妊娠中期营养指导对妊娠期糖尿病孕妇及新生儿的影响
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摘要
目的探讨妊娠中期营养指导对妊娠期糖尿病孕妇及新生儿的影响。方法收集内蒙古医科大学附属医院271例常规检查的孕妇,在其孕中期给予个性化饮食指导,并在孕22～24周进行妊娠期糖尿病筛查,根据孕妇血糖水平将正常血糖水平的孕妇作为对照组(n=221例),明确诊断为妊娠期糖尿病的孕妇作为研究组(n=50)。比较2组孕妇基本资料、胎儿一般资料、孕妇饮食状况及并发症等情况。结果 2组孕妇年龄、身高、孕前BMI、孕24周BMI及产前体质量等情况比较,差异无统计学意义(P均>0.05);2组新生儿体质量、身长及胎盘重比较,差异无统计学意义(P均>0.05);研究组孕妇剖宫产率、生殖道感染与妊娠并发症发生率显著低于对照组(P均<0.05);研究组早产儿、新生儿窒息及低体重儿发生率显著低于对照组(P均<0.05);2组孕妇脂肪、蛋白质、能量摄入、碳水化合物比较,差异无统计学意义(P均>0.05)。结论妊娠中期营养指导能够有效控制妊娠期糖尿病孕妇体质量增长速度,降低母婴不良结局的发生率,有利于改善妊娠结局。
Objective To analyze the influence of nutritional guidance during middle trimester of pregnancy on pregnant women with gestational diabetes mellitus and neonates. Methods The data of 271 pregnant women for routine examination was collected in the Affiliated Hospital of Inner Mongolia medical university. The personalized dietary guidance was given during the second trimester of pregnancy. In the 22-24 weeks of pregnancy, the gestational diabetes screening was carried for them. According to the blood glucose levels, pregnant women with normal glucose levels were as the control group(n=221), and the gestational diabetes mellitus were as the study group(n=50). The basic data of pregnant women, general information of fetus, the diet condition of pregnant women, complications and other data were compared between the two groups. Results There was no significant difference in age, height, BMI before pregnancy, BMI at 24 weeks of gestation and prenatal body mass between the two groups(P>0.05); there was no significant difference in neonatal body mass, body length and placental weight between the two groups(P>0.05); the rate of cesarean section, reproductive tract infection and complications of pregnancy in the study group was significantly lower than that in the control group(P<0.05); and preterm birth in the study group was significantly lower than that in the control group(P<0.05). The incidence of neonatal asphyxia and low birth weight infants was significantly lower than that of the control group(all P<0.05); there was no significant difference in fat, protein, energy intake and carbohydrates between the two groups(all P>0.05). Conclusion Nutrition guidance during the second trimester of pregnancy can effectively control the body mass of pregnant women with gestational diabetes mellitus, which can reduce the incidence rate of complications in mother and infant, so it can improve the pregnancy outcomes.
Objective To analyze the influence of nutritional guidance during middle trimester of pregnancy on pregnant women with gestational diabetes mellitus and neonates. Methods The data of 271 pregnant women for routine examination was collected in the Affiliated Hospital of Inner Mongolia medical university. The personalized dietary guidance was given during the second trimester of pregnancy. In the 22-24 weeks of pregnancy, the gestational diabetes screening was carried for them. According to the blood glucose levels, pregnant women with normal glucose levels were as the control group(n=221), and the gestational diabetes mellitus were as the study group(n=50). The basic data of pregnant women, general information of fetus, the diet condition of pregnant women, complications and other data were compared between the two groups. Results There was no significant difference in age, height, BMI before pregnancy, BMI at 24 weeks of gestation and prenatal body mass between the two groups(P>0.05); there was no significant difference in neonatal body mass, body length and placental weight between the two groups(P>0.05); the rate of cesarean section, reproductive tract infection and complications of pregnancy in the study group was significantly lower than that in the control group(P<0.05); and preterm birth in the study group was significantly lower than that in the control group(P<0.05). The incidence of neonatal asphyxia and low birth weight infants was significantly lower than that of the control group(all P<0.05); there was no significant difference in fat, protein, energy intake and carbohydrates between the two groups(all P>0.05). Conclusion Nutrition guidance during the second trimester of pregnancy can effectively control the body mass of pregnant women with gestational diabetes mellitus, which can reduce the incidence rate of complications in mother and infant, so it can improve the pregnancy outcomes.
引文
[1] KANANI M,LEUVA B.A study of glycemic control with diet in women with gestational diabetes mellitus[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3428-3433.
[2] MOHAN J,SURIYAMOORTHI J,MENON M.Correlation of raised serum uric acid in first trimester of pregnancy and the risk of gestational diabetes:a prospective study[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3633-3636.
