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目的:探讨巨大儿发生的危险因素,为预防分娩巨大儿的干预措施提供参考依据。方法:选择常规产检并分娩巨大儿的孕妇89例为病例组,同期分娩正常体重儿的孕妇390例为对照组,分析两组孕妇年龄、孕前体型、孕期体重增长情况、孕36周宫高及腹围水平等差异。结果:单因素分析年龄≥35岁、孕前体质指数(BMI)≥24.0、妊娠期糖尿病、孕期总体重增长超过16 kg、孕36周腹围身高比≥0.66是巨大儿发生的危险因素,多因素Logistic回归分析妊娠期糖尿病、孕36周腹围身高比、孕期体重增长与巨大儿的发生有关。对孕36周宫高及孕36周宫高+腹围进行受试者工作曲线(ROC)分析,结果显示两者曲线下面积分别为0.876及0.751(P<0.01);当孕36周宫高临界值为36 cm时,灵敏度为0.755,误诊率为0.124,而孕36周宫高+腹围临界值为140 cm时,灵敏度为0.663,误诊率为0.225。结论:分娩巨大儿的危险因素多样,尤其是针对孕前体型超重、高龄的孕妇更应加强孕期健康宣传教育及高危监测管理,控制其体重增长,预防妊娠期糖尿病的发生,关注其宫高及腹围的变化。以孕36周宫高临界值为36cm来评估巨大儿发生的预测价值比孕36周宫高+腹围临界值为140 cm在灵敏度及误诊率方面效果更佳。
Objective: To investigate the risk factors of macrosomia and to provide a reference for the prevention of macrosomia in childbirth. Methods: A total of 89 pregnant women were selected as the control group. Among them, 390 pregnant women with normal birth weight were selected as the control group. The age, body weight, weight gain during pregnancy, Abdominal circumference and other differences. Results: Univariate analysis showed that age ≥35 years old, body mass index (BMI) ≥24.0 before pregnancy, gestational diabetes mellitus, the total weight gain during pregnancy increased by more than 16 kg, gestational 36 weeks gestational age≥60, which was the risk factor for macrosomia. Logistic regression analysis of gestational diabetes mellitus, gestational 36 weeks gestational age ratio, weight gain during pregnancy and macrosomia occurred. The receiver operating characteristic curve (ROC) analysis of the 36-week gestational age and the gestational age at 36 weeks showed that the area under the curve was 0.876 and 0.751 respectively (P <0.01) When the critical value was 36 cm, the sensitivity was 0.755 and the misdiagnosis rate was 0.124. The sensitivity was 0.663 and the misdiagnosis rate was 0.225 when the critical value of uterine height at 36 weeks of pregnancy was 140 cm. Conclusion: There are many risk factors for childbirth. Especially for pregnant women who are overweight and old, pregnant women should strengthen health education and risk management during pregnancy to control their weight gain and prevent gestational diabetes. Around the change. 36 weeks of pregnancy to 36-h high threshold for the assessment of macrosomia occurred in children than the predictive value of 36 weeks of pregnancy + abdominal circumference threshold of 140 cm in sensitivity and misdiagnosis rate better.