妊娠期糖尿病孕妇补充维生素D的效果及对妊娠结局影响
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摘要
目的探讨妊娠期糖尿病孕妇补充维生素D的效果及对妊娠结局影响。方法选取2017年1～12月在我院建立健康档案且定期产检的孕妇118例,随机分为两组,对照组患者进行规范且常规科学的产检,对患者的运动情况及饮食情况进行了解,并提出相应建议,合理控制患者的体重;研究组患者定期进行血清维生素D的检查,若血清维生素D3水平正常每日补充400 U,若缺乏可以加大剂量最高至1200 U,具体剂量遵从医嘱。对比两组患者的糖化血红蛋白(HbA1c)、25(OH)D3、血磷(P)、血钙(Ca)、甲状旁腺激素(PTH)以及BMI等临床相关指标;另比较妊娠期糖尿病的发生情况、妊娠结局以及两组患者维生素D缺乏的改善情况。结果治疗后研究组的血清Ca及25(OH)D3明显升高,且PTH的含量明显下降(P<0.05),对照组各项指标在治疗前后无明显变化(P>0.05);研究组患者在治疗后维生素D的缺乏及不足的例数明显减少(P<0.05);对照组患者发生糖尿病的平均孕周明显早于研究组(P<0.05),研究组患者妊娠期糖尿病的发生率明显低于对照组(P<0.05);研究组的新生儿窒息、早产儿、新生儿死胎以及巨大儿的发生率明显低于对照组(P<0.05),对照组的顺产率明显低于研究组(P<0.05),两组的高胆红血症及产钳助产率没有明显差异(P>0.05)。结论对妊娠期患者补充维生素D,能够有效降低妊娠期糖尿病的发生,提高顺产率,降低不良妊娠的风险。
Objective To investigate the effect of vitamin D supplementation on pregnant women with gestational diabetes and its effect on pregnancy outcome.Methods A total of 118 pregnant women who were established with a health record and underwent prenatal checkups regularly in our hospital from January to December 2017 were randomly divided into two groups.The control group was received standardized and routine scientific prenatal checkups.The patient's exercise and diet was understood,and corresponding suggestions were made to control the patient's weight reasonably.The serum vitamin D in the study group patients was regularly checked.If the serum vitamin D3 level was normal,400 U of vitamin D3 was added per day.If the serum vitamin D3 was lack,the dose could increase up to 1200 U,with the specific dose following the doctor's advice.The clinically relevant indicators of glycosylated hemoglobin(HbA1 c),25(OH) D3,blood phosphorus(P),serum calcium(Ca),parathyroid hormone(PTH) and BMI in the two groups were compared.The occurrence of gestational diabetes,pregnancy outcomes,and improvement in vitamin D deficiency in both groups were compared.Results After treatment,serum Ca and 25(OH)D3 in the study group were significantly increased,and the content of PTH was significantly decreased(P<0.05).There was no significant change in the indexes before and after treatment(P>0.05).The deficiency of vitamin D and the number of patients with vitamin D deficiency and was significantly reduced after treatment(P<0.05).The average gestational age of the occurrence of diabetes in the control group was significantly earlier than that of the study group(P<0.05).The incidence of diabetes during pregnancy in the study group was significantly lower than that of the control group(P<0.05).The incidence of neonatal asphyxia,premature delivery,neonatal stillbirth and macrosomia in the study group was significantly lower than that of the control group(P<0.05).The natural labour rate of the control group was significantly lower than that of the study group(P<0.05).There was no significant difference in high bilirubin hyperlipidemia and forceps delivery rate between the two groups(P>0.05).Conclusion Vitamin D supplementation in pregnant women can effectively reduce the incidence of gestational diabetes,improve the yield and reduce the risk of adverse pregnancy.
