Risk Factors And Individualized Prediction Of Macrosomia In A Grade A Hospital In Hefei

Objective:To analyze the risk factors of macrosomia during pregnancy and construct an individualized prediction model of macrosomia risk.To identify high-risk groups,formulate intervention strategies and reduce the incidence of macrosomia to provide guidance.Method :Using our hospital’s “His” case information system to collect inpatient clinical data of pregnant women who gave birth in Hospitalization of Hefei Maternal and Child Health Hospital from January 2017 to December 2019,and meetting the inclusion and exclusion criteria for single births in our hospital.43 194 pregnant women who gave birth were the research subjects,of whom had huge children 4 241 cases,as study group,38 953 children with normal weight,as control group.By consulting medical history,it has got details about mothers during pregnancy and newborn,which include,General clinical data such as age,production time,gestational age,etc;Pregnancy complications and complications such as gestational diabetes,polyhydramnios,etc;Pregnancy outcomes such as fetal distress,shoulder dystocia,uterine rupture,postpartum hemorrhage,etc;The general situation of newborns and pregnancy outcome such as fetal weight,fetal sex neonatal asphyxia,fetal death.The single factor and multivariate logistic regression were used to analyse the risk factors for macrosomia.A forecast nomogram model was built using the R software.Bootstrap method was used to prove the nomogram pattern and ROC was used to explore the forecast effect of the model in forecasting the macrosomia.uterine,etc.Result :1.The incidence of macrosomia in our hospital in 2017-2019 was 9.21%,and the overall incidence of macrosomia in 2017 、 2018 and 2019 was 9.95%,9.27% and8.44%,respectively,and there were statistical differences among them(x2=22.21,p<0.001).2.The study group:advanced maternal age,postpartum women,assisted reproductive technology,production time,gestational diabetes mellitus,polyhydramnios,premature rupture of membranes,fetal distress,total stage of labor,lateral perineum or soft birth canal laceration,shoulder dystocia,cephalopelvic disproportion,malposition,uterine rupture,postpartum hemorrhage,puerperal infection,puerperal intestinal obstruction,boy baby,etc.are all higher than the control group the difference was statisticallysignificant(P <0.05);The umbilical cord around the neck,oligohydramnios in the study group was lower than that in the control group,and the difference was statisticallysignificant(P<0.05);Hypertension disorders of pregnancy,abnormal thyroid function during pregnancy,intrahepatic cholestasis of pregnancy,placenta previa,placenta accreta or percreta,placental abruption,prolapse of the cord,cord entanglement,postpartum retention of urine,intrauterine fetal death,neonatal asphyxia among the two teams were no statistical difference(p>0.05).3.The multivariate logistic regression analysis showed that polyhydramnios(OR=3.769,95%CI:2.753～5.159),gestational diabetes mellitus(OR=1.927,95%CI:1.778～2.087),production time(OR=1.871,95%CI:1.8021.944),male baby(OR=1.866,95%CI: 1.745～1.996),assisted reproductive technology(OR=1.391,95%CI: 1.066～1.816),advanced maternal age(OR=1.257,95%CI:1.152～1.371)and postpartum women(OR=1.346,95%CI:1.247～1.453)are all independent risk factors for the occurrence of giant babies during pregnancy(P<0.05).4.The nomogram constructed based on the risk factors of macrosomia showed that the C-index of the nomogram model predicting the risk of macrosomia during pregnancy was 0.690;the ROC curve showed that the area under the curve for the nomogram model to predict the occurrence of macrosomia was 0.689(95%CI:0.636～0.741).Conclusion:1.The incidence of macrosomia in our hospital is higher than the state level.2.Macrosomia increase adverse pregnancy outcomes such as fetal distress,lateral perineal incision or soft birth canal laceration,shoulder dystocia,cephalopelvic disproportion,uterine rupture,postpartum hemorrhage,puerperal infection,and puerperal intestinal obstruction.3.This study is based on 7 independent risk factors of polyhydramnios,gestational diabetes mellitus,production time,male baby,assisted reproductive technology advanced maternal age and postpartum women.The nomogram model of individualized prediction of the risk of large infants is constructed with good discrimination.It has high application value for health care guidance during pregnancy,and has guiding significance for identifying high-risk groups and formulating intervention strategies.It is simple to apply and has strong operability.