妊娠期合并/并发症与巨大儿相关性的倾向性评分配对研究

Matched study on propensity score of the correlation between pregnancy complications and macrosomia

目的分析孕妇早期体质指数(body mass index,BMI)及妊娠期合并/并发症与巨大儿发生的相关性,为巨大儿的早期预防提供依据。方法利用广东省中山市妇幼保健信息系统中所记录的孕妇孕产期保健管理档案数据进行研究,选取于2017年1月1日至2020年12月31日接受首次产检,并成功分娩的孕妇及其新生儿为研究对象,共计136019对足月单胎母子。将其中的4830例巨大儿及其母亲纳入巨大儿组,用孕妇和新生儿一般情况进行倾向性评分,1∶2配对出生体重正常儿(正常体重儿组),根据配对的两组数据分析孕妇孕早期BMI等级及孕期各种合并/并发症与巨大儿的相关性和发生风险。结果共有4828例巨大儿成功配对,即巨大儿组入选母子4828对,正常体重儿组入选母子9656对。多因素分析结果显示,孕妇孕早期超重(OR=1.68,95%CI:1.53~1.84)、肥胖(OR=2.99,95%CI:2.60~3.44)、妊娠期合并/并发糖尿病(OR=1.56,95%CI:1.33~1.82)、并发羊水过多(OR=1.87,95%CI:1.03~3.37)、孕期体重增加过多(OR=2.21,95%CI:1.99~2.46)均会增加巨大儿的发生风险。孕妇孕早期低体重(OR=0.44,95%CI:0.38~0.51)、妊娠期并发羊水过少(OR=0.21,95%CI:0.06~0.73)及妊娠期体重不足(OR=0.56,95%CI:0.49~0.63)与巨大儿呈负相关,未发现妊娠期其他合并/并发症与巨大儿相关。结论孕妇保持适宜的孕早期体重、孕期体重增长和正常的孕期血糖水平是预防巨大儿发生的关键措施。

Objective To analyze the correlation between early pregnant women’body mass index(BMI)and gestational complications with macrosomia,so as to provide evidence for early prevention of macrosomia.Methods Totally 136019 full-term singletons and their mothers who received first perinatal care from Jan 1st 2017 to Dec 31th 2020 were involved.The data were from Zhongshan Women and Children Hospital’s perinatal management information system.And 4830 cases of macrosomia and their mothers were recruited as macrosomia group,and propensity scores were given based on their general status.Control group(normal birth weight)was matched in a 1∶2 ratio.Early pregnant women’BMI and the correlation between gestational complications and macrosomia were analyzed.Results Finally 4828 cases of macrosomia were matched successfully,which meaned 4828 cases of macrosomia and their mothers were macrosomia group while 9656 cases of normal birth weight newborns and their mothers were normal birth weight group.The results of multivariate analysis showed that maternal early-pregnancy overweight(OR=1.68,95%CI:1.53−1.82),obesity(OR=2.99,95%CI:2.60−3.44),gestational diabetes mellitus(OR=1.56,95%CI:1.33−1.82),polyhydramnios(OR=1.87,95%CI:1.03−3.37),and excessive gestational weight gain(OR=2.21,95%CI:1.99−2.46)were risk factors of macrosomia.Maternal early-pregnancy underweight(OR=0.44,95%CI:0.38−0.51),oligohydramnios(OR=0.21,95%CI:0.06−0.73),and insufficient gestational weight gain(OR=0.56,95%CI:0.49−0.63)were negatively correlated with macrosomia.No other pregnancy complications were found to be associated with macrosomia.Conclusion Maintaining proper bodyweight in early pregnancy,appropriate gestational weight gain,and normal blood glucose level during pregnancy are key measures to prevent the occurrence of macrosomia.