Abstract: Background　In recent years，with the extensive development and active intervention of screening for gestational diabetes mellitus，the incidence of diabetic macrosomia has gradually decreased.However，the proportion of macrosomia in pregnant women with normal glucose metabolism has increased year by year.Objective　To explore the incidence of non-diabetic fetal macrosomia （NDFMS） and its influencing factors，and to provide relevant evidence for community interventions.Methods　From January 2016 to June 2017，maternity patients who were hospitalized in the Obstetrics and Gynecology Department of Daxing Teaching Hospital of Capital Medical University and the birth weight of whose newborn baby was more than 4 000 g were selected，and 186 women who were excluded from pregnancy with diabetes were selected as the NDFMS group.And 197 women who gave birth to newborns with normal birth weight during the same period were randomly selected as the normal group.General data of maternity women and their spouses，and diet data during pregnancy and exercise-related data were collected in the form of face-to-face interviews within 5 days after delivery.Multivariate Logistic regression was used to analyze the influencing factors of NDFMS.Results　The total delivery volume was 9 942 cases，and 785 cases were fetal macrosomia，including 114 cases of diabetic fetal macrosomia and 671 cases of NDFMS.The incidence rate of diabetic fetal macrosomia was 9.77% （114/1 167），and the incidence rate of NDFMS was 7.65% （671/8 775）．The difference was statistically significant （χ2=6.377，P=0.012）．The proportion of primipara，maternal height，gestational weight gain，spouses' height，daily average staple food intake，daily average sugar intake，and daily average fruit intake in the NDFMS group were higher than those of women in the normal group （P<0.05）．Multivariate Logistic regression analysis showed that the parity 〔OR=0.556，95%CI（0.363，0.882）〕，maternal height 〔OR=1.126，95%CI（1.074，1.181）〕，gestational weight gain 〔OR=1.030，95%CI（1.004，1.056）〕，daily average fruit intake 〔OR=0.998，95%CI（0.997，0.999）〕 was the independent factors affecting NDFMS （P<0.05）．Conclusion　The incidence of NDFMS is the result of multiple factors.The primiparity，maternal height and the gestational weight gain are the high risk factors of NDFMS.Properly increasing the intake of fruit on the basis of reasonable diet may be the protective factor of NDFMS.

Key words: Fetal macrosomia, Pregnant women, Weight gain, Diet, Root cause analysis

摘要： 背景　近年来随着妊娠期糖尿病筛查工作的广泛开展和积极干预，糖尿病性巨大胎儿的发病率逐渐下降，然而临床中糖代谢正常的孕妇分娩巨大胎儿的比例逐年升高。目的　探讨非糖尿病性巨大胎儿（NDFMS）发生情况及其影响因素，为社区干预提供相关依据。方法　选取2016年1月—2017年6月在首都医科大学大兴教学医院妇产科住院分娩，新生儿体质量≥4 000 g，且排除妊娠合并糖尿病的186例产妇为NDFMS组，同时随机抽取同期分娩正常体质量新生儿的197例正常产妇为正常组。分娩后5 d内以面对面访谈的形式，采集两组产妇及配偶的一般资料、妊娠期饮食和运动相关数据，NDFMS影响因素分析采用多元Logistic回归分析。结果　2016年1月—2017年6月总分娩量为9 942例，其中巨大胎儿785例，包括糖尿病性巨大胎儿114例，NDFMS 671例。妊娠合并糖尿病产妇分娩胎儿数1 167例，非妊娠合并糖尿病产妇分娩胎儿数8 775例，糖尿病性巨大胎儿发生率为9.77%（114/1 167），NDFMS发生率为7.65%（671/8 775），差异有统计学意义（χ2=6.377，P=0.012）。NDFMS组初产妇比例、产妇身高、妊娠期增重、配偶身高、产妇妊娠期日均主食量、日均摄糖量、日均水果摄入量均高于正常组（P<0.05）。多元Logistic回归分析结果显示，产次〔OR=0.556，95%CI（0.363，0.882）〕、产妇身高〔OR=1.126，95%CI（1.074，1.181）〕、妊娠期增重〔OR=1.030，95%CI（1.004，1.056）〕、日均水果摄入量〔OR=0.998，95%CI（0.997，0.999）〕是NDFMS的独立影响因素（P<0.05）。结论　NDFMS的发生是多因素共同作用的结果，初产、产妇身高、妊娠期增重过多是NDFMS发生的高危因素，合理膳食基础上适当增加水果摄入可能是NDFMS的保护因素。

关键词: 巨大胎儿, 孕妇, 体重增长, 膳食, 影响因素分析