中华妇幼l临床医学杂志(电子版)2013年8月第9卷第4期巨大儿的发生及其影响因素陈蔚武明辉张娣侯东敏王军华蒋京伟贾朝霞【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,将其人组巨大儿组("一593,出生体重≥4000g)和正常体重儿组(n一7212,4000g>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(BMD,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OGTT1h,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(Pbirthweight≥2500g).AlltheindicatorsrelevanttOmacrosomiawereanalyzed,suchasbodymassindex(BMD,oralglucosetolerancetest(0GTT),commonsituation,gestationalweight,bloodglucoseanddeliverysituation.Theywerefirstlyanalyzedbyunivariateanalysismethod.Thenthemeaningfulindicatorswereanalyzedbynon-conditionalmultivariatelogisticregressionmethod.ThestudyprotocolwasapprovedbytheEthicalReviewBoardofInvestigationinHumanBeingofCapitalMedicalUniversityAffixedBeijingObstetricsandGynecologyHospital.Informedconsentwasobtainedfromtheparentsofeachparticipatingneonate.Results①Therehadsignificancedifferencebetweentwogroupsamongages,parities,gestationalageattimetObeginantenatalexaminationandasphyxiarateofneonates(P>0.05).②Therehadsignificancedifferencebetweentwogroupsamonggravidities,pre-pregnancyweight,pre—pregnancyBMI,prenatalweight,prenatalBMI,gestationalweightgain,fastingplasmaglucose,levelsofOGTT1h,2h,gestationalage,modesofdelivery,gestationalageatdelivery,andbirthweight,sexofneonates(P<0.05).③Analyzedbynon-conditionalmultivariatelogisticregressionshowedthosehighriskfactorsformacrosomiaweregestationalage≥40weeks,BMI≥28kg/cm2atdelivery,thenumberofpregnanciesreaching6,cesareansection,fastingplasmaglucose≥5.1mmol/L,malefetusandbloodglucoselevelsofO...