Cruz Jeddú, Grandía Raiden, Padilla Liset, Rodríguez Suilbert, Hernández García Pilar, Lang Prieto Jacinto, Márquez-Guillén Antonio
National Endocrinology Institute, Havana, Cuba.
MEDICC Rev. 2015 Jul;17(3):27-32. doi: 10.37757/MR2015.V17.N3.6.
INTRODUCTION Fetal macrosomia is the most important complication in infants of women with diabetes, whether preconceptional or gestational. Its occurrence is related to certain maternal and fetal conditions and negatively affects maternal and perinatal outcomes. The definitive diagnosis is made at birth if a newborn weighs >4000 g. OBJECTIVE Identify which maternal and fetal conditions could be macrosomia predictors in infants born to Cuban mothers with gestational diabetes. METHODS A case-control study comprising 236 women with gestational diabetes who bore live infants (118 with macrosomia and 118 without) was conducted in the América Arias University Maternity Hospital, Havana, Cuba, during 2002-2012. The dependent variable was macrosomia (birth weight >4000 g). Independent maternal variables included body mass index at pregnancy onset, overweight or obesity at pregnancy onset, gestational age at diabetes diagnosis, pregnancy weight gain, glycemic control, triglycerides and cholesterol. Fetal variables examined included third-semester fetal abdominal circumference, estimated fetal weight at ≥28 weeks (absolute and percentilized by Campbell and Wilkin, and Usher and McLean curves). Chi square was used to compare continuous variables (proportions) and the student t test (X ± SD) for categorical variables, with significance threshold set at p <0.05. ORs and their 95% CIs were calculated. RESULTS Significant differences between cases and controls were found in most variables studied, with the exception of late gestational diabetes diagnosis, total fasting cholesterol and hypercholesterolemia. The highest OR for macrosomia were for maternal hypertriglyceridemia (OR 4.80, CI 2.34-9.84), third-trimester fetal abdominal circumference >75th percentile (OR 7.54, CI 4.04-14.06), and estimated fetal weight >90th percentile by Campbell and Wilkin curves (OR 4.75, CI 1.42-15.84) and by Usher and McLean curves (OR 8.81, CI 4.25-18.26). CONCLUSIONS Most variables assessed were predictors of macrosomia in infants of mothers with gestational diabetes. They should therefore be taken into account for future studies and for patient management. Wide confidence intervals indicate uncertainty about the magnitude of predictive power. KEYWORDS Fetal macrosomia, fetal diseases, gestational diabetes, risk factors, risk prediction, Cuba.
引言 巨大胎儿是糖尿病女性（无论是孕前糖尿病还是妊娠期糖尿病）所生婴儿中最重要的并发症。其发生与某些母体和胎儿状况有关，并对母体和围产期结局产生负面影响。如果新生儿体重>4000g，则在出生时做出明确诊断。
目的 确定哪些母体和胎儿状况可能是古巴妊娠期糖尿病母亲所生婴儿巨大胎儿的预测因素。
方法 2002年至2012年期间，在古巴哈瓦那的阿美利加阿里亚斯大学妇产医院进行了一项病例对照研究，纳入了236例患有妊娠期糖尿病并分娩活婴的妇女（118例为巨大胎儿，118例非巨大胎儿）。因变量为巨大胎儿（出生体重>4000g）。独立的母体变量包括妊娠开始时的体重指数、妊娠开始时超重或肥胖、糖尿病诊断时的孕周、孕期体重增加、血糖控制、甘油三酯和胆固醇。检查的胎儿变量包括孕晚期胎儿腹围、≥28周时的估计胎儿体重（根据坎贝尔和威尔金曲线以及厄舍和麦克林曲线进行绝对值和百分位数计算）。采用卡方检验比较连续变量（比例），采用学生t检验（X±SD）比较分类变量，显著性阈值设定为p<0.05。计算比值比（OR）及其95%可信区间（CI）。
结果 在大多数研究变量中发现病例组和对照组之间存在显著差异，但妊娠晚期糖尿病诊断、空腹总胆固醇和高胆固醇血症除外。巨大胎儿的最高OR值出现在母体高甘油三酯血症（OR 4.80，CI 2.34 - 9.84）、孕晚期胎儿腹围>第75百分位数（OR 7.54，CI 4.04 - 14.06）以及根据坎贝尔和威尔金曲线估计胎儿体重>第90百分位数（OR 4.75，CI 1.42 - 15.84）和根据厄舍和麦克林曲线（OR 8.81，CI 4.25 - 18.26）。
结论 大多数评估变量是妊娠期糖尿病母亲所生婴儿巨大胎儿的预测因素。因此，在未来的研究和患者管理中应予以考虑。较宽的可信区间表明预测能力大小存在不确定性。
关键词 巨大胎儿；胎儿疾病；妊娠期糖尿病；危险因素；风险预测；古巴
