摘要目的 了解2011年中国单胎足月巨大儿的发生率及其危险因素. 方法 采用分层整群随机抽样的方法,调查全国14个省(自治区、直辖市)37家不同级别的医院2011年1月1日至12月31日分娩的101723例足月、单胎、活产新生儿.采用比值比(odd ratio,OR),95％可信区间(confidence interval,CI)描述相关危险因素与巨大儿发生的危险.采用人群归因危险度(population attributable risk,PAR)定量描述相关危险因素与巨大儿发生的关系. 结果 14个省(自治区、直辖市)巨大儿的总体发生率为7.3％(7403/101 723),范围为4.1％～13.4％.Logistic回归分析结果显示,巨大儿的发生危险因素为:北方地区(校正OR=1.4,95％ CI:1.2～1.6,PAR=19.9％)、母亲年龄≥35岁(校正OR=1.11,95％CI:0.9～1.3,PAR=8.7％)、孕前体重指数≥28.0(校正OR=3.6,95％CI:2.9～4.5,PAR=15.1％)、孕次＞1次(校正OR=1.2,95％CI:1.1～1.4,PAR=10.8％)、产次＞1次(校正OR=1.8,95％CI:1.5～2.1,PAR=10.1％)、母亲身高≥160 cm(校正OR=1.6,95％CI:1.4～1.9,PAR=29.5％)、孕期增重≥16 kg(校正OR=2.2,95％CI:1.9～2.4,PAR=25.2 ％)、妊娠期糖尿病(校正OR=1.2,95％CI:1.0～1.3,PAR=3.2％)、分娩孕周≥40周(校正OR=2.4,95％ CI:2.1～2.7,PAR=34.4％)、男胎(校正OR=1.6,95％CI:1.4～1.8,PAR=25.4％).其中孕前体重指数、分娩孕周、孕期增重是3个与巨大儿发生关系最为密切的危险因素.结论 巨大儿发生率有明显地域差别.孕前体重指数、分娩孕周、孕期增重作为可调控危险因素,应受到更多关注.

abstractsObjective To investigate the prevalence of macrosomia in China and the risk factors.Methods By stratified cluster random sampling,the medical records of 101 723 singleton term infants born in 37 hospitals nation wide (in 14 provinces) from January 1,2011 to December 31,2011 were reviewed.Adjusted odd ratio (aOR) and 95％ confidence interval (CI) were used to describe the risk factors.Population attribute risk (PAR) was used to quantitatively describe the associations between risk factors and the prevalence of macrosomia.Results The general prevalence of macrosomia was 7.3％ (7403/101 723).The prevalence varied among provinces (4.1％ to 13.4 ％).Logistic regression analysis showed that macrosomia were positively associated with living in northern China (aOR =1.4,95 ％ CI:1.2 ～ 1.6,PAR =19.9 ％),maternal age ≥ 35 (aOR =1.1,95％ CI:0.9～1.3,PAR=8.7％),pre-pregnant BMI≥28 (aOR=3.6,95％ CI:2.9～4.5,PAR=15.1％),gravidity＞1 (aOR=1.2,95％ CI:1.1～1.4,PAR=10.8％),parity＞1 (aOR=1.8,95％ CI:1.5～ 2.1,PAR=10.1％),maternal height≥160 cm (aOR =1.6,95％ CI:1.4～ 1.9,PAR=29.5％),gestational weight gain (GWG) ≥16 kg (aOR=2.2,95％ CI:1.9～2.4,PAR=25.2％),gestational diabetes mellitus (aOR=1.2,95％ CI:1.0～ 1.3,PAR =3.2％),gestational weeks≥40(aOR=2.4,95％ CI:2.1～ 2.7,PAR=34.4％)and baby boy (aOR=l.6,95％ CI:1.4～1.8,PAR=25.4％).Maternal BMI,gestational week and GWG were most strongly associated with macrosomia.Conclusions The prevalence of macrosomia varied dramatically between different areas in China.Pre-pregnancy BMI,gestational week and GWG,as the main modifiable risk factors for macrosomia,need more attention from health care providers.