孕14周后巨大儿的生长轨迹、分娩方式选择分析及影响因素的个性化预测

Analysis of growth trajectory and delivery mode selection of macrosomia after 14 weeks of pregnancy and personalized prediction of influencing factors

目的探究孕14周后巨大儿(FM)的生长轨迹、分娩方式的选择及影响因素的个性化预测。方法选择2019年1月至2022年12月于巴彦淖尔市医院产检及生产新生儿的孕妇(525例)为研究对象;根据新生儿出生体质量,分为FM组(105例,新生儿体质量≥4000 g)和正常出生体质量儿(NBWI)组(420例,新生儿体质量2500~3999 g);根据FM组孕妇分娩方式,分为剖宫产组(54例)和阴道分娩组(51例)。按照相同标准,另选孕妇(175例)纳入验证集,以验证预测模型的有效性。收集孕妇及新生儿的临床资料,分析FM的生长轨迹及分娩方式的选择。多因素Logistic回归分析危险因素,计算危险因素比值比(OR)。使用逐步回归方法筛选FM最重要的关联因素,用于构建列线图预测模型并评价。结果孕20周后,FM组胎儿宫内生长各相关指标均显著高于NBWI组(P<0.05)。年龄、经产妇、分娩时孕龄、妊娠糖尿病(GDM)、羊水过多、胎盘质量以及糖化血红蛋白(HbA1c)水平,均是FM发生的独立影响因素(P<0.05)。逐步回归分析筛选出胎盘质量、分娩时孕龄、GDM和经产妇与FM关联最大,并用于构建列线图预测模型。模型评价结果显示,其具有较高的精准度,且有效性较好,安全可靠,实用性强。与阴道分娩组相比,剖宫产组孕妇产中、产后出血量均更少(P<0.05),住院时间更短(P<0.05)。结论孕20周以后,FM组各生长发育指标己明显高于NBWI组。基于胎盘质量、分娩时孕龄、GDM和经产妇这4项独立危险因素,构建的FM发生风险个体化预测列线图模型,具有一定的临床应用价值,对临床制订干预性策略具有指导意义,可操作性强。且FM选择剖宫产的安全性更高。

Objective Explore the growth trajectory of fetal macrosomia(FM)after 14 weeks of pregnancy,the selection of delivery methods,and personalized prediction of influencing factors.Methods Pregnant women(525 cases)who underwent prenatal examination and gave birth to newborns in Bayannur Hospital from January 2019 to December 2022 were selected as the research subjects.According to the birth weight of newborns,they were divided into FM group(105 cases,newborn weight≥4000 g)and normal birth weight infant(NBWI)group(420 cases,newborn weight 2500-3999 g).According to the mode of delivery of women in FM group,they were divided into Caesarean section group(54 cases)and vaginal delivery group(51 cases).According to the same criteria,another pregnant woman(175 cases)was selected to be included in the validation set to verify the effectiveness of the prediction model.Collect clinical data of pregnant women and newborns,analyze the growth trajectory of FM and the selection of delivery methods.Multivariate Logistic regression analysis of risk factors and calculation of risk factor odds ratio(OR).Use stepwise regression method to screen the most important correlation factors of FM,and construct a column chart prediction model for evaluation.Results After 20 weeks of pregnancy,all relevant indicators of fetal intrauterine growth in the FM group were significantly higher than those in the NBWI group(P<0.05).Age,multiparous women,gestational age at delivery,gestational diabetes mellitus(GDM),polyhydramnios,placental quality and glycosylated hemoglobin(HbA1c)level were all independent influencing factors of FM(P<0.05).Stepwise regression analysis screened out the placental mass,gestational age at delivery,GDM,and postpartum women with the highest correlation with FM,and used it to construct a column chart prediction model.The model evaluation results show that it has high accuracy,good effectiveness,safety,reliability,and strong practicality.Compared with the vaginal delivery group,the caesarean section group had less intrapartum and postpartum bleeding bleeding(P<0.05)and shorter hospital stay(P<0.05).Conclusion After 20 weeks of pregnancy,the growth and development indicators of FM were significantly higher than those of NBWI.Based on four independent risk factors,namely placental quality,gestational age at delivery,GDM,and postpartum women,a personalized prediction column chart model for FM occurrence risk is constructed,which has certain clinical application value and guiding significance for the development of intervention strategies in clinical practice,with strong operability.The safety of FM choosing caesarean section is higher.