宫内发育迟缓的孕前因素研究

摘要

Objective:To analyze the pre-conception factors for intrauterine growth retardation.Methods:A nested case-control study was conducted in a cohort of 1368 women from 14 Child and Maternity Health Care Departments by cluster sampling method in Liuyang City, Hunan Province. Following-up until delivery, we collected their medical records and maternal health care manual materials. All neonates with intrauterine growth retardation were detected in the follow-up (the case group) and another 186 neonates without intrauterine growth retardation, matched with gender and mother’s age, were randomly selected from the cohort as controls.χ2 test and multiple conditional logistic regression were used to investigate the determinants of intrauterine growth retardation. n Results: Intrauterine growth retardation was associated with BMI (OR=64.775), waist circumference (OR=0.166), abortion (OR=6.997), level of total cholesterol (OR=0.045), folic acid (OR=0.077), and cortisol (OR=9.164). n Conclusion:Intrauterine growth retardation is associated with BMI, waist circumference, abortion,level of total cholesterol, folic acid, and cortisol. Effective measures to reduce intrauterine growth retardation in children include strengthening the detection of pre-pregnancy blood biochemical indicators to guide health care during pregnancy, and increasing nutrition during pregnancy according to pre-pregnancy BMI and waist circumference.%目的：探讨胎儿宫内发育迟缓的孕前影响因素。方法：采用巢式病例对照研究方法，将在湖南省浏阳市14个乡镇妇幼保健所就诊的1368名育龄妇女纳入孕前队列，追踪其妊娠结局。将在随访期内发生的宫内发育迟缓儿作为病例组，从该队列已分娩的正常新生儿中按1：3匹配抽取对照。采用单因素卡方检验和多因素条件logistic回归分析胎儿宫内发育迟缓的孕前影响因素。结果：孕前BMI(OR=64.775)、腰围(OR=0.166)、流产史(OR=6.997)、总胆固醇水平(OR=0.045)、叶酸水平(OR=0.077)、皮质醇水平(OR=9.164)与宫内发育迟缓的发生有关。结论：宫内发育迟缓与孕前BMI、腰围、流产史、总胆固醇水平、叶酸水平、皮质醇水平有关。加强孕前血液生化指标的检测以指导孕前保健，并根据孕前BMI和腰围适当增加孕妇营养，可能是预防宫内发育迟缓的有效措施。