广东巨大儿发病率调查及高危因素分析

【目的】 调查广东巨大儿发生率及探讨其高危因素。【方法】 收集中山大学附属第一医院等广东13所大型医院产科2010年10月至2010年11月住院分娩的巨大儿(≥4000 g)共222例作为研究组,随机抽取同期正常体质量(2 500 ~ 3 999 g)的新生儿414例作为对照组。计算巨大儿发生率,比较两组间孕妇年龄、孕次、产次、身高、孕前体质量、产前体质量、孕期增重、孕周、分娩方式、新生儿体质指标、孕妇及新生儿并发症等情况,统计分析巨大儿的相关因素及高危因素。【结果】 巨大儿共 222 例,总发生率为 2.78 %;两组间孕妇孕期增重有统计学差异[对照组(15 ± 5)kg vs 巨大儿组(18 ± 5)kg, P < 0.05];巨大儿组中妊娠期糖尿病(16.9 % vs 5.6 %, P < 0.01)、羊水过多(7.8 % vs 1.2 %, P < 0.01)的发生率更高;巨大儿组顺产率更低(20.1% vs 47.5%, P < 0.05),手术产率更多(78.5 % vs 51.0 %, P < 0.01);巨大组和对照组的男女婴比例有显著差异(146/76 vs 229/185, P < 0.01);头围也有统计学差异[(35.75 ± 1.07) cm vs (33.70 ± 1.53) cm, P < 0.01]。分娩巨大儿的相关因素为孕周、孕次、身高、孕前体质量、孕前BMI、产前体质量、产前BMI、孕期增重等;分娩巨大儿的高危因素为年龄、孕周、产前体质量、妊娠期糖尿病等。【结论】 广东巨大儿发生率约为2.78 %,高危因素为年龄、孕周、产前体质量、妊娠期糖尿病等;在具有分娩巨大儿高危因素的孕妇当中,要注意筛查巨大儿,特别是在四步触诊临床估计胎重及超声测量中。

Analysis of Mobidity and Risk Factors of Macrosomia in Guangdong

【Objective】 To investigate the morbidity of macrosomia and to explore its risk factors in Guangdong.【Methods】A total of 222 cases of macrosomia(≥4000 g) were collected as the study group from 13 large hospitals such as First Affiliated Hospital of Sun Yat-sen University in Guangdong during Oct 2010 to Nov 2010.Meanwhile,414 neonates of normal birth weight(2500-3999 g) were gathered as the control group.To calculate the morbidity of macrosomia and to compare their mothers age,gravidity,parity,height,pregestational weight,prepartum weight,weight gain,geatational weeks,mode of delivery,neonatal body index and complication;To analyze the related factors and risk factors of macrosomia.【Results】 There were 222 cases of macrosomia and its morbidity was 2.78 %;Weight gain were different between the control group and the study group [(14.59 ± 4.47) kg vs(17.73 ± 5.08) kg,P < 0.05];In the study group,incidence of gestational diabetes mellitus(16.9 % vs 5.6 %,P < 0.01) and polyhydramnios(7.8 % vs 1.2 %,P < 0.01) was higher;Incidence of vaginal spontanese delivery(20.1% vs 47.5%,P < 0.05) was lower and incidence of c-section was higher(78.5 % vs 51.0 %,P < 0.01);There was significant difference in gender distribution between the study group and the control group(146/76 vs 229/185,P < 0.01);So was head circumstance [(35.75 ± 1.07) cm vs(33.70 ± 1.53) cm,P<0.01].Related factors of macrosomia were gestational weeks,gravidity,height,pregestational weight,pregestational BMI,prepartum weight,prepartum BMI and weight gain;Risk factors of macrosomia were age,geatational weeks,prepartum weight and gestational diabetes mellitus.【Conclusion】 The morbidity of macrosomia is 2.78 % in Guangdong and its risk factors were age,gestational weeks,prepartum weight and gestational diabetes mellitus;Macrosomia should be paid enough attention to and estimated by four maneuvers of Leopold and ultrasound in those pregnant women of risk factors.