营养干预体重管理对孕前超重孕产妇脂、糖代谢及妊娠结局的影响
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摘要
目的:研究孕前超重孕产妇进行营养干预体重管理,对其脂、糖代谢及妊娠结局的影响。方法:选择2016年6月——2017年5月在本院立卡并分娩的136例孕前超重孕产妇作为研究对象,其中进行营养干预体重管理者设为干预组(70例),采取常规护理者设为对照组(66例)。比较两组的血脂水平、整个孕期的增长体重、血糖水平、妊娠结局、胎儿结局、并发症。结果:孕36周时,干预组的TG、TC、LDL、HDL显著低于对照组,差异均有统计学意义(P<0. 01)。对照组整个孕期的增长体重显著大于干预组,差异具有统计学意义(P<0. 01)。干预组GDM发生率(24. 29%)显著低于对照组GDM发生率(37. 88%),差异具有统计学意义(P<0. 05)。干预组剖宫产率、巨大儿率显著低于对照组,对照组阴道分娩率、正常儿率显著低于干预组,差异均有统计学意义(P<0. 05)。干预组并发症率为12. 86%,与对照组并发症率19. 69%比较,差异无统计学意义(P>0. 05)。结论:对孕前超重孕产妇进行营养干预体重管理,可有效控制其妊娠期间的脂、糖代谢紊乱及体重增加,从而减少剖宫产率,促进母婴良性结局。
【Objective】 To study the effect of nutritional intervention weight management on fat,glucose metabolism and pregnancy outcome in overweight gravida on pre-pregnancy. 【Method】 A total of 136 overweight maternity women on pre-pregnancy delivering in our hospital from June 2016 to May 2017 were selected as the study objects. Women treated with nutritional intervention weight management were set as the intervention group( 70 cases). The rest treated with conventional care were set as the control group( 66 cases). Blood lipid level,growth weight throughout the pregnancy,blood glucose level,pregnancy outcome,fetal outcome and complications were compared between the two groups. 【Result】 At 36 weeks of gestation,TG,TC,LDL and HDL in the intervention group were significantly lower than those in the control group,and the differences were statistically significant( P < 0. 01). The growth weight of the control group during the whole pregnancy was significantly bigger than that of the intervention group,and the difference was statistically significant( P<0. 01). The incidence of GDM in the intervention group was 24. 29%,which was significantly lower than that of the control group( 37. 88%),the difference was statistically significant( P<0. 05). The cesarean section rate and the macrosomia rate in the intervention group were significantly lower than those in the control group. The vaginal delivery rate and the normal rate in the control group were significantly lower than those in the intervention group,and the differences were statistically significant( P<0. 05). The complication rate was 12. 86% in the intervention group and 19. 69% in the control group,with no statistical significance( P>0. 05). 【Conclusion】 Performing nutrition intervention weight managementto overweight gravida on pre-pregnancy can effectively control the lipid and glucose metabolism during pregnancy and weight increase,thereby reduce the cesarean section rate and promote maternal and child benign outcome.
【Objective】 To study the effect of nutritional intervention weight management on fat,glucose metabolism and pregnancy outcome in overweight gravida on pre-pregnancy. 【Method】 A total of 136 overweight maternity women on pre-pregnancy delivering in our hospital from June 2016 to May 2017 were selected as the study objects. Women treated with nutritional intervention weight management were set as the intervention group( 70 cases). The rest treated with conventional care were set as the control group( 66 cases). Blood lipid level,growth weight throughout the pregnancy,blood glucose level,pregnancy outcome,fetal outcome and complications were compared between the two groups. 【Result】 At 36 weeks of gestation,TG,TC,LDL and HDL in the intervention group were significantly lower than those in the control group,and the differences were statistically significant( P < 0. 01). The growth weight of the control group during the whole pregnancy was significantly bigger than that of the intervention group,and the difference was statistically significant( P<0. 01). The incidence of GDM in the intervention group was 24. 29%,which was significantly lower than that of the control group( 37. 88%),the difference was statistically significant( P<0. 05). The cesarean section rate and the macrosomia rate in the intervention group were significantly lower than those in the control group. The vaginal delivery rate and the normal rate in the control group were significantly lower than those in the intervention group,and the differences were statistically significant( P<0. 05). The complication rate was 12. 86% in the intervention group and 19. 69% in the control group,with no statistical significance( P>0. 05). 【Conclusion】 Performing nutrition intervention weight managementto overweight gravida on pre-pregnancy can effectively control the lipid and glucose metabolism during pregnancy and weight increase,thereby reduce the cesarean section rate and promote maternal and child benign outcome.
引文
[1]李华.个体化营养干预和体重指数管理对改善妊娠糖尿病母儿结局的影响[J].中国妇幼保健,2014,29(16):2509-2511.
[2]谢明聪.生物合成人胰岛素注射液联合营养干预应用于妊娠期糖尿病患者对于妊娠结局的影响探析[J].中国医师进修杂志,2014,37(15):54-56.
