摘要
目的:探讨有巨大儿分娩史女性再次妊娠不同孕期增重情况下,巨大儿分娩史与不良妊娠结局的关系。方法:选取2020年1月至2023年11月在吉林大学第二医院分娩的有巨大儿分娩史的单胎经产妇作为巨大儿分娩史组(500例)进行回顾性研究。同时按年龄(±1岁)进行1∶3匹配,选取无巨大儿分娩史单胎经产妇1500例作为对照组。比较两组孕妇的一般情况、孕期增重及妊娠结局的差异。根据中国卫生行业标准推荐的增重适宜值将两组孕妇分为增重不足、增重适宜和增重过多,采用多因素Logistic回归分析比较不同孕期增重情况下巨大儿分娩史与不良妊娠结局的关系。结果:巨大儿分娩史组孕妇孕期增重过多的比例(50.60%vs.48.13%),妊娠期糖尿病(GDM)发生率(23.40%vs.17.07%)、剖宫产率(60.20%vs.45.33%)及巨大儿分娩率(26.60%vs.7.87%)均显著高于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,巨大儿分娩史是再次妊娠发生GDM、剖宫产及巨大儿的独立危险因素(aOR>1,P<0.05)。根据孕期增重进行分层分析时发现,与对照组比较,无论孕期增重情况如何,有巨大儿分娩史孕妇发生剖宫产及巨大儿的风险均较高(aOR>1,P<0.05),而有巨大儿分娩史的孕期增重过多者子痫前期(aOR 3.167,P<0.05)及GDM(aOR 1.661,P<0.05)的发生风险显著增加。当有巨大儿分娩史孕妇孕期增重适宜时,巨大儿分娩史与子痫前期及GDM无显著相关性(P>0.05)。结论:巨大儿分娩史会增加GDM、剖宫产及巨大儿等多种不良妊娠结局的发生风险,对于不同孕期增重的经产妇,巨大儿分娩史女性发生剖宫产及巨大儿的风险都显著升高;当孕期增重在适宜范围时,巨大儿分娩史未发现是子痫前期及GDM的独立危险因素。
Objective:To explore the association between macrosomia delivery history and adverse pregnancy outcomes in subsequent pregnancies under different stratification of gestational weight gain(GWG).Methods:A retrospective study was conducted on 500 multiparous women with a history of macrosomia delivery who gave birth at The Second Hospital of Jilin University from January 2020 to November 2023.Meanwhile,1500 multiparous women without a history of delivering macrosomic infants were selected as the control group through 1∶3 matching based on age(±1 year).The differences in general characteristics,GWG,and pregnancy outcomes between the two groups were compared.According to the appropriate GWG values recommended by Chinese health industry standards,pregnant women in both groups were classified into insufficient GWG,appropriate GWG,and excessive GWG.Multivariate Logistic regression analysis was used to compare the relationship between a history of macrosomia delivery and adverse pregnancy outcomes under different GWG stratifications.Results:The History of macrosomia group had significantly higher rates of excessive GWG(50.60%vs.48.13%),incidence of gestational diabetes mellitus(GDM)(23.40%vs.17.07%),rate of cesarean section(60.20%vs.45.33%),and rate of macrosomia(26.60%vs.7.87%)compared to the control group(P<0.05).Multivariate Logistic regression analysis showed that a history of macrosomia delivery was an independent risk factor for GDM,cesarean section,and macrosomia in subsequent pregnancies(aOR>1,P<0.05).Stratified analysis based on GWG revealed that,compared with the control group,regardless of the GWG status,the risk of cesarean section and macrosomia was higher in women with a history of macrosomia delivery(aOR>1,P<0.05).Moreover,for those with a history of macrosomia delivery and excessive weight gain during pregnancy,the risk of preeclampsia(aOR 3.167,P<0.05)and GDM(aOR 1.661,P<0.05)was significantly increased.When the GWG was appropriate for pregnant women with a history of macrosomia delivery,there was no significant correlation between a history of macrosomia delivery and preeclampsia or GDM(P>0.05).Conclusions:A history of macrosomia delivery increased the risk of multiple adverse pregnancy outcomes,such as GDM,cesarean section,and macrosomia.For multiparous women at different GWG levels,the risk of cesarean section and macrosomia was significantly increased in those with a history of macrosomia delivery.When GWG was appropriate,a history of macrosomia delivery was not found to be an independent risk factor for preeclampsia and GDM.
作者
王佳
郑亚男
李雪松
夏晶莹
隋颖
赵艳晖
WANG Jia;ZHENG Yanan;LI Xuesong(Department of Obstetrics,The Second Hospital of Jilin University,Changchun Jilin 130041,China)
出处
《实用妇产科杂志》
北大核心
2025年第11期935-939,共5页
Journal of Practical Obstetrics and Gynecology
基金
吉林省卫生健康科技能力提升项目(编号:2021LC018)。
关键词
巨大儿分娩史
巨大儿
妊娠期糖尿病
孕期增重
History of macrosomia delivery
Macrosomia
Gestational diabetes mellitus
Gestational weight gain
