Hatsuishi Hospital, Kashiwa, Chiba, Japan.
Lancet. 2013 Feb 9;381(9865):476-83. doi: 10.1016/S0140-6736(12)61605-5. Epub 2013 Jan 4.
Macrosomia is a risk factor for adverse delivery outcomes. We investigated the prevalence, risk factors, and delivery outcomes of babies with macrosomia in 23 developing countries in Africa, Asia, and Latin America.
We analysed data from WHO's Global Survey on Maternal and Perinatal Health, which was a facility-based cross-sectional study that obtained data for women giving birth in 373 health facilities in 24 countries in Africa and Latin America in 2004-05, and in Asia in 2007-08. Facilities were selected by stratified multistage cluster sampling and women were recruited at admission for delivery. We extracted data from the medical records with a standardised questionnaire. We used logistic regression with random effects to assess the risk factors for macrosomia and the risks for caesarean section and adverse maternal and perinatal outcomes (assessed by a composite score) in babies with the disorder.
Of 290,610 deliveries, we analysed data for 276,436 singleton livebirths or fresh stillbirths. Higher maternal age (20-34 years), height, parity, body-mass index, and presence of diabetes, post-term pregnancy, and male fetal sex were associated with a significantly increased risk of macrosomia. Macrosomia was associated with an increased risk of caesarean section because of obstructed labour and post-term pregnancy in all regions. Additionally, macrosomia was associated with an increased risk of adverse maternal birth outcomes in all regions, and of adverse perinatal outcomes only in Africa.
Increasing prevalence of diabetes and obesity in women of reproductive age in developing countries could be associated with a parallel increase in macrosomic births. The effect and feasibility of control of diabetes and preconception weight on macrosomia should be investigated in these settings. Furthermore, increased institutional delivery in countries where rates are low could be crucial to reduce macrosomia-associated morbidity and mortality.
None.
巨大儿是不良分娩结局的一个危险因素。我们研究了非洲、亚洲和拉丁美洲 23 个发展中国家巨大儿的流行率、危险因素和分娩结局。
我们分析了世卫组织全球孕产妇和围产保健调查的数据，这是一项基于机构的横断面研究，在 2004-05 年期间在非洲和拉丁美洲的 24 个国家的 373 个卫生机构中收集了分娩妇女的数据，在 2007-08 年期间在亚洲收集了数据。机构采用分层多阶段聚类抽样选择，妇女在入院分娩时被招募。我们从病历中提取数据，并使用具有随机效应的逻辑回归来评估巨大儿的危险因素，以及患有该疾病的婴儿行剖宫产术和不良母婴围产结局（通过综合评分评估）的风险。
在 290610 次分娩中，我们分析了 276436 例单胎活产或新鲜死产的数据。母亲年龄（20-34 岁）、身高、产次、体重指数以及糖尿病、过期妊娠和男性胎儿性别较高与巨大儿风险显著增加相关。巨大儿与所有地区因梗阻性分娩和过期妊娠而行剖宫产术的风险增加相关。此外，巨大儿与所有地区母婴不良分娩结局的风险增加相关，仅在非洲与围产儿不良结局的风险增加相关。
发展中国家生育年龄妇女中糖尿病和肥胖症的患病率不断增加，可能与巨大儿出生人数的平行增加有关。应在这些环境中调查控制糖尿病和孕前体重对巨大儿的效果和可行性。此外，在低机构分娩率的国家增加机构分娩可能对降低与巨大儿相关的发病率和死亡率至关重要。
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