Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and...Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.展开更多
Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important questi...Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important question is whether GDM is independently associated with fetal macrosomia,or whether this relationship is merely the result of maternal obesity acting as a confounder.In this review of the literature,we attempt to further elucidate the relationship between GDM,maternal obesity,and fetal macrosomia.展开更多
目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,...目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,根据是否分娩巨大儿分为巨大儿组(104例)和对照组(258例),比较2组基本情况和妊娠期糖脂水平,并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果:相较于正常对照组,巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油(triglyceride,TG)水平更高,妊娠早晚期高密度脂蛋白(high density lipoprotein,HDL)水平更低,且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小(均P<0.05)。与妊娠期增重适宜的正常孕妇相比,增重过多的正常孕妇分娩巨大儿的风险升高142%(OR=2.42,95%CI:1.34~4.39),增重不足的正常孕妇分娩巨大儿的风险降低73%(OR=0.27,95%CI:0.10~0.77);妊娠晚期HDL每升高1 mmol/L,分娩巨大儿风险下降79%(OR=0.21,95%CI:0.08~0.57)。结论:正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险,并且仍需关注血脂代谢,其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。展开更多
新生儿的出生体质量可用于衡量胎儿宫内营养状况,也与妊娠结局密切相关。随着新生儿出生体质量的增加,分娩期新生儿和母体的致伤、致残、致死风险逐渐增高,新生儿成年期心血管疾病及代谢性疾病发病风险也增加。因此,提高对巨大儿的风险...新生儿的出生体质量可用于衡量胎儿宫内营养状况,也与妊娠结局密切相关。随着新生儿出生体质量的增加,分娩期新生儿和母体的致伤、致残、致死风险逐渐增高,新生儿成年期心血管疾病及代谢性疾病发病风险也增加。因此,提高对巨大儿的风险认识,降低巨大儿的发生率非常必要,也是提高妊娠期保健质量的重要方面。孕妇的体质量指数(body mass index,BMI)和妊娠期体质量增加(gestational weight gain,GWG)是衡量孕妇营养状况的指标,肥胖、BMI过高、GWG过度导致巨大儿、大于胎龄儿(large for gestational age infant,LGA)发生风险增加。孕妇营养是新生儿出生体质量的重要影响因素,可以通过人为方式进行干预。孕妇在妊娠前、妊娠期适量摄入营养可减少巨大儿的出生率。展开更多
目的:构建并验证妊娠期高血糖(hyperglycemia in pregnancy,HIP)患者分娩巨大儿风险的列线图模型。方法:回顾性分析2020年11月—2022年2月在太原市妇幼保健院分娩的HIP患者资料。采用多因素Logistic回归分析筛选发生巨大儿的独立影响因...目的:构建并验证妊娠期高血糖(hyperglycemia in pregnancy,HIP)患者分娩巨大儿风险的列线图模型。方法:回顾性分析2020年11月—2022年2月在太原市妇幼保健院分娩的HIP患者资料。采用多因素Logistic回归分析筛选发生巨大儿的独立影响因素,R软件构建列线图模型,采用受试者工作特征曲线下面积对该模型的效能进行评估,决策曲线分析(decision curve analysis,DCA)评估模型的临床使用价值。结果:(1)纳入1098例HIP患者进行建模,其中92例(8.38%)孕妇分娩巨大儿。按7∶3比例将所有患者随机分为训练集(761例)和测试集(337例)。(2)多因素Logistic回归分析发现,经产妇(OR=3.19,95%CI:1.58~6.54,P=0.001)、高血压家族史(OR=2.28,95%CI:1.06~4.90,P=0.034)、妊娠前体质量指数(OR=1.18,95%CI:1.08~1.30,P<0.001)、双顶径(OR=13.52,95%CI:4.04~48.38,P<0.001)、腹围(OR=2.83,95%CI:2.17~3.81,P<0.001)是孕妇分娩巨大儿的独立危险因素,并据此建立列线图模型。(3)该模型在训练集和测试集的受试者工作特征曲线下面积分别为0.93(95%CI:0.90~0.97)和0.92(95%CI:0.88~0.97),差异无统计学意义(P=0.69),说明模型在训练集和测试集中效果均良好。(4)DCA结果显示,当阈值概率≥7%时,采用该列线图预测模型可以使孕妇的净获益提高,该模型有一定的临床使用价值。结论:初步建立了预测HIP患者分娩巨大儿的列线图模型。该模型有一定准确度,有望成为指导临床制定终止妊娠时机、进行个体化产程监护、决定分娩方式的量化工具。展开更多
文摘Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.