[3] American Diabetes Association.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2014,37(Suppl1):S81-S90.
[4] D′SOUZA K,KERSHAW E E,PULINILKUNNIL T,et al.Regulation of autotaxin and its role in obesity-induced tissue insulin resistance[J].Can J Diabet,2016,40(5):S19-S20.
[5] 罗静,常青,王廷洲,等.新妊娠期糖尿病诊断标准与围生期母儿结局分析[J].实用妇产科杂志,2012,28(9):755-758.
[6] PURNO N,DURBIC T,THORPE K,et al.Impact of normal postpartum glucose tolerance on postpartum weight change in women with recent gestational diabetes mellitus[J].Can J Diabet,2016,40(5):S17-S19.
[7] 徐晓锋,李华萍,石琴,等.生活方式干预治疗妊娠期糖尿病的研究进展[J].中国妇幼健康研究,2015,26(6):1326-1328.
[8] DALL T M,YANG W,HALDER P,et al.The economic burden of elevated blood glucose levels in 2012:diagnosed and undiagnosed diabetes,gestational diabetes mellitus,and prediabetes[J].Diabetes Care,2014,37(12):3172-3179.
[9] 孙培文,董晓静.妊娠期糖尿病的医学营养治疗疗效评价[J].实用妇产科杂志,2013,29(5):355-358.
[10] GJESING A P,RUI G,LAUENBORG J,et al.High prevalence of diabetes-predisposing variants in MODY genes among Danish women with gestational diabetes mellitus[J].J Endoc Soc,2017,1(6):681-690.
[11] 张丽红,王秋菊,曲永安,等.孕前空腹血糖、体质量指数对妊娠期糖尿病发生的预测价值[J].中华医学杂志,2015,95(33):2695-2697.
[12] 蒋新华.个体化营养膳食在妊娠期糖尿病中的应用[J].广东医学,2014,35(1):125-127.
[13] 邓翠艳,向雪雯,崔风云,等.饮食运动管理对妊娠期糖尿病的应用研究[J].中国妇幼健康研究,2016,27(12):1488-1490.
[14] JOHN L B,GHOSE S.Maternal factors associated with large for gestational age babies and its outcome when compared with those of appropriate for gestational age[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3586-3589.
[2] MOHAN J,SURIYAMOORTHI J,MENON M.Correlation of raised serum uric acid in first trimester of pregnancy and the risk of gestational diabetes:a prospective study[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3633-3636.
[3] American Diabetes Association.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2014,37(Suppl1):S81-S90.
[4] D′SOUZA K,KERSHAW E E,PULINILKUNNIL T,et al.Regulation of autotaxin and its role in obesity-induced tissue insulin resistance[J].Can J Diabet,2016,40(5):S19-S20.
[5] 罗静,常青,王廷洲,等.新妊娠期糖尿病诊断标准与围生期母儿结局分析[J].实用妇产科杂志,2012,28(9):755-758.
[6] PURNO N,DURBIC T,THORPE K,et al.Impact of normal postpartum glucose tolerance on postpartum weight change in women with recent gestational diabetes mellitus[J].Can J Diabet,2016,40(5):S17-S19.
[7] 徐晓锋,李华萍,石琴,等.生活方式干预治疗妊娠期糖尿病的研究进展[J].中国妇幼健康研究,2015,26(6):1326-1328.
[8] DALL T M,YANG W,HALDER P,et al.The economic burden of elevated blood glucose levels in 2012:diagnosed and undiagnosed diabetes,gestational diabetes mellitus,and prediabetes[J].Diabetes Care,2014,37(12):3172-3179.
[9] 孙培文,董晓静.妊娠期糖尿病的医学营养治疗疗效评价[J].实用妇产科杂志,2013,29(5):355-358.
[10] GJESING A P,RUI G,LAUENBORG J,et al.High prevalence of diabetes-predisposing variants in MODY genes among Danish women with gestational diabetes mellitus[J].J Endoc Soc,2017,1(6):681-690.
[11] 张丽红,王秋菊,曲永安,等.孕前空腹血糖、体质量指数对妊娠期糖尿病发生的预测价值[J].中华医学杂志,2015,95(33):2695-2697.
[12] 蒋新华.个体化营养膳食在妊娠期糖尿病中的应用[J].广东医学,2014,35(1):125-127.
[13] 邓翠艳,向雪雯,崔风云,等.饮食运动管理对妊娠期糖尿病的应用研究[J].中国妇幼健康研究,2016,27(12):1488-1490.
[14] JOHN L B,GHOSE S.Maternal factors associated with large for gestational age babies and its outcome when compared with those of appropriate for gestational age[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3586-3589.