巨大儿的发生及其影响因素  

Occurrence and Influencing Factors of Macrosomia

作　　者：陈蔚[1] 武明辉[1] 张娣[1] 侯东敏[1] 王军华[1] 蒋京伟[1] 贾朝霞[1] 

机构地区：[1]首都医科大学附属北京妇产医院北京妇幼保健院,北京100026

出　　处：《中华妇幼临床医学杂志（电子版）》2013年第4期397-401,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的探讨产妇分娩巨大儿的危险因素。方法自2010年1月至12月在本院产科分娩的产妇中,选取病历资料完整的7805例产妇(单胎妊娠)为研究对象。按照产妇分娩新生儿的出生体重,将其入组巨大儿组(n=593,出生体重≥4000g)和正常体重儿组(n=7212,4000g>出生体重≥2500g)。采取回顾性分析法对两组产妇的相关指标,如体重指数(BMI),葡萄糖耐量试验(OGTT)结果及产妇的一般情况、孕期体重、血糖、分娩情况等进行单因素分析。对单因素分析中有统计学意义的指标,进行非条件多因素logistic回归分析(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。结果①两组产妇的分娩年龄、产前检查开始孕龄、产次、新生儿窒息率等比较,差异无统计学意义(P>0.05)。②巨大儿组产妇孕次、孕前体重与BMI,产前体重与BMI、空腹血糖值及OGTT 1h,2h血糖值,分娩孕龄、方式与新生儿性别、出生体重、窒息率等与正常体重儿组产妇比较,差异有统计学意义(P<0.05)。③分娩孕龄≥40孕周、产前肥胖、孕次为6次、分娩方式为剖宫产、空腹血糖≥5.1mmol/L、分娩男胎及OGTT 2h血糖≥8.5mmol/L是巨大儿发生的高危因素。结论控制空腹及餐后2h血糖,控制孕期体重增加,降低产前BMI,适时终止妊娠等,可降低巨大儿的发生。Objective To investigate the risk factors of gestational women who delivered macrosomia. Methods Clinical data of 7805 pregnant women（singleton pregnancy）who had antenatal care and delivered in Capital Medical University Affixed Beijing Obstetrics and Gynecology Hospital from January to December 2010 were retrospectively analyzed. According to birthweight of neonats, they were divided into macrosomia group （n=593, birthweight≥4000 g） and normal neonate weight group（n= 7212,4000 g〉birthweight≥ 2500 g）. All the indicators relevant to maerosomia were analyzed, such as body mass index（BMI）, oral glucose tolerance test（OGTT）, common situation, gestational weight, blood glucose and delivery situation. They were firstly analyzed by univariate analysis method. Then the meaningful indicators were analyzed by non-conditional multivariate logistic regression method. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Capital Medical University Affixed Beijing Obstetrics and Gynecology Hospital. Informed consent was obtained from the parents of each participating neonate. Results ①There had significance difference between two groups among ages, parities, gestational age at time to begin antenatal examination and asphyxia rate of neonates （P〉0. 05）. ② There had significance difference between two groups among gravidities, pre-pregnancy weight, pre-pregnancy BMI, prenatal weight, prenatal BMI, gestational weight gain, fasting plasma glucose, levels of OGTT 1 h, 2 h, gestational age, modes of delivery, gestational age at delivery,and birth weight, sex of neonates（P〈0.05）. QAnalyzed by non-conditional multivariate logistic regression showed those high risk factors for macrosomia were gestational age≥ 40 weeks, BMI≥ 28 kg/cm^2 at delivery, the number of pregnancies reaching 6, cesarean section, fasting plasma glucoseS5.1 retool/L, male fetus and blood glucose levels of OGTT 2 h≥ 8.5 mmol/L. Conclusions To control levels of fasting plasma gl

关 键 词：巨大儿 影响因素 血糖 孕期体重 分娩次数 

分 类 号：R714.5[医药卫生—妇产科学]