Ye Jiangfeng, Zhang Lin, Chen Yan, Fang Fang, Luo ZhongCheng, Zhang Jun
MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
PLoS One. 2014 Jun 18;9(6):e100192. doi: 10.1371/journal.pone.0100192. eCollection 2014.
Macrosomia has been defined in various ways by obstetricians and researchers. The purpose of the present study was to search for a definition of macrosomia through an outcome-based approach.
In a study of 30,831,694 singleton term live births and 38,053 stillbirths in the U.S. Linked Birth-Infant Death Cohort datasets (1995-2004), we compared the occurrence of stillbirth, neonatal death, and 5-min Apgar score less than four in subgroups of birthweight (4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g vs. reference group 3500-4000 g) and birthweight percentile for gestational age (90th-94th percentile, 95th-96th, and ≥ 97th percentile, vs. reference group 75th-90th percentile).
There was no significant increase in adverse perinatal outcomes until birthweight exceeded the 97th percentile. Weight-specific odds ratios (ORs) elevated substantially to 2 when birthweight exceeded 4500 g in Whites. In Blacks and Hispanics, the aORs exceeded 2 for 5-min Apgar less than four when birthweight exceeded 4300 g. For vaginal deliveries, the aORs of perinatal morbidity and mortality were larger for most of the subgroups, but the patterns remained the same.
A birthweight greater than 4500 g in Whites, or 4300 g in Blacks and Hispanics regardless of gestational age is the optimal threshold to define macrosomia. A birthweight greater than the 97th percentile for a given gestational age, irrespective of race is also reasonable to define macrosomia. The former may be more clinically useful and simpler to apply.
产科医生和研究人员对巨大儿有多种定义方式。本研究的目的是通过基于结局的方法寻找巨大儿的定义。
在美国出生-婴儿死亡队列关联数据集（1995 - 2004年）中，对30,831,694例单胎足月活产和38,053例死产进行研究，我们比较了出生体重亚组（4000 - 4099克、4100 - 4199克、4200 - 4299克、4300 - 4399克、4400 - 4499克、4500 - 4999克与参照组3500 - 4000克）以及孕周对应的出生体重百分位数（第90 - 94百分位数、第95 - 96百分位数和≥第97百分位数，与参照组第75 - 90百分位数）中死产、新生儿死亡以及5分钟阿氏评分低于4分的发生率。
直到出生体重超过第97百分位数，围产期不良结局才显著增加。在白人中，当出生体重超过4500克时，体重特异性比值比（OR）大幅升至2。在黑人和西班牙裔中，当出生体重超过4300克时，5分钟阿氏评分低于4分的调整后比值比超过2。对于阴道分娩，大多数亚组的围产期发病率和死亡率的调整后比值比更大，但模式相同。
无论孕周如何，白人出生体重超过4500克，或黑人和西班牙裔出生体重超过4300克是定义巨大儿的最佳阈值。对于给定孕周，出生体重超过第97百分位数，无论种族如何，定义巨大儿也合理。前者在临床上可能更有用且应用更简单。
