Maternal height and newborn size relative to risk of intrapartum caesarean delivery and perinatal distress
Maternal height and newborn size relative to risk of intrapartum caesarean delivery and perinatal distress
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DOI：
10.1111/j.1471-0528.2001.00181.x
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发表时间：
2001-07-01
期刊：
影响因子：
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通讯作者：
Kestler, E
中科院分区：
文献类型：
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作者：
Merchant, KM;Villar, J;Kestler, E
目的评估通过改善母亲营养等干预措施增加出生体积可能引起的产时剖腹产和围产期窘迫风险的变化;通过出生时的大小来确定与产妇身高相关的分娩风险。设计使用危地马拉围产期研究的数据对这些风险进行建模。设置危地马拉社会福利院妇产科医院的产前门诊1984年4月至1986年1月间首次产前检查的妇女。方法采用多变量logistic回归模型估计产时剖腹产和围产期窘迫的发生率，并计算与尺寸变化相关的风险变化。主要结局指标产时剖腹产和围产期窘迫的发生率。结果身高146 cm（-1SD）的妇女与身高160 cm（+1SD）的妇女相比，产时剖腹产的风险高2.5倍。新生儿头围和体重的增加（从-1 SD到+1 SD）分别与产时剖腹产的风险增加（分别为2.0倍和1.5倍）独立相关。出生体重从2.450克增加到2克，550 g与围产期窘迫风险降低（34/1000例）和产时剖腹产风险增加（8/1000例）相关。结论：与妊娠期营养改善相关的胎儿生长的增加，与围产期窘迫风险的增加相比，产妇有剖腹产的风险。产妇身材越高，产时剖腹产的风险越低。
Objective To estimate the changes in risk of intrapartum caesarean delivery and perinatal distress that may be introduced through increased birth size, resulting from interventions such as improving nutrition of the mother; and to characterise delivery risk relative to maternal stature by birth size.Design Model these risks using data from the Guatemalan Perinatal Study.Setting The antenatal clinic of the Gynaecology and Obstetrics Hospital of the Guatemalan Social Security Institute in Guatemala City serving predominantly working class women.Population Women who had their first prenatal visit between April 1984 and January 1986.Methods Multivariate logistic regression models were developed to estimate incidence of intrapartum caesarean delivery and perinatal distress and used to calculate changes in risk associated with changes in size.Main outcome measures Incidences of intrapartum caesarean delivery and perinatal distress.Results A woman of 146cm height (-1 SD) relative to another of 160cm (+1 SD) has a 2.5 times higher risk of intrapartum caesarean delivery. An increase in newborn head circumference and weight (from -1 SD to +1 SD) are each independently associated with an increase in risk of intrapartum caesarean delivery (2.0 times and 1.5 times, respectively). An increase in birthweight from 2.450 g to 2,550 g is associated with a decrease in risk of perinatal distress of 34/1000 cases and an increase in risk of intrapartum caesarean delivery of 8/1000 cases.Conclusions Increases in fetal growth comparable to those attributable to improved nutrition during pregnancy are associated with a larger decrease in risk of perinatal distress relative to the increase in risk of intrapartum caesarean delivery for the mother. Greater maternal stature is associated with lower risk of intrapartum caesarean delivery.