Objective To investigate the effect of vitamin D supplementation on pregnant women with gestational diabetes and its effect on pregnancy outcome.Methods A total of 118 pregnant women who were established with a health record and underwent prenatal checkups regularly in our hospital from January to December 2017 were randomly divided into two groups.The control group was received standardized and routine scientific prenatal checkups.The patient's exercise and diet was understood,and corresponding suggestions were made to control the patient's weight reasonably.The serum vitamin D in the study group patients was regularly checked.If the serum vitamin D3 level was normal,400 U of vitamin D3 was added per day.If the serum vitamin D3 was lack,the dose could increase up to 1200 U,with the specific dose following the doctor's advice.The clinically relevant indicators of glycosylated hemoglobin(HbA1 c),25(OH) D3,blood phosphorus(P),serum calcium(Ca),parathyroid hormone(PTH) and BMI in the two groups were compared.The occurrence of gestational diabetes,pregnancy outcomes,and improvement in vitamin D deficiency in both groups were compared.Results After treatment,serum Ca and 25(OH)D3 in the study group were significantly increased,and the content of PTH was significantly decreased(P<0.05).There was no significant change in the indexes before and after treatment(P>0.05).The deficiency of vitamin D and the number of patients with vitamin D deficiency and was significantly reduced after treatment(P<0.05).The average gestational age of the occurrence of diabetes in the control group was significantly earlier than that of the study group(P<0.05).The incidence of diabetes during pregnancy in the study group was significantly lower than that of the control group(P<0.05).The incidence of neonatal asphyxia,premature delivery,neonatal stillbirth and macrosomia in the study group was significantly lower than that of the control group(P<0.05).The natural labour rate of the control group was significantly lower than that of the study group(P<0.05).There was no significant difference in high bilirubin hyperlipidemia and forceps delivery rate between the two groups(P>0.05).Conclusion Vitamin D supplementation in pregnant women can effectively reduce the incidence of gestational diabetes,improve the yield and reduce the risk of adverse pregnancy.
引文
[1]谢玲,赵得雄,李宋英.二甲双胍联合黄芪四君子汤对妊娠期糖尿病孕妇妊娠结局的影响研究[J].辽宁中医杂志,2016,(8):1678-1680.
[2]王丽萍,黄金,杨卉.口服葡萄糖耐量试验不同时间点血糖水平对妊娠期糖尿病诊断结果的差异及妊娠结局的影响研究[J].中国全科医学,2016,19(32):3918-3922.
[3] Damm P,Ho ushmand-Oeregaard A,Kelstrup L,et al.Gestational diabetes mellitus and long-term consequences for mother and offspring:A view from Denmark[J].Diabetologia,2016,59(7):1396-1399.
[4]朱庆霞.血清C反应蛋白、25-羟基维生素D3在妊娠期糖尿病发病中的意义[J].山东医药,2016,56(14):55-56.
[5]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.
[6]丁琅娟,程芙蓉.中西医结合对先兆流产早期患者的疗效及妊娠结局的影响分析[J].中华中医药学刊,2017,(5):1342-1344.
[7] Stamatina I,Jennifer S,Kelsey TW, et al. Accuracy of circulating adiponectin for predicting gestational diabetes:A systematic review and meta-analysis[J]. Diabetologia,2016,59(4):692-699.
[8] Rayanagoudar G,Hashi AA,Zamora J,et al. Quantification of the type 2 diabetes risk in women with gestational diabetes:A systematic review and meta-analysis of 95,750 women[J]. Diabetologia,2016,59(7):1403-1411.
[9]张晓,周剑利,邢军,等.妊娠期糖尿病75gOGTT不同时点血糖异常孕妇的临床特点与妊娠结局分析[J].现代妇产科进展,2016,25(4):265-268.
[10]张智慧,杨倩,石亮,等.循证护理对妊娠期糖尿病患者血糖及妊娠结局的影响[J].山东医药,2016,56(38):85-87.
[11]赵叶芳,王炳杰,焦亚楼,等.亚临床甲状腺功能减退合并妊娠期糖尿病对妊娠结局的影响[J].现代预防医学,2016,43(3):443-445.
[12] E. P. O’Sullivan,Avalos G,O’Reilly M,et al. Atlantic diabetes in pregnancy(DIP):The prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria[J]. Diabetologia,2016,54(7):1670-1675.
[13] Fu S,Li F,Zhou J,et al. The relationship between body iron status,iron intake and gestational diabetes:A systematic review and meta-analysis[J]. Medicine,2016,95(2):e2383.
[14]谢俊豪,刘玉环,黄勤.妊娠期低甲状腺素血症对妊娠结局影响的回顾性分析[J].解放军医学杂志,2017,42(3):211-216.
[15]徐先明,李菲菲.妊娠合并自身免疫性1型糖尿病对母胎的影响及诊治[J].中国实用妇科与产科杂志,2016,32(10):959-963.
[16]王巧敏,刘怀昌,李蕊,等.甲状腺功能减退对妊娠期糖尿病孕妇糖代谢及胰岛素敏感性的影响[J].广东医学,2016,37(2):245-246.
