孕妇体质量及其他因素与分娩巨大儿的相关性研究

摘要

Objective:To study the relationship of macrosomia to pre-pregnancy body mass index,gestational weight gain and other factors.At the same time,providing guidance for macrosomia prevention.Methods:10044 cases of pregnant women in the West China Second University Hospital from January 1,2013 to December 31,2014,were enrolled in this study.There were 466 cases of macrosomia and non-macrosomia 9578 cases.Logistics regression was used to analyze the correlation of macrosomia to gestational weight gain and other factors (gestational diabetes mellitus,history of macrosomia and multiple pregnancy),meanwhile to analyze the correlation of macrosomia with different BMI.Results:①pre-pregnancy body mass index,gestational weight gain,GDM and the history of macrosomia were independent risk factors of macrosomia(P ＜ 0.05).Multiple pregnancy may decrease the incidence of macrosomia(P ＜ 0.05).②According to the BMI layer,for pre-pregnancy BMI normal women,low weight gain and multiple pregnancy may decrease the incidence of macrosomia (P ＜ 0.05),gestational weight gain,excessive weight gain and the history of macrosomia were independent risk factors of macrosomia(P ＜0.05);for pre-pregnancy BMI underweight women,gestational weight gain and excessive weight gain were independent risk factors of macrosomia(P ＜ 0.05);for pre-pregnancy BMI overweight women,gestational weight gain and GDM were independent risk factors of macrosomia(P ＜0.05).Conclusions:High pre-pregnancy BMI,excessive weight gain,gestational diabetes and history of macrosomia delivery increased risk of macrosomia.Differet pre-pregnancy BMI women have different risk factors of macrosomia.Excessive weight gain can improve the incidence of macrosomia,especially for pre-pregnancy BMI underweight and normal women.%目的:探讨孕妇孕前和孕期体质量及有关因素与分娩巨大儿的相关性,为其预防提供指导.方法:选择2013年1月1日至2014年12月31日在四川大学华西第二医院住院分娩符合纳入标准的孕产妇10044例,其中分娩巨大儿466例,非巨大儿9578例.采用Logistics回归分析孕妇体质量及其他因素(妊娠期糖尿病、分娩巨大儿史、多胎妊娠等)与分娩巨大儿的相关性及不同BMI分类与分娩巨大儿的相关性.结果:①孕前BMI、孕期总体质量增长、妊娠期糖尿病及既往分娩过巨大儿是分娩巨大儿的独立危险因素(P＜0.05);多胎妊娠是分娩巨大儿的保护因素(P＜0.05).②通过BMI分层后,对于孕前BMI正常者,孕期体质量增长过少和多胎妊娠是分娩巨大儿的保护因素(P＜0.05);孕期总体质量增长、孕期体质量增长过多、有巨大儿分娩史是分娩巨大儿的独立危险因素(P＜0.05).对于孕前体质量过轻者,孕期总体质量增长和孕期体质量增长过多是分娩巨大儿独立危险因素(P＜0.05).对于孕前超重的孕妇,孕期总体质量增长和妊娠期糖尿病是分娩巨大儿独立危险因素(P＜0.05).结论:孕前BMI过高、孕期体质量增长过多、发生妊娠期糖尿病及既往分娩巨大儿史均可使再次妊娠发生巨大儿的风险明显增高;孕前不同BMI孕妇其分娩巨大儿的危险因素有不同,孕期体质量增长过多可能增加孕前偏瘦和体质量正常孕妇巨大儿的发生风险.