目的 了解湖南省两市小于胎龄儿(SGA)和大于胎龄儿(LGA)的发生率,并分析其影响因素,为预防SGA和LGA的发生提供理论依据。方法 采用分层整群抽样方法,选择2016年1-6月在湖南省株洲市和湘潭市当地助产机构住院分娩的孕妇作为研究对象,收集孕妇及其丈夫的社会人口学特征、家庭经济情况和妊娠情况,记录新生儿出生结局。运用χ2检验和Fisher确切概率法进行单因素的SGA和LGA发生率比较,采用无序多分类Logistic回归模型进行多因素SGA和LGA的影响因素分析。结果 SGA发生率为6.5%(328/5 012),LGA发生率为7.9%(394/5 012)。无序多分类Logistic回归模型显示,孕妇孕期进行规范产前检查为SGA和LGA共同的保护因素,孕期贫血和妊娠期高血压疾病是SGA的危险因素,妊娠糖尿病、孕妇年龄≥35岁、丈夫年龄≥30岁是LGA的危险因素。结论 孕妇孕期进行规范产前检查可降低SGA和LGA的发生风险,孕期贫血和妊娠期高血压疾病会增加SGA的发生风险,妊娠糖尿病、孕妇高龄和丈夫高龄会增加LGA的发生风险。
Abstract
Objective To understand the incidence of small gestational age (SGA) and large gestational age (LGA) infants in two cities of Hunan province,and analyze their determinants to provide evidence for prevention on SGA and LGA infants. Method sA stratified cluster sampling method was used to select the subjects,who were pregnant women hospitalized in local midwifery institutions in Zhuzhou city and Xiangtan city of Hunan province from January 2016 to June 2016.The sociodemographic characteristics of parents,family economic status and conditions related to the pregnancy were collected,and the birth information of the neonates was recorded.Chi-square test and Fisher probabilities method were used to compare the incidence of SGA and LGA infants,and multinomial Logistic regression was used to analyze the determinants of SGA and LGA infants. Results The incidence of SGA infants was 6.5% (328/5 012),and 7.9% (394/5 012) for LGA infants.The multinomial Logistic regression showed that the regulatory prenatal examination during pregnancy was the common protective factor for SGA and LGA,anemia during pregnancy and hypertensive disorders complicating pregnancy were the independent risk factors for SGA,diabetes mellitus complicating pregnancy,maternal age ≥ 35 years,and paternal age ≥ 30 years were the independent risk factors for LGA. Conclusion Regulatory prenatal examination would decrease the risk of SGA and LGA,anemia during pregnancy and hypertensive disorders complicating pregnancy would increase the risk of SGA,diabetes mellitus complicating pregnancy,increasing maternal age and paternal age would increase the risk of LGA.
关键词
小于胎龄儿 /
大于胎龄儿 /
发生率 /
影响因素
Key words
small for gestational age /
large for gestational age /
incidence /
determinant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Ruiz M,Goldblatt P,Morrison J,et al.Mother's education and the risk of preterm and small for gestational age birth:a DRIVERS meta-analysis of 12 European cohorts[J].J Epidemiol Community Health,2015,69(9):826-833.
[2] Henriksen T.The macrosomic fetus:a challenge in current obstetrics[J].Acta Obstet Gynecol Scand,2008,87(2):134-145.
[3] 徐蓉,郝加虎,陶芳标,等.10107名单胎活产儿SGA发生率及其影响因素的队列研究[J].中国妇幼保健,2012,27(4):560-565.
[4] 彭婷婷,岳福娟,王芳,等.孕前体重指数及孕期增重与小于胎龄儿的关系[J].中华流行病学杂志,2015,36(6):644-648.
[5] 袁力,何善阳,陈淑琴,等.孕前体重指数和孕期体重增加对大于胎龄儿和巨大儿发生风险的影响[J].中国妇幼保健,2010,25(35):5198-5200.
[6] 冷俊宏,王蕾棽,李卫芹,等.孕早期谷丙转氨酶与发生巨大儿和大于胎龄儿关系[J].中国公共卫生,2016,32(7):956-960.
[7] 朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制[J].中华儿科杂志,2015,53(2):97-103.
[8] Anderson NH,Sadler L,Stewart AW,et al.Independent risk factors for infants who are small for gestational age by customised birthweight centiles in a multi-ethnic New Zealand population[J].Aust N Z J Obstet Gynaecol,2013,53(2):136-142. [9] Ren A,Wang J,Ye RW,et al.Low first-trimester hemoglobin and low birth weight,preterm birth and small for gestational age newborns[J].Int J Gynaecol Obstet,2007,98(2):124-128.
[10] Palatnik A,Grobman WA,Miller ES.Is a history of preeclampsia associated with an increased risk of a small for gestational ageinfant in a future pregnancy [J].Am J Obstet Gynecol,2016,215(3):355.
[11] Sebastian T,Yadav B,Jeyaseelan L,et al.Small for gestational age births among South Indian women:temporal trend and risk factors from 1996 to 2010[J].BMC Pregnancy Childbirth,2015,15:7.
[12] Jeyaseelan L,Yadav B,Silambarasan V,et al.Large for gestational age births among South Indian women:temporal trend and risk factors from 1996 to 2010[J].J Obstet Gynaecol India,2016,66(Suppl 1):42-50.
[13] Chiavaroli V,Castorani V,Guidone P,et al.Incidence of infants born small- and large-for-gestational-age in an Italian cohort over a 20-year period and associated risk factors[J].Ital J Pediatr,2016,42:42.
[14] Kim SY,Sharma AJ,Sappenfield W,et al.Association of maternal body mass index,excessive weight gain,andgestational diabetes mellitus with large-for-gestational-age births[J].Obstet Gynecol,2014,123(4):737-744.
[15] Wang LF,Wang HJ,Ao D,et al.Influence of pre-pregnancy obesity on the development of macrosomia and large for gestational age in women with or without gestational diabetes mellitus in Chinese population[J].J Perinatol,2015,35(12):985-990.
[16] 中华医学会儿科学分会新生儿学组.我国小于胎龄儿现状分析[J].中国实用儿科杂志,2009,24(3):177-180.
基金
国家自然科学基金面上项目(81172680)