胎儿生长受限营养干预效果不良的影响因素分析

目的 探讨不同类型胎儿生长受限营养干预治疗效果的影响因素。方法 通过深圳市妇幼保健系统和医院信息系统收集2014年1月至2017年6月在深圳市南山区妇幼保健院分娩的经超声诊断为胎儿生长受限的单胎新生儿和孕妇的基本情况、妊娠期及胎儿出生时的相关信息,在校正产妇年龄、文化程度、产次和新生儿性别后,采用多分类logistic回归模型探讨不同类型胎儿生长受限营养干预治疗效果不良的影响因素。结果 本研究对3 051对符合研究条件的产妇及其新生儿进行分析,产妇年龄为18~44岁, 18~34岁占86.7%（2 644人）,汉族占95.3%（2 909人）,大学及以上文化程度占55.1%（1 680人）,孕前BMI 18.5~23.9占64.0%（1 954人）。校正孕妇年龄等混杂因素后的多分类logistic回归分析结果显示,孕前体重过低（OR=1.44）、妊娠高血压（OR=2.86）、羊水过少（OR=2.39）、脐带异常（OR=1.49）、胎盘重量<500 g（OR=3.72）的产妇所生新生儿为匀称型小于胎龄儿（SGA）的可能性较高;贫血（OR=0.70）、微量元素缺乏（OR=0.62）的产妇所生新生儿为匀称型SGA的可能性较低;孕前体重过低（OR=2.59）、羊水过少（OR=3.30）、胎盘重量<500 g（OR=2.39）、早产（OR=2.81）的产妇所生新生儿为非匀称型SGA的可能性较高;贫血（OR=0.60）、生殖系统感染（OR=0.47）的产妇所生新生儿为非匀称型SGA的可能性较低。结论 影响胎儿生长受限营养干预效果不良的因素是多方面的,不同预后结局的影响因素存在差别。

Factors affecting adverse effect of nutrition intervention on fetal growth restriction

Objective To explore factors affecting the effectiveness of nutritional intervention for fetal growth restriction （FGR）. Methods Data of social demography, pregnancy and birth of singleton neonates and pregnant women who were diagnosed with FGA by ultrasound and delivered at the Maternal and Child Health Hospital of Nanshan District, Shenzhen from January 2014 to June 2017 were collected through the Shenzhen Maternal and Child Health Care System and Hospital Information System. After adjusting for maternal age, education, parity, and newborn sex, a multiclass logistic regression model was used to explore the factors affecting effectiveness of nutrition intervention on different types of FGR. Results In this study, 3 051 eligible mothers and their newborns were recruited. The maternal ages were 18 to 44 years, 86.7% （2 644） of them were 18 to 34 years, 95.3% （2 909） were Han nationality, 55.1% （1 680） had the university education or above, and 64.0% （1 954） had BMI from 18.5 to 23.9 before pregnancy. After adjusting for the maternal age and other confounding factors, multiclass logistic regression showed that the parturients with low pre-pregnancy weight （OR=1.44）, gestational hypertension （OR=2.86）, oligohydramnios （OR=2.39）, abnormal umbilical cord （OR=1.49）, and placental weight <500 g （OR=3.72） were more likely to give birth to symmetrical small for gestational age （SGA） newborns; the parturients with anemia （OR =0.70） and trace element deficiency （OR =0.62） were less likely to have symmetrical SGA newborns; the parturients with low pre-pregnancy weight （OR=2.59）, oligohydramnios （OR=3.30）, placental weight <500 g （OR=2.39）, preterm delivery （OR=2.81） were more likely to give birth to asymmetric SGA newborns; the parturients with anemia （OR=0.60） and reproductive system infection （OR=0.47） were less likely to have asymmetric SGA newborns. Conclusions There are many factors affecting the effectiveness of nutritional intervention on FGR and the influencing factors of different prognosis outcomes are different.