[17]田艾军,龙璨,唐琴,等.妊娠期糖尿病对胎儿体质量、皮下组织厚度及肝脏长度的影响[J].中国超声医学杂志,2016,32(1):57-60.
[18]吴跃跃,陈琳,黄新梅,等.妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察[J].中华内分泌代谢杂志,2017,33(3):198-202.
[19]张晓,白洁,赵楠楠,等.诊断GDM血糖异常点的数量与孕妇临床表现及妊娠结局关系的分析[J].中国妇产科临床杂志,2016,12(3):207-209.
[20]王秋菊,张丽红,齐峰,等.降低孕前空腹血糖受损诊断下限对妊娠期糖尿病风险评估的影响[J].中华内分泌代谢杂志,2016,32(6):475-479.
[2]王丽萍,黄金,杨卉.口服葡萄糖耐量试验不同时间点血糖水平对妊娠期糖尿病诊断结果的差异及妊娠结局的影响研究[J].中国全科医学,2016,19(32):3918-3922.
[3] Damm P,Ho ushmand-Oeregaard A,Kelstrup L,et al.Gestational diabetes mellitus and long-term consequences for mother and offspring:A view from Denmark[J].Diabetologia,2016,59(7):1396-1399.
[4]朱庆霞.血清C反应蛋白、25-羟基维生素D3在妊娠期糖尿病发病中的意义[J].山东医药,2016,56(14):55-56.
[5]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.
[6]丁琅娟,程芙蓉.中西医结合对先兆流产早期患者的疗效及妊娠结局的影响分析[J].中华中医药学刊,2017,(5):1342-1344.
[7] Stamatina I,Jennifer S,Kelsey TW, et al. Accuracy of circulating adiponectin for predicting gestational diabetes:A systematic review and meta-analysis[J]. Diabetologia,2016,59(4):692-699.
[8] Rayanagoudar G,Hashi AA,Zamora J,et al. Quantification of the type 2 diabetes risk in women with gestational diabetes:A systematic review and meta-analysis of 95,750 women[J]. Diabetologia,2016,59(7):1403-1411.
[9]张晓,周剑利,邢军,等.妊娠期糖尿病75gOGTT不同时点血糖异常孕妇的临床特点与妊娠结局分析[J].现代妇产科进展,2016,25(4):265-268.
[10]张智慧,杨倩,石亮,等.循证护理对妊娠期糖尿病患者血糖及妊娠结局的影响[J].山东医药,2016,56(38):85-87.
[11]赵叶芳,王炳杰,焦亚楼,等.亚临床甲状腺功能减退合并妊娠期糖尿病对妊娠结局的影响[J].现代预防医学,2016,43(3):443-445.
[12] E. P. O’Sullivan,Avalos G,O’Reilly M,et al. Atlantic diabetes in pregnancy(DIP):The prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria[J]. Diabetologia,2016,54(7):1670-1675.
[13] Fu S,Li F,Zhou J,et al. The relationship between body iron status,iron intake and gestational diabetes:A systematic review and meta-analysis[J]. Medicine,2016,95(2):e2383.
[14]谢俊豪,刘玉环,黄勤.妊娠期低甲状腺素血症对妊娠结局影响的回顾性分析[J].解放军医学杂志,2017,42(3):211-216.
[15]徐先明,李菲菲.妊娠合并自身免疫性1型糖尿病对母胎的影响及诊治[J].中国实用妇科与产科杂志,2016,32(10):959-963.
[16]王巧敏,刘怀昌,李蕊,等.甲状腺功能减退对妊娠期糖尿病孕妇糖代谢及胰岛素敏感性的影响[J].广东医学,2016,37(2):245-246.
[17]田艾军,龙璨,唐琴,等.妊娠期糖尿病对胎儿体质量、皮下组织厚度及肝脏长度的影响[J].中国超声医学杂志,2016,32(1):57-60.
[18]吴跃跃,陈琳,黄新梅,等.妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察[J].中华内分泌代谢杂志,2017,33(3):198-202.
[19]张晓,白洁,赵楠楠,等.诊断GDM血糖异常点的数量与孕妇临床表现及妊娠结局关系的分析[J].中国妇产科临床杂志,2016,12(3):207-209.
[20]王秋菊,张丽红,齐峰,等.降低孕前空腹血糖受损诊断下限对妊娠期糖尿病风险评估的影响[J].中华内分泌代谢杂志,2016,32(6):475-479.