502例单胎足月巨大儿的发生现状及危险因素分析

摘要

To analyze the incidence and influencing factors on fetal macrosomia among single full term birth neonates in the First Affiliated Hospital of Dalian Medical University.A retrospective analysis of 502 cases of fetal macrosomia in women from January 2014 to December 2016 delivery,4 162 cases of maternal related data compared to the same period of delivery,using Logistic regression analysis to influence factors of fetal macrosomia.Results showed the total prevalence of macrosomia were 12.06％ in the hospital from 2014 to 2016 (11.14％ in 2014,15.84％ in 2015,and 10.67％ in 2016,respectively).Multiple Logistic regression analysis showed that risk factors for macrosomia were pre-pregnant body mass index (p-BMI≥ 24.0kg/m2 (24.0kg/m2 ～ 27.9kg/m2) (OR =1.663,95 ％:1.158 ～ 1.828),gestational weight gain (GWG) (OR=1.389,95 ％ CI:1.262 ～ 1.530),being multipara (OR =1.458,96 ％ CI:1.146 ～ 1.854) and gestational diabetes mellitus (OR =5.294,95 ％ CI:3.710 ～ 7.555) were risk factors for the fetal macrosomia.GWG overproof,overweight and gestational diabetes mellitus had the strongest associations with macrosomia (all P＜0.01).The incidence of fetal macrosomia in the hospital was higher than the national figures.The risk of cesarean section increased in pregnant women with macrosomia(OR=1.843,95％CI:1.624～ 2.091).p-BMI and GWG and gestational diabetes mellitus were three risk factors that had the strongest associations with macrosomia (all P＜0.01),thus should receive more attentions.Reasonable diet during pregnancy,appropriate exercise,guiding weight gain during pregnancy,strengthening management is particularly important.%分析大连医科大学附属第一医院单胎足月出生的巨大儿发生现状及其危险因素.分析2014年1月1日～2016年12月31日分娩的502例巨大儿的产妇临床资料,对比同期病例资料完整的4 162例产妇相关资料,运用Logistic回归分析发生巨大儿的影响因素.结果显示巨大儿总体发生率为12.06％,2014年～2016年巨大儿发生率分别为11.14％、15.84％、10.67％.Logistic回归分析孕妇年龄≥35岁(OR=1.453,95％CI:0.501～0.946)、孕前超重(OR=1.663,95％CI:(1.158～1.828)、孕期体重增加超标(OR=1.389,95％CI:1.262～1.530)、非初孕(OR=1.236,95％CI:1.089～1.403)、经产妇(OR=1.458,95％CI:1.146～1.854)以及孕妇患有妊娠期糖尿病(OR=5.294,95％CI:3.710～7.555)均是发生巨大儿的危险因素.2014年～2016年大连医科大学附属第一医院单胎足月巨大儿发生率高于同期全国以及北方地区平均水平;发生巨大儿的孕妇剖官产的风险增加(OR=1.843,95％CI:1.624～2.091).孕前超重、孕期体重增长超标、存在妊娠期糖尿病均与巨大儿的发生呈强相关性(P＜0.01),其中孕期体重增加和妇女孕前BMI是降低巨大儿发生的可控因素,应当引起足够重视和关注;孕期合理膳食、适当运动,指导孕期体重增长、加强管理尤为重要.