[3]姜晓静,李艳,侯克霞,等.孕前、孕期个体化营养管理对妊娠并发症及妊娠结局的影响[J].中国妇幼保健,2016,31(21):4384-4385.
[4]李霞,等.孕前体重指数和孕期体重控制对妊娠结局的影响[J].护理研究,2016,30(25):3141-3143.
[5] Poston L,Bell R,Croker H,et al. Effect of a behavioural intervention in obese pregnant women(the UPBEAT study):a multicentre,randomised controlled trial[J]. Lancet Diabetes&Endocrinology,2015,3(10):767-777.
[6]杨慧霞,狄文.妇产科学[M].北京:人民卫生出版社,2016.
[7]薛娜茹.孕前体重指数及孕期体重增长对妊娠结局的影响[J].中国医刊,2014,23(6):81-84.
[8]王艳,马永红,陆云.孕期体重指数干预对妊娠期糖耐量受损孕妇妊娠结局的影响[J].生殖医学杂志,2016,25(11):987-991.
[9] Luo X D,Dong X,Zhou J. Effects of nutritional management intervention on gestational weight gain and perinatal outcome[J]. Saudi Medical Journal,2014,35(10):1267-1270.
[10]王丽萍,等.超重孕妇孕期营养干预的效果评价[J].新疆医科大学学报,2017,40(5):659-661.
[11]张泽琛,滕越,王杰,等.营养干预对妊娠期糖尿病患者体重与妊娠结局的影响[J].卫生研究,2016,45(2):337-340.
[12] Zhang R,et al. Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women:a meta-analysis of randomized controlled trials[J].European Journal of Nutrition,2016,57(1):1-11.
[13]张洁,等.针对性膳食指导和营养管理对妊娠结局的影响[J].中国妇幼健康研究,2016,27(7):886-889.
[14]丁丽丽,程博,陈燕波,等.孕中期营养指导对妊娠糖尿病孕妇体重增长及妊娠结局的影响研究[J].中国食物与营养,2015,21(12):69-72.
[15] Grieger J A,Clifton V L. A review of the impact of dietary intakes in human pregnancy on infant birthweight[J]. Nutrients,2015,7(1):153-178.
[16]姚雪梅,等.个体化营养干预对体重指数正常孕妇妊娠结局的影响[J].实用预防医学,2017,24(4):462-464.
[2]谢明聪.生物合成人胰岛素注射液联合营养干预应用于妊娠期糖尿病患者对于妊娠结局的影响探析[J].中国医师进修杂志,2014,37(15):54-56.
[3]姜晓静,李艳,侯克霞,等.孕前、孕期个体化营养管理对妊娠并发症及妊娠结局的影响[J].中国妇幼保健,2016,31(21):4384-4385.
[4]李霞,等.孕前体重指数和孕期体重控制对妊娠结局的影响[J].护理研究,2016,30(25):3141-3143.
[5] Poston L,Bell R,Croker H,et al. Effect of a behavioural intervention in obese pregnant women(the UPBEAT study):a multicentre,randomised controlled trial[J]. Lancet Diabetes&Endocrinology,2015,3(10):767-777.
[6]杨慧霞,狄文.妇产科学[M].北京:人民卫生出版社,2016.
[7]薛娜茹.孕前体重指数及孕期体重增长对妊娠结局的影响[J].中国医刊,2014,23(6):81-84.
[8]王艳,马永红,陆云.孕期体重指数干预对妊娠期糖耐量受损孕妇妊娠结局的影响[J].生殖医学杂志,2016,25(11):987-991.
[9] Luo X D,Dong X,Zhou J. Effects of nutritional management intervention on gestational weight gain and perinatal outcome[J]. Saudi Medical Journal,2014,35(10):1267-1270.
[10]王丽萍,等.超重孕妇孕期营养干预的效果评价[J].新疆医科大学学报,2017,40(5):659-661.
[11]张泽琛,滕越,王杰,等.营养干预对妊娠期糖尿病患者体重与妊娠结局的影响[J].卫生研究,2016,45(2):337-340.
[12] Zhang R,et al. Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women:a meta-analysis of randomized controlled trials[J].European Journal of Nutrition,2016,57(1):1-11.
[13]张洁,等.针对性膳食指导和营养管理对妊娠结局的影响[J].中国妇幼健康研究,2016,27(7):886-889.
[14]丁丽丽,程博,陈燕波,等.孕中期营养指导对妊娠糖尿病孕妇体重增长及妊娠结局的影响研究[J].中国食物与营养,2015,21(12):69-72.
[15] Grieger J A,Clifton V L. A review of the impact of dietary intakes in human pregnancy on infant birthweight[J]. Nutrients,2015,7(1):153-178.
[16]姚雪梅,等.个体化营养干预对体重指数正常孕妇妊娠结局的影响[J].实用预防医学,2017,24(4):462-464.