyzed retrospectively,and the risk factors of macrosomia in GDM patients were analyzed by multivariate Logistic regression.Results There were statistically signifi cant diff erences in pre-pregnancy weight,gestational week at delivery,fetal weight,oral glucose tolerance test(OGTT fasting blood glucose),glycated hemoglobin(HbA1c),delivery mode,pre-pregnancy body mass index(BMI)and pregnancy weight increase between 2 groups(P<0.05).Multivariate logistic regression analysis showed that pre-pregnancy overweight,obesity,excessive weight gain during pregnancy,pregnancy HbA1c≥5.5%were risk factors for macrosomia delivery(P<0.05).Conclusion Pre-pregnancy overweight and obesity,excessive weight gain during pregnancy and unsatisfactory control of HbA1c can increase the risk of macrosomia in patients with gestational diabetes mellitus.Targeted preventive measures should be taken in clinical work to reduce the incidence of macrosomia.