孕早期医学营养治疗对妊娠期糖尿病高危妊娠女性体重及血糖代谢并发症的影响
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摘要
目的探讨孕早期医学营养治疗(medical nutrition therapy,MNT)对有妊娠期糖尿病(gestational diabetes mellitus,GDM)高危风险因素的妊娠女性妊娠期体重及代谢并发症的影响。方法采用问卷调查形式对在北京大学人民医院建档并于2018年7月1日至12月30日分娩的GDM高危妊娠女性286例进行研究。根据问卷调查结果分组,孕早期MNT方案执行率≥50%者的130例妊娠女性为MNT组,孕早期MNT方案执行率<50%者连同未经过营养医师制定MNT方案者共156例为非MNT组。比较两组孕期总增重及孕早、中、晚期阶段性增重水平,口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果以及GDM和糖代谢相关妊娠合并症发病情况。结果 MNT组整个孕期及孕晚期体重增长水平明显低于非MNT组(P<0.05);孕早期、孕中期增重水平,孕中后期OGTT 0h、1h及2h血糖水平以及GDM、妊娠期高血压疾病、妊娠期血脂异常及妊娠期增重过多的发生率,两组差异无显著性(P>0.05)。结论孕早期MNT有助于GDM高危女性孕期的体重管理,控制孕晚期及孕期整体增重水平。
Objective To explore the effects of early nutrition intervention on weight and glycometabolism of pregnant women with high risk diabetes mellitus. Method A questionnaire was used to analyze the clinical data of patients with high-risk diabetes mellitus. A total of286 cases were divided into two groups including early medical nutrition therapy(MNT) group(n=130) and non-MNT group(n=156). The weight gain during pregnancy and three trimesters respectively, results of OGTT and the incidence of metabolic pregnancy complications were compared between the two groups. Result Weight gain during pregnancy and the third trimester were signi?cantly lower in the early MNT group than those in non-MNT group(P < 0. 05) while difference of weight gain during other period, blood glucose level of OGTT as well as the incidence of gestational diabetes mellitus(GDM), gestational hypertension, dyslipidemia and excessive weight gain during pregnancy were not signi?cant(P>0.05). Conclusion Early MNT intervention can effectively optimize the weight management of women with high-risk GDM.
Objective To explore the effects of early nutrition intervention on weight and glycometabolism of pregnant women with high risk diabetes mellitus. Method A questionnaire was used to analyze the clinical data of patients with high-risk diabetes mellitus. A total of286 cases were divided into two groups including early medical nutrition therapy(MNT) group(n=130) and non-MNT group(n=156). The weight gain during pregnancy and three trimesters respectively, results of OGTT and the incidence of metabolic pregnancy complications were compared between the two groups. Result Weight gain during pregnancy and the third trimester were signi?cantly lower in the early MNT group than those in non-MNT group(P < 0. 05) while difference of weight gain during other period, blood glucose level of OGTT as well as the incidence of gestational diabetes mellitus(GDM), gestational hypertension, dyslipidemia and excessive weight gain during pregnancy were not signi?cant(P>0.05). Conclusion Early MNT intervention can effectively optimize the weight management of women with high-risk GDM.
引文
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[12]柳亚芬,吕艳丽,王秀云,等.孕期规范化综合营养干预对妊娠期糖尿病孕妇妊娠结局的改善作用观察[J].中国医刊,2018,53(1):57-60.
[13]Shi M,Liu ZL,Steinmann P,et al.Medical nutrition therapy for pregnant women with gestational diabetes mellitus-A retrospective cohort study[J].Taiwan J Obstet Gynecol,2016,55(5):666-671.
[14]黄岩.孕前及孕期体重增长对妊娠期糖尿病发病及妊娠结局的影响[J].中国民康医学,2018,30(21):70-72.
[15]Badon SE,Enquobahrie DA,Wartko PD,et al.Healthy lifestyle during early pregnancy and risk of gestational diabetes mellitus[J].Am J Epidemiol,2017,186(3):326-333.
[16]魏玉梅,杨慧霞.妊娠期糖尿病不同诊断标准适宜性的比较[J].中华妇产科杂志,2011,46(8):578-581.
[17]李海龙,井路路,朱赛楠,等.中国糖尿病患者医学营养治疗知识调查及影响因素分析[J].中国医刊,2017,52(6):71-74.
[2]Zhu WW,Yang HX,Wang C,et al.High prevalence of gestational diabetes mellitus in beijing:effect of maternal birth weight and other risk factors[J].Chin Med J(Engl),2017,130(9):1019-1025.
[3]Pintaudi B,Fresa R,Dalfra M,et al.The risk stratification of adverse neonatal outcomes in women with gestational diabetes(STRONG)study[J].Acta Diabetol,2018,55(12):1261-1273.
[4]中华医学会糖尿病学分会,中国医师协会营养医师专业委员会.中国糖尿病医学营养治疗指南(2013)[J].糖尿病临床,2016,10(7):289-307.
[5]National Collaborating Centre for Women's and Children's Health(UK).Diabetes in Pregnancy:Management of Diabetes and Its Complications from Preconception to the Postnatal Period[M].London:National Institute for Health and Care Excellence(UK),2015.
[6]Muktabhant B,Lawrie TA,Lumbiganon P,et al.Diet or exercise,or both,for preventing excessive weight gain in pregnancy[J].Cochrane Database Syst Rev,2015(6):D7145.
[7]李斌.妊娠期糖尿病早期筛查干预对胎儿代谢及发育的影响[J].中国妇幼保健,2015,30(20):3388-3390.
[8]Song C,Li J,Leng J,et al.Lifestyle intervