摘要
目的：探讨分娩巨大儿的危险因素，为降低巨大儿发生率的干预措施提供参考依据，同时评价营养治疗对改善妊娠期糖尿病（ gestational diabetes mellitus, GDM.）孕妇妊娠结局的效果。方法：于2013-2014年期间，追踪随访在厦门市妇幼保健院常规产检并足月分娩的孕妇1041例。收集研究对象的病历档案资料。妊娠期糖尿病的孕妇，一旦确诊后，即给予饮食指导，必要时使用胰岛素治疗。根据分娩结局将研究对象分为巨大儿组与非巨大儿组，探讨发生巨大儿的危险因素。同时，评价营养治疗对改善GDM孕妇妊娠结局的效果。结果：①随着年龄的增长，孕前BMI指数的增加，胎儿的出生体重有上升的趋势；同时，胎儿出生体长与出生体重呈正相关关系，相关系数为0．717。②多因素Logistic回归分析显示，孕前BMI指数越大（OR1=2．345，P1=0．046；OR2=4．597，P2=0．005）、孕妇身高越高（OR1=2．086，P1=0．016；OR2=9．934，P2=0．001）、孕期体重总增长超过18kg（OR=2．941，P=0．001）、胎儿性别为男性（OR=1．945，P=0．022）均是分娩巨大儿的危险因素（P〈0．05）。③GDM孕妇，饮食控制血糖的达标率为79．8％。卡方分层分析显示，饮食控制未达标组的剖宫产率高于糖耐量试验正常组，差异有统计学意义（X^2=6．682，P〈0．0125）。在出生体重异常率方面，3组间（即GDM饮食控制达标组、饮食控制未达标组及糖耐量试验正常组）差异无统计学意义（P〉0．0125）。结论：①巨大儿的发生与孕前体型超重、孕妇身材高大（尤其是身高超过170cm）、孕期体重总增长超过18kg、胎儿性别为男性有关。由于孕妇身高、胎儿出生时身长、胎儿出生体重三者间呈正相关关系，胎儿出生身长与胎儿出生体重的相关性为0．717，因此在判定是否为巨大儿方面，应当要考虑胎儿出生身长的因素。②�
Objective： To discuss about the relationship between the occurrence of the macrosomia and the risk factors. To analyze the effect of the nutritional interference on the gestational diabetes mellitus （ GDM ） by pursuing the outcome of the pregnancy among the whole pregnant women. Methods： During the year from 2013 to 2014, 1 041 pregnant women were collected who did the regular check-up and had the parturition in the Xiamen Maternal and Child Health Hospital. Meanwhile, the pregnant women＇s information were collect- ed. Their outcome of the pregnancy was pursued. As soon as the pregnant women were diagnosed as the GDM, they would be guided how to control their diet and suggested them to test the glucose level. After collecting the results of the pregnancy among the whole pregnant women, they were divided into the macrosomia group and the non- maerosomia group. To explore the risk factors of the occurrence of the macrosomia by mastering those data, meanwhile to assess the effect of the nutritional inference on the result of the pregnancy of the GDM pregnant women. Results： ①With the growth of the age, the BMI was increased, the bodyweight of the fetus was arised. And the correlation ship be- tween the height and the weight of the fetus was positive （R=0. 717） . ②After analyzing the data by the multiple unconditional logistic re- gression analysis, the higher level of the BMI before pregnancy （ OR1 = 2. 345, P1 = 0. 046 ; OR2 = 4. 597, P2 = 0. 005 ）, the higher of the pregnant women＇s height （ OR1 = 2. 086, Pj = 0. 016 ; ORS = 9. 934, P2 = 0. 001 ） , the bodyweight gain over 18 kg during the whole preg- nancy （ OR=2. 941, P=0. 001 ） and the fetus was male （ OR= 1. 945, P=O. 022） might affect the incidence of the macrosomia. ③79. 8% of the GDM pregnant women could keep their glucose level in normal situation by the way of controlling diet. The rate of the cesarean section in the GDM group whom inject insulin to control the glucose level was higher than that of the control group
出处
《中国妇幼保健》
CAS
2015年第19期3246-3250,共5页
Maternal and Child Health Care of China
基金
福建省厦门市卫生和计划生育委员会研究经费资助课题
关键词
巨大儿
危险因素
妊娠期糖尿病
营养治疗
Macrosomia
Risk factors
Gestational diabetesmellitus
Nutritional inference
