上海市巨大儿影响因素及妊娠结局  

Effect factors and pregnancy outcome of macrosomia in Shanghai

作　　者：许厚琴[1,2] 杜莉[1,2] 秦敏[1,2] 张礼[1,2] 谭晶[1,2] 金辉[1,2] 朱丽萍[1,2] 

机构地区：[1]上海市妇女保健所 [2]同济大学附属第一妇婴保健院,上海200040

出　　处：《中国妇幼保健》2010年第9期1184-1188,共5页Maternal and Child Health Care of China

基　　金：上海市公共卫生优秀学科带头人资助项目(项目编号:08GWD13)

摘　　要：目的:探讨1999～2008年上海市巨大儿发生率及其影响因素,为制定控制巨大儿发生的干预措施提供依据。方法:随机抽取1999～2008年上海19个区县的接产医院产科病历,按统一要求填写调查表,共收集有效表4883张,用卡方和Logistic回归等方法进行统计分析。结果:(1)上海市近10年巨大儿发生率平均为8.4%,2008年发生率为7.4%。(2)巨大儿的危险因素:①产次。经产妇的调整OR值为1.28(P<0.05);②孕早期BMI。母亲超重的巨大儿调整OR值为2.40(P<0.01);③孕期增重。孕期增重大于12.5kg的调整OR值为2.35(P<0.01);④胎儿性别。男性的调整OR值为2.14(P<0.001);⑤孕期营养门诊咨询。可以避免巨大儿的发生,调整OR值为0.69(P<0.05);⑥糖尿病。调整OR值为2.26(P<0.01)。(3)妊娠结局:巨大儿母亲的剖宫产率为79.6%,高于正常体重儿母亲的36.9%;产时并发症的发生率8.8%,显著高于非巨大儿的5.4%;阴道分娩产程延长的发生率为3.7%,显著高于正常儿的1.7%;巨大儿母亲的平均产后出血量(257.36ml)显著高于非巨大儿(225.47ml);巨大儿母亲的平均住院天数比非巨大儿多0.9天。结论:巨大儿与不良妊娠结局相关,需要通过相关干预措施如孕期血糖、孕期体重增长的控制及加强孕期饮食指导来降低巨大儿的发生以改善妊娠结局。Objective： To explore the incidence and effect factors of macrosomia from 1999 to 2008 in Shanghai, provide evidence for making intervention measures of controlling macrosomia incidence. Methods： Obstetric medical records from maternal hospitals in 19 counties were sampled randomly from 1999 to 2008, the clinical information was filled in unified questionnaires, then 4 883 effective forms were collected. Chi - square and logistic regression were used in the study. Results： The average incidence of macrosomia in Shanghai from 1999 to 2008 was 8.4%, the incidence was 7.4% in 2008. The risk factors of macrosomia included： parity： the adjusted OR value of mul- tiparous women was 1.28 （P 〈 0. 05 ） ; BMI in early pregnancy： the adjusted OR value of overweight mothers was 2.40 （P 〈 0. 01 ） ; weight gain in pregnancy ： the adjusted OR value of women with weight gain in pregnancy more than 12. 5 kg was 2. 35 （ P 〈 0. 01 ） ; fetal sex ： the adjusted OR value of boys was 2. 14 （P 〈 0. 001 ） ; nutritional consultation during gestational period to prevent macrosomia： the adjusted OR value was 0. 69 （P 〈0.05） ; gestational diabetes： the adjusted OR value was 2. 26 （P 〈0.01 ） . Pregnancy outcomes： the rate of cesarean section in mothers with macrosomia was 79. 6%, which was significantly higher than that in mothers with normal body weight neonates （36. 9% ） ; the incidence of labor complications in mothers with macrosomia was 8. 8% , which was significantly higher than that in mothers with normal body weight neonates （ 5.4% ） ; the incidence of duration delay in vaginal delivery in mothers with macrosomia was 3.7%, which was significantly higher than that in mothers with normal body weight neonates （ 1.7% ） ; the average amount of postpartum hemorrhage in mothers with macrosomia was 257. 36 ml, which was significantly higher than that in mothers with normal body weight neonates （225.47 ml） ; the average hospital stays in mothers with macrosomia was signif

关 键 词：巨大儿 妊娠结局 影响因素 发生率 

分 类 号：R714.43[医药卫生—妇产科学]