Effect of early pregnancy medical nutrition therapy on blood glucose, weight control, maternal and infant outcomes and medical compliance in gestational diabetes mellitus
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摘要:
目的 观察对妊娠期糖尿病(gestationaldiabetesmellitus, GDM)孕妇孕早期实施个体化医学营养治疗(medicalnutritiontherapy，MNT)对其孕期血糖、体重及妊娠结局的影响。 方法 2018年1—12月在衢州市妇幼保健院产科共纳入建档行定期孕检的孕早期(孕3个月)GDM孕妇100例进行临床观察。按随机数字表法分成2组，每组50例，对照组按常规进行孕检及孕期饮食指导、控制血糖的治疗，观察组在常规孕检基础上执行个体化MNT方案。比较2组孕期增重(总增重，增重异常的比例)、血糖控制情况(空腹血糖，早、中、晚餐后2 h血糖，糖化血红蛋白)、遵医行为(严格控制饮食、定期监测血糖、合理有氧运动、控制体重)执行率、糖代谢相关妊娠并发症(妊娠期高血压、妊娠期血脂异常、娩出巨大新生儿)的发生率。 结果 干预3个月后，2组血糖控制结果比较差异有统计学意义(均P>0.05)。观察组在严格控制饮食、定期监测血糖方面的遵医行为执行率(86.0%、90.0%)与对照组(70.0%、76.0%)比较差异无统计学意义(均P>0.05)，观察组在合理有氧运动、控制体重方面的遵医行为执行率(88.0%、84.0%)优于对照组(70.0%、66.0%，均P < 0.05)。观察组妊娠期血脂异常、娩出巨大新生儿发生率均低于对照组(均P < 0.05)。 结论 孕早期个体化MNT方案可以更好地提升GDM妇女遵医行为，控制孕期增重，有利于降低不良妊娠结局发生率。 Abstract:Objective This study aimed to investigate the effect of medical nutrition therapy (MNT) on blood glucose, body weight and pregnancy outcome of pregnant women with gestational diabetes mellitus (GDM). Methods A total of 100 cases of pregnant women with GDM in the first trimester of pregnancy (3 months of pregnancy), who were admitted in our hospital obstetrics department from January to December 2018 for clinical observation, were included in this study. On the basis of the random number table method, the patients were divided into two groups, 50 cases in each group. The control group received routine pregnancy examination, diet guidance and blood glucose control during pregnancy, whereas the observation group received individualised MNT regimen on the basis of routine pregnancy examination. Weight gain during pregnancy (total weight gain, the proportion of abnormal weight gain), blood glucose control results (fasting blood glucose, 2 h blood glucose after breakfast, lunch and dinner, glycosylated haemoglobin), compliance rate (strict diet control, regular blood glucose monitoring, reasonable aerobic exercise and weight control) and the incidence of pregnancy complications related to glucose metabolism (gestational hypertension, dyslipidaemia during pregnancy and delivery of giant newborns) were compared between the two groups. Results After 3 months of intervention, the results of blood glucose control in the observation group were better than those in the control group, with significant difference between the two groups (all P>0.05). The total weight gain and abnormal weight gain ratio in the observation group were lower than those in the control group (all P < 0.05). The improvement of compliance rate with strict control of diet and regular monitoring of blood sugar in the control group (70.0%, 76.0%) was better than that in the observation group (86.0%, 90.0%; all P>0.05). The improvement of compliance rate with reasonable aerobic exercise and weight control in the observation group (88.0%, 84.0%) was better than that in the control group (70.0%, 66.0%; all P < 0.05). The incidence of abnormal blood lipid in the delivery group was lower than that in the control group (P < 0.05). Conclusion Individualised MNT in early pregnancy can change the compliance rate of women with GDM, control weight gain during pregnancy and reduce the incidence of adverse pregnancy outcomes. Therefore, MNT in early pregnancy has potential clinical application. -
表 1 2组孕妇干预前一般资料比较(x±s)
组别 例数 年龄(岁) 身高(cm) BMI 分娩孕周(周) 观察组 50 33.49±3.26 161.10±5.27 26.74±0.41 39.14±1.57 对照组 50 33.37±3.18 161.33±5.46 26.82±0.53 39.05±1.88 t值 0.186 0.214 0.884 0.260 P值 0.852 0.830 0.399 0.795 
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表 2 2组孕妇干预后血糖控制情况比较(x±s)
组别 例数 空腹血糖(mmol/L) 早餐后2 h血糖(mmol/L) 中餐后2 h血糖(mmol/L) 晚餐后2 h血糖(mmol/L) 糖化血红蛋白(%) 观察组 50 4.58±0.52 6.75±1.30 6.59±1.18 6.64±1.38 6.42±0.59 对照组 50 5.96±0.89 8.68±1.57 8.48±1.62 8.71±1.52 7.11±0.90 t值 9.467 6.695 6.668 7.130 4.534 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 3 2组孕妇孕期增重情况比较(x±s)
组别 例数 孕前体重(kg) 孕期总增重(kg) 孕期增重异常[例(%)] 观察组 50 61.07±8.22 15.33±2.12 36(72.0) 对照组 50 60.88±8.15 16.97±4.63 47(94.0) 统计量 0.116a 2.277a 8.575b P值 0.908 0.025 0.003 注：a为t值，b为χ2值。
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表 4 2组孕妇遵医行为执行率比较[例(%)]
组别 例数 严格控制饮食 定期监测血糖 合理有氧运动 控制体重 观察组 50 43(86.0) 45(90.0) 44(88.0) 42(84.0) 对照组 50 35(70.0) 38(76.0) 35(70.0) 33(66.0) χ2值 3.730 3.473 4.882 4.320 P值 0.053 0.062 0.027 0.038
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表 5 2组孕妇相关妊娠并发症发生率比较[例(%)]
组别 例数 妊娠期高血压 妊娠期血脂异常 娩出巨大新生儿 观察组 50 0(0.0) 1(2.0) 1(2.0) 对照组 50 3(6.0) 12(24.0) 10(20.0) χ2值 3.093 10.698 8.274 P值 0.079 ＜0.001 0.004
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