| BackgroundMacrosomia is defined as newborns of birth weight≥4.0kg.Macrosomia seriously affects the short-term and long-term health of mothers and newborns.The incidence of our country’s macrosomia from 1994 to 2005 had increased from 6.0%to 7.8%,shown an upward trend,but varied greatly between regions.Therefore,the preventive measures for macrosomia should be formulated according to the specific conditions of each region.There are many influence factors of macrosomia.Among them,the effect of maternal obesity on fetal weight is bidirectional,which can not only lead to the increased risk of the occurrence of macrosomia,but also the increased risk of the occurrence of small for gestational age.And the results of multiple previous studies have shown that between different pre-pregnancy BMI women,the risk factors for giant children are different,however,most of these studies use chi-square test or regression analysis,and chi-square test or regression analysis can only determine the independent role of those factors,but cannot judge the impact of the combination of multiple related or unrelated factors.However,there are many influencing factors simultaneously in human body.Only by exploring the overall distribution of each factor in the body,can we fully explore the association between macrosomia and the comprehensive effects of various influence factors,and screen out the high-risk subgroups of macrosomia in population to develop effective preventive interventions.The method of latent class analysis can realize the feature clustering of the influence factors of macrosomia,explore the distribution of each influence factor in population,and evaluate the influence of each distribution according to group level.But at present,there are few studies on the distribution characteristics of influence factors of macrosomia.ObjectiveBased on the newborn population of Pingyin Country,this study described the morbidity of macrosomia in Pingyin County,designed case-control studies to explore the influence factors of macrosomia,and analyzed the correlation between the maternal pre-pregnancy BMI levels and offspring macrosomia by using multiple methods such as cluster analysis and potential category analysis,then further explored whether there are differences in the distribution characteristics of influence factors of macrosomia in different pre-pregnancy BMI levels,to provide a scientific basis for making the prevention and control measures of macrosomia.Methods1.Research on the incidence of macrosomia in Pingyin County in the 2017 statistical yearAccording to the data of Pingyin County in the 2017 statistical year(2016.10.1-2017.9.30),including the "Birth Medical Certificate" issued by the Maternal and Child Health Hospital and the "Newborn Birth Report Card" reported quarterly by the institutions,we calculated the number and birth weight of live births and the incidence of macrosomia and singleton macrosomia.2.Exploring the influence factors of macrosomiaWe designed a case-control study,collected and collected the information of all singletons and mothers who recorded the pre-pregnancy weight in the 2017 statistical year through the electronic information system of hospitalization records in Pingyin County People’s Hospital.And then we divided the mother-child pairs into a case group(macrosomia group)and a control group(normal birth weight infant group)according to the birth weight of newborns.Univariate analysis used chi-square test or univariate logistic regression analysis,and multi-factor analysis used multi-factor logistic regression analysis to explore the influence factors of macrosomia.3.Research on the distribution characteristics of influence factors of macrosomia with different pre-pregnancy BMI levelsBased on the morbidity rate of macrosomia delivered by different pre-pregnancy BMI mothers,we used the systematic clustering method to regroup case-control study data into the macrosomia high-risk group,which was the pre-pregnancy BMI level group with a higher risk of macrosomia and the macrosomia low-risk group,which was the pre-pregnancy BMI level group with a lower risk of macrosomia.And then,we used latent class analysis to compare the differences in the distribution characteristics of macrosomia between the two groups.Results1.Basic situation of macrosomia in Pingyin County in the 2017 statistical yearIn the 2017 statistical year,4,530 newborns were delivered in Pingyin County,with 429 cases of macrosomia.The incidence of macrosomia was 9.47%.Thereinto,the number of singletons and macrosomia was 4433 and 428 respectively,and the incidence of singleton macrosomia was 9.65%.2.Research results of exploring the influence factors of macrosomiaA total of 1571 mother-child pairs were included in this study,and there were 168 macrosomia mother-child pairs and 1403 control mother-child pairs.The results of multivariate logistic regression analysis between the two groups showed that pre-pregnancy BMI overweight(OR:1.76,95%CI:1.20-2.57),excessive weight gain during pregnancy(OR:1.85,95%CI:1.24-2.75),previous history of macrosomia pregnancy(OR:6.14,95%CI:3.84-9.83),polyhydramnios(OR:3.40,95%CI:1.32-8.79),delivery gestational age≥40(OR:2.29,95%CI:1.58-3.30),summer delivery(autumn(OR:2.74,95%CI:1.51-4.98),winter(OR:2.08,95%CI:1.22-3.56)),maternal height≥165cm(OR:2.14,5%CI:1.47-3.12)were risk factors for macrosomia(P<0.05),and female fetus(OR:0.41,95%CI:0.28-0.58),umbilical cord around neck(OR:0.59,95%CI:0.41-0.84)were protective factors for macrosomia(P<0.05).3.Research results on distribution characteristics of influence factors of macrosomia in different pre-pregnancy BMI levelsThe incidence of maternal pre-pregnancy BMI overweight in the study subjects was 36.35%.Compared with the pre-pregnancy BMI≤23.50 group,when the pre-pregnancy BMI was>23.50,the risk of the occurrence of macrosomia did not increase with the increase of the pre-pregnancy BMI level.The results of cluster analysis showed that the risk of morbidity in macrosomia was clearly clustered,and the incidence of macrosomia in the macrosomia high-risk group(23.50<pre-pregnancy BMI≤29.50)was 16.30%,the incidence of macrosomia in the macrosomia low-risk groups(pre-pregnancy BMI≤23.50 or>29.50)was 7.50%.The difference in the incidence of macrosomia between the two groups was statistically significant(P<0.05).Latent category analysis results showed that the influencing factors of the macrosomia high-risk group and low-risk group could be aggregated into three potential category distribution patterns.Compared with the macrosomia low-risk groups,the macrosomia high-risk groups had a lower percentage of "the low risk factor distribution" in the population(P<0.001),and a higher percentage of "the distribution of multipara no-scarred uterine type"(P<0.001).Conclusion1.The incidence of giant children in Pingyin County is 9.47%in 2017 Statistical Year,which is at a relatively high level nationwide.2.Pre-pregnancy BMI overweight,excessive weight gain during pregnancy,the height of pregnant women≥165cm,previous pregnancy history of macrosomia,polyhydramnios,gestational age of delivery≥40,delivery in autumn or winter are risk factors for macrosomia in Pingyin County.3.When pregnant women are overweight before pregnancy,the risk of macrosomia does not increase with the increase in pre-pregnancy BMI levels.4.There are differences in the distribution characteristics of influential factors of macrosomia in different pre-pregnancy BMI levels.The pre-pregnancy BMI level group with a higher risk of macrosomia mainly was the "distribution of uterine scars by women".We suggest that Pingyin County should take targeted prevention and control measures for pregnant women with different pre-pregnancy BMI levels,focus on strengthening the mnagement of pregnant women who have a history of childbirth and are at the pre-pregnancy BMI levels where there is a higher risk of developing macrosomia. |
PDF Full Text Request