Davis R, Woelk G, Mueller B A, Daling J
Department of Epidemiology, University of Washington Medical Center, Seattle, USA.
Epidemiology. 1995 Nov;6(6):607-11. doi: 10.1097/00001648-199511000-00008.
Macrosomia (birthweight > or = 4,500 gm) is associated with increased perinatal morbidity and mortality. Although past studies have evaluated risk factors for macrosomia, little is known about the effect of a prior macrosomic birth on the risk for a macrosomic infant in a subsequent birth. To assess the risk for delivery of a macrosomic infant subsequent to a previous macrosomic infant, we performed a population-based cohort study utilizing the Washington State linked infant birth file for 1984-1990. We identified 1,793 infants with birthweight > or = 4,500 gm who were linked to a subsequent birth and 3,596 randomly selected infants with birthweight of < 4,500 gm also linked to a subsequent livebirth. We then compared the risks for subsequent macrosomic births between the two groups. Infants with birthweights > or = 4,500 gm were 7.0 times more likely (95% confidence interval = 5.4-9.1) to have a subsequent macrosomic sibling than were infants with smaller birthweights, after controlling for pregnancy smoking status, parity, and gestational age. Race, maternal age or marital status, and diabetes mellitus did not materially affect this relation. The overall prevalence of macrosomic infants subsequent to a previous macrosomic birth was 22%, a proportion that did not vary notably with parity, or when paternity changed between successive births. Mothers with one macrosomic infant are at markedly increased risk for repeat macrosomic births.
巨大儿（出生体重≥4500克）与围产期发病率和死亡率增加相关。尽管过去的研究评估了巨大儿的风险因素，但对于既往有巨大儿出生史对后续出生时巨大儿风险的影响知之甚少。为了评估既往有巨大儿出生史后再次分娩巨大儿的风险，我们利用华盛顿州1984 - 1990年的关联婴儿出生档案进行了一项基于人群的队列研究。我们确定了1793名出生体重≥4500克且与后续出生相关的婴儿，以及3596名随机选择的出生体重<4500克且也与后续活产相关的婴儿。然后我们比较了两组后续巨大儿出生的风险。在控制了孕期吸烟状况、产次和孕周后，出生体重≥4500克的婴儿有后续巨大儿同胞的可能性是出生体重较小的婴儿的7.0倍（95%置信区间 = 5.4 - 9.1）。种族、母亲年龄或婚姻状况以及糖尿病对这种关系没有实质性影响。既往有巨大儿出生史后巨大儿婴儿的总体患病率为22%，这一比例在产次方面或连续出生时父亲身份改变时没有显著变化。有一个巨大儿婴儿的母亲再次分娩巨大儿的风险显著增加。
