孕妇体重指数变化对新生儿体重影响

孕妇体重指数变化对新生儿体重影响 [摘要] 目的:探讨孕妇体重指数变化对新生儿体重的影 响。方法:对近2年来我院产检并分娩的447例初产妇的妊 娠初期体重指数、妊娠37周后体重指数及其新生儿体重,应 用Logistic回归分析评估其与巨大儿的关系。结果:496例产 妇中,共有447例用于分析,检出巨大儿56例,检出率为 12.5%。与非巨大儿母亲孕期体重指数增量>6者的构成比 (90/391,23.0%)相比,巨大儿母亲孕期体重指数增量>6者的 构成比(43/56,76.8%)较高(P6是巨大儿的危险因素 (RR=11.016,95% CI为5.650~21.477,P6与巨大儿有关。 [关键词] 初产妇;巨大儿;体重指数 [中图分类号] R714.1[文献标识码]A [文章编 号]1673-7210(2010)04(c)-032-02 Effect of change in antenatal body mass index of neonatal macrosomia on the body mass of newborns LI Fengyun, LI Junlin, JIANG Jun, ZHU Xiuqiong (Department of Obstetrics and Gynecology, Kexuecheng Hospital of Mianyang City, Mianyang 621900, China) [Abstract] Objective: To evaluate the predictive value of 1 change in antenatal maternal body mass index (BMI) and the relationship with macrosomia. Methods: We analyzed data of consecutive deliveries of 447 cases from the recent 2 years in our hospital, focusing on first visit (first trimester) BMI, last visit (37 weeks or later) BMI and fetal birth weight. Logistic regression was used to evaluate the relationship between change in BMI and macrosomia. Results: Of the 496 consecutive deliveries, 447 were analyzed, of which 56 (12.5%) of the infants were macrosomic. Among macrosomic infants, 76.8% (43/56) of their mothers had a more than 6 increase in BMI compared with 23.0% (90/391) of mothers of normal weight infants (P42周分娩、死胎、死 产及双胎、多胎。 1.2 方法 妊娠初期(妊娠12周内)产检时,首次应用BMI测量仪按标 准要求测孕妇BMI,记录人口统计学信息,在妊娠晚期(妊娠 37周后)用同样的方法再次测孕妇BMI。新生儿在出生后即 刻应用专用电子测重仪测重,>4 000 g为巨大儿。 1.3 统计学分析 计量资料以均数?差(x?s)示,采用SPSS 13.0软件 进行统计学分析,两组计量资料比较用t检验,两组计数资料 比较用χ2检验,孕期BMI增量对新生儿体重的影响用 2 Logistic回归分析,P6者构成比情况 与非巨大儿组母亲孕期BMI增量>6者的构成比(90/391,23.0%)比较,巨大儿组母亲孕期BMI增量>6者的构成比(43/56,76.8%)较高,差异有高度统计学意义(χ2=67.754,P6是巨大儿的危险因素 以年龄(加权处理:?25岁为0,26,30岁为1,>30岁为2)、孕次、孕期BMI增量(加权处理:?6为0,>6为1)为自变量,以巨大儿(加权处理:非为0,是为1)为应变量,进行Logistic回归分析,结果显示,孕期BMI增量>6是巨大儿的危险因素,年龄和孕次对巨大儿发生率的影响不明显。见表2。 表2巨大儿影响因素Logistic回归分析 Tab.2Logistic analysis of influence factors of macrosomia 3 讨论 尽管巨大儿的定义尚未统一,但已被广泛接受的是大于4 000 g[5]。胎儿超过4 000 g,围生期并发症明显增加[6]。近年来,孕妇BMI变化对巨大儿的影响日趋明显,而早期研究认为,巨大儿与妊娠期BMI变化关系不密切[7-9]。近年来,有资料分析显示,巨大儿的发生与其母亲的遗传因素及妊娠时年龄、BMI、孕次有关[10-11]。但本资料分析显示,巨大儿组母亲妊娠时年龄、孕初BMI及孕次与非巨大儿组比较,差异无统计学意义(P6者巨大儿发生率明显增高(RR=11.016,P 3 随着社会物质供应的不断丰富,巨大儿发生率呈上升趋势 [3-4]。本组资料显示,巨大儿56例,占12.5%。Pamela等[12] 通过对1992,2001年出生新生儿的数据分析发现,大于胎 龄儿在此10年间增加23.0%,其原因在于其母亲BMI增长过 度。由于年轻女性肥胖人数不断增加,预计在今后一段时间内, 巨大儿的出生还会继续增加,而孕晚期是胎儿生长发育最快 的时期。因此,为减少巨大儿的发生,必须指导孕妇,特别是体 重增加过快、过多的孕妇进行孕期营养宣教,以降低剖宫产率 及母婴分娩并发症率[13]。 [参考文献] [1]Boulet SL, Alexander GR, Salihu HM, et al. Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk [J]. Am J Obstet Gynecol,2003,188(5):1372-1378. [2]Dickstein Y, Ohel I, Levy A, et al. Lack of prenatal care: an independent risk factor for perinatal mortality among macrosomic newborns [J]. Arch Gynecol Obstet,2008,277(6):511-514. [3]沈敏,赵欣.10年巨大儿发病率及其相关因素的分析[J]. 4 上海医学,2002,25(8):513-514. [4]Campaigne AL, Conway DL. Detection and prevention of macrosomia [J]. Obstet Gynecol Clin North Am,2007,34(2):309-322. [5]Nahum GG. Detecting and managing fetal macrosomia [J]. Contemp Ob Gyn,2000,6(1):89-119. [6]Thomas KY, Barbara W. Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain [J]. Am J Obstet Gynecol,2002,187(2):312-320. [7]Abrams BF, Laros RK Jr. Prepregnancy weight, weight gain, and birth weight [J]. Am J Obstet Gynecol,1986,171(3):503-509. [8]Abrams BF, Selvin S. Maternal weight gain pattern and birth weight [J]. Obstet Gynecol,1995,95(2):163-169. [9]Cogswell ME, Serdula MK, Hungerford DW, et al. Gestational weight gain among average-weight and overweight women―what is excessive? [J]. Am J Obstet Gynecol,1995,180(2 Pt 1):705-712. [10]Saemundur G, Anne-Charlotte H, Pelle L. Correlation of birth injury with maternal height and birth weight [J]. BJOG,2005,112(6):764-767. [11]Jensen DM, 5 Damm P, Sorensen B, et al. Pregnancy outcome and prepregnancy body mass index in 2549 glucose-tolerant Danish women [J]. Am J Obstet Gynecol,2003,188(1):239-244. [12]Pamela JS, Chung H, Anna LVJ, et al. Reasons for increasing trends in large for gestational age births [J]. Obstet Gynecol,2004,104(4):720-726. [13]张群芳,吴元赭.重度妊娠期高血压合并低蛋白血症临 床分析[J].医学研究生学报,2007,20(12):1274-1276. (收稿日期:2010-01-27) 6