文摘Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important question is whether GDM is independently associated with fetal macrosomia,or whether this relationship is merely the result of maternal obesity acting as a confounder.In this review of the literature,we attempt to further elucidate the relationship between GDM,maternal obesity,and fetal macrosomia.
文摘目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,根据是否分娩巨大儿分为巨大儿组(104例)和对照组(258例),比较2组基本情况和妊娠期糖脂水平,并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果:相较于正常对照组,巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油(triglyceride,TG)水平更高,妊娠早晚期高密度脂蛋白(high density lipoprotein,HDL)水平更低,且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小(均P<0.05)。与妊娠期增重适宜的正常孕妇相比,增重过多的正常孕妇分娩巨大儿的风险升高142%(OR=2.42,95%CI:1.34~4.39),增重不足的正常孕妇分娩巨大儿的风险降低73%(OR=0.27,95%CI:0.10~0.77);妊娠晚期HDL每升高1 mmol/L,分娩巨大儿风险下降79%(OR=0.21,95%CI:0.08~0.57)。结论:正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险,并且仍需关注血脂代谢,其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。
文摘新生儿的出生体质量可用于衡量胎儿宫内营养状况,也与妊娠结局密切相关。随着新生儿出生体质量的增加,分娩期新生儿和母体的致伤、致残、致死风险逐渐增高,新生儿成年期心血管疾病及代谢性疾病发病风险也增加。因此,提高对巨大儿的风险认识,降低巨大儿的发生率非常必要,也是提高妊娠期保健质量的重要方面。孕妇的体质量指数(body mass index,BMI)和妊娠期体质量增加(gestational weight gain,GWG)是衡量孕妇营养状况的指标,肥胖、BMI过高、GWG过度导致巨大儿、大于胎龄儿(large for gestational age infant,LGA)发生风险增加。孕妇营养是新生儿出生体质量的重要影响因素,可以通过人为方式进行干预。孕妇在妊娠前、妊娠期适量摄入营养可减少巨大儿的出生率。
文摘目的:构建并验证妊娠期高血糖(hyperglycemia in pregnancy,HIP)患者分娩巨大儿风险的列线图模型。方法:回顾性分析2020年11月—2022年2月在太原市妇幼保健院分娩的HIP患者资料。采用多因素Logistic回归分析筛选发生巨大儿的独立影响因素,R软件构建列线图模型,采用受试者工作特征曲线下面积对该模型的效能进行评估,决策曲线分析(decision curve analysis,DCA)评估模型的临床使用价值。结果:(1)纳入1098例HIP患者进行建模,其中92例(8.38%)孕妇分娩巨大儿。按7∶3比例将所有患者随机分为训练集(761例)和测试集(337例)。(2)多因素Logistic回归分析发现,经产妇(OR=3.19,95%CI:1.58~6.54,P=0.001)、高血压家族史(OR=2.28,95%CI:1.06~4.90,P=0.034)、妊娠前体质量指数(OR=1.18,95%CI:1.08~1.30,P<0.001)、双顶径(OR=13.52,95%CI:4.04~48.38,P<0.001)、腹围(OR=2.83,95%CI:2.17~3.81,P<0.001)是孕妇分娩巨大儿的独立危险因素,并据此建立列线图模型。(3)该模型在训练集和测试集的受试者工作特征曲线下面积分别为0.93(95%CI:0.90~0.97)和0.92(95%CI:0.88~0.97),差异无统计学意义(P=0.69),说明模型在训练集和测试集中效果均良好。(4)DCA结果显示,当阈值概率≥7%时,采用该列线图预测模型可以使孕妇的净获益提高,该模型有一定的临床使用价值。结论:初步建立了预测HIP患者分娩巨大儿的列线图模型。该模型有一定准确度,有望成为指导临床制定终止妊娠时机、进行个体化产程监护、决定分娩方式的量化工具。
