不同程度小于胎龄儿发生的影响因素分析

Factors influencing the occurrence of small for gestational age at different degrees

摘要:

目的 探讨不同程度小于胎龄儿（small for gestational age, SGA）发生的影响因素，为早期识别重度SGA的发生提供依据。方法 回顾性收集2018年1月—2022年12月北京大学人民医院产科出生的新生儿及其母亲围产期资料。新生儿分为重度SGA组（出生体重低于同胎龄同性别婴儿的第3百分位数）、轻度SGA组（出生体重≥第3百分位数且<第10百分位数）和非SGA组（出生体重≥第10百分位数）。采用有序多分类logistic回归模型分析不同程度SGA发生的影响因素。结果 共纳入14 821例新生儿，其中重度SGA组258例（1.74%），轻度SGA组902例（6.09%），非SGA组13 661例（92.17%）。早产儿比例和死产比例均为重度SGA组>轻度SGA组>非SGA组（P<0.0125）；重度SGA组与轻度SGA组新生儿窒息比例均大于非SGA组（P<0.0125）。有序多分类logistic回归分析显示：母孕前消瘦（OR=1.838）、母孕前肥胖（OR=3.024）、体外受精-胚胎移植（OR=2.649）、妊娠合并子痫前期（OR=1.743）、妊娠合并结缔组织病（OR=1.795）、脐带绕颈（OR=1.213）、羊水少（OR=1.848）、宫内生长受限（OR=27.691）等均与发生更严重的SGA有关（P<0.05）；孕母为经产妇（OR=0.457）更倾向于不发生严重的SGA（P<0.05）。结论 母孕前消瘦、母孕前肥胖、体外受精-胚胎移植、妊娠合并子痫前期、妊娠合并结缔组织病、羊水少、脐带绕颈、宫内生长受限与更严重的SGA发生密切相关；孕母为经产妇是发生严重SGA的保护因素。

Abstract:

Objective To investigate the factors influencing the occurrence of small for gestational age (SGA) at different degrees and provide a basis for early identification of severe SGA cases.Methods Neonatal and maternal prenatal information were retrospectively collected from January 2018 to December 2022 at Peking University People's Hospital. The neonates were divided into three groups: severe SGA group (birth weight below the 3rd percentile for gestational age and sex), mild SGA group (birth weight ≥3rd percentile and <10th percentile), and non-SGA group (birth weight ≥10th percentile). An ordered multinomial logistic regression model was used to analyze the factors influencing the occurrence of SGA at different degrees.Results A total of 14 821 neonates were included, including 258 cases (1.74%) in the severe SGA group, 902 cases (6.09%) in the mild SGA group, and 13 661 cases (92.17%) in the non-SGA group. The proportions of preterm births and stillbirths were higher in the severe SGA group compared to the mild SGA and non-SGA groups (P<0.0125). The proportion of neonatal asphyxia was higher in both the severe SGA and mild SGA groups compared to the non-SGA group (P<0.0125). Ordered multinomial logistic regression analysis showed that maternal pre-pregnancy underweight (OR=1.838), maternal pre-pregnancy obesity (OR=3.024), in vitro fertilization-embryo transfer (OR=2.649), preeclampsia (OR=1.743), connective tissue disease during pregnancy (OR=1.795), nuchal cord (OR=1.213), oligohydramnios (OR=1.848), and intrauterine growth restriction (OR=27.691) were all associated with a higher risk of severe SGA (P<0.05). Maternal parity as a multipara (OR=0.457) was associated with a lower likelihood of severe SGA (P<0.05).Conclusions Maternal pre-pregnancy underweight, maternal pre-pregnancy obesity, in vitro fertilization-embryo transfer, preeclampsia, connective tissue disease during pregnancy, oligohydramnios, nuchal cord, and intrauterine growth restriction are closely related to the occurrence of more severe SGA. Maternal parity as a multipara acts as a protective factor against the occurrence of severe SGA.