1994-2005 年中国东南部巨大儿的世俗趋势。
Secular trends of macrosomia in southeast China, 1994-2005.
机构信息
School of Public Health, Peking University Health Science Center, Beijing 100191, China.
出版信息
BMC Public Health. 2011 Oct 20;11:818. doi: 10.1186/1471-2458-11-818.
BACKGROUND
The rate of macrosomia (birth weight≥4, 000 g) increased over the past four decades in many parts of the world. Macrosomia is associated not only with higher risks of maternal and neonatal complications but also with health risks in adulthood. We examined trends in neonatal macrosomia and large-for-gestational-age (LGA) births among singleton, live, term and postterm births (≥37 complete weeks' gestation) in southeast China from 1994 to 2005 and explored possible causes of the temporal trends.
METHODS
Data from Perinatal Health Care Surveillance System in 12 cities and counties in southeast China were analyzed for trends in birth weight, neonatal macrosomia and LGA from 1994 to 2005. A total of 594, 472 singleton live births were included. We conducted multiple logistic regression analyses to relate these trends to changes in maternal and pregnancy characteristics.
RESULTS
The rate of macrosomia rose from 6.00% in 1994 to 8.49% in 2000 and then levelled off to 7.83% in 2005. Similar trends were observed in mean birth weight. The incidence of LGA births increased continuously from 13.72% in 1994 to 18.08% in 2000, but the LGA rate remained relatively stable from 2002 to 2005. There was a decrease in gestational age and a significant increase in frequency of prelabor caesarean delivery from 1994 to 2005. In an adjusted multivariable model, the increase in LGA rate from 1994 to 2000 was associated with increasing net gestational weight gain, maternal age, maternal height and maternal education. But they didn't fully explain the increase. The trends of 2002-2005 LGA declined after adjusted for maternal and neonatal characteristics.
CONCLUSIONS
In southeast China, the incidence of macrosomia increased from 1994 to 2000 was mainly related to increasing net gestational weight gain. The incidence of macrosomia has levelled off in recent years partly due to increasing use of prelabor caesarean delivery and earlier delivery and partly due to moderation of gestational weight gain.
背景
在过去的四十年中，世界上许多地区的巨大儿（出生体重≥4000 克）发生率都有所增加。巨大儿不仅与母婴并发症风险增加有关，而且与成年后的健康风险有关。我们研究了中国东南部 1994 年至 2005 年期间单胎、活产、足月和过期产（≥37 周完整妊娠）新生儿巨大儿和大于胎龄儿（LGA）出生的趋势，并探讨了这种时间趋势的可能原因。
方法
对中国东南部 12 个城市和县城的围产保健监测系统数据进行分析，了解 1994 年至 2005 年期间出生体重、新生儿巨大儿和 LGA 的趋势。共纳入 594472 例单胎活产。我们进行了多项逻辑回归分析，以研究这些趋势与产妇和妊娠特征变化的关系。
结果
巨大儿发生率从 1994 年的 6.00%上升到 2000 年的 8.49%，然后在 2005 年趋于平稳。平均出生体重也呈现出类似的趋势。LGA 出生的发生率从 1994 年的 13.72%持续上升到 2000 年的 18.08%，但 2002 年至 2005 年 LGA 率相对稳定。从 1994 年到 2005 年，胎龄减少，产前剖宫产的频率显著增加。在调整后的多变量模型中，1994 年至 2000 年 LGA 发生率的增加与净妊娠期体重增加、产妇年龄、产妇身高和产妇教育程度的增加有关。但这些因素并不能完全解释这种增加。调整产妇和新生儿特征后，2002-2005 年 LGA 发生率的下降趋势。
结论
在中国东南部，1994 年至 2000 年巨大儿发生率的增加主要与净妊娠期体重增加有关。近年来，巨大儿的发生率趋于平稳，部分原因是产前剖宫产的应用增加和分娩提前，部分原因是妊娠期体重增加的缓和。
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