综合营养管理对妊娠期糖尿病患者的血糖及妊娠结局的影响OACSTPCD
Effect of comprehensive nutrition management on blood glucose and pregnancy outcome of individuals with gestational diabetes mellitus
目的 探讨综合营养管理对妊娠期糖尿病(GDM)患者糖脂代谢及妊娠结局的影响.方法 本研究纳入了2021 年 5 月～2021 年 7 月共 121 名在全国 6 个分中心医院产科建档的妊娠 24～28 周的GDM孕妇,随机分为干预组(n=74)和对照组(n=47).干预组接受综合营养管理,包括至少 6 次门诊干预、个体化营养管理及妊娠期糖尿病半日规范化门诊宣教,并持续使用动态血糖监测仪和指血血糖监测仪监测血糖,每 4 周进行糖化白蛋白和尿常规检测,记录体质量、体成分、饮食运动实施、胎儿发育以及并发症发生情况.对照组接受常规营养指导.比较两组孕 37 周的血糖相关指标、分娩前的体质量增加和部分脂类代谢指标、妊娠结局以及产后 42d口服葡萄糖耐量试验(OGTT)结果的差异.结果 与对照组相比,干预组孕妇的产前空腹血糖(P=0.006)、餐后 2h静脉血浆葡萄糖(P=0.009)、血酮(P=0.044)水平显著降低.两组间体质量增加值与体质量达标率没有显著性差异.干预组孕妇的产后 2h OGTT试验结果小于对照组(P=0.006),差异有统计学意义,子痫前期的发生率和产后出血量低于对照组,但两组之间没有统计学差异.对于新生儿来说,干预组的巨大儿(P=0.042)、剖宫产(P=0.048)的发生率略低于对照组,结果有统计学差异.其他不良妊娠结局在两组之间没有统计学差异.结论 强化综合营养管理能够更好地控制孕妇血糖水平,改善GDM妇女的孕产妇和新生儿结局.
Objective To investigate the effects of comprehensive nutrition management on glycolipid metabolism and pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 121 pregnant women with GDM at 24-28 weeks gestation who were registered in the obstetrics department of 6 sub-central hospi-tals in China from May 2021 to July 2021 were included in this study and were randomly divided into intervention group(n=74)and control group(n=47).The intervention group received intensive comprehensive nutrition man-agement,including at least 6 outpatient interventions,individualized nutrition management and a half-day standard-ized outpatient education on gestational diabetes mellitus,continuous dynamic blood glucose monitoring and micro-blood glucose monitoring,and routine check of glycated albumin and urine every 4 weeks.Body weight,body com-position and diet and exercise implementation procedures and fetal development as well as complications were recor-ded.The control group received conventional nutritional guidance.The two groups were compared for difference in blood glucose related indicators at 37 weeks of gestation,weight gain before delivery,some lipid metabolism indica-tors,pregnancy outcomes,and oral glucose tolerance test(OGTT)at 42 days postpartum.Results Compared with the control group,the level of prenatal fasting blood glucose(P=0.006),intravenous plasma glucose(P=0.009)and blood ketone(P = 0.044)in the intervention group was significantly reduced.There was no significant difference in weight gain and weight attainment rate between the two groups.The 2-hour postpartum OGTTs of preg-nant women in the intervention group(P=0.006)were significantly lower than those in the control group,and the incidence of preeclampsia and postpartum blood loss were lower than those in the control group but no statistical difference was found.For newborns,the incidence of macrosomia(P=0.042)and planation(P=0.048)in the in-tervention group was slightly lower than that in the control group,and the results were statistically different.Other adverse pregnancy outcomes were not statistically different between the two groups.Conclusions Intensive compre-hensive nutrition management has a positive impact on the control of the blood glucose in pregnant women and im-proves the maternal and neonatal outcomes of women with GDM.
王瑞;柒铭铭;杨微涛;黄健;肖锦艳;李一春;王永红;刘燕萍
中国医学科学院 北京协和医学院 北京协和医院 临床营养科,北京 100730株洲市中心医院 临床营养科,湖南 株洲 412001长沙市妇幼保健院 妇产科,湖南 长沙 410007中南大学湘雅二医院 妇产科,湖南 长沙 410011岳阳市妇幼保健院 妇产科,湖南 岳阳 414021南华大学附属第二医院 妇产科,湖南 衡阳 421000郴州市第一人民医院 妇产科,湖南 郴州 423003
预防医学
妊娠期糖尿病综合营养管理妊娠结局
gestational diabetes mellituscomprehensive nutrition managementpregnancy outcome
《基础医学与临床》 2024 (004)
434-439 / 6
中国医药教育协会(药教协项字[2021]第007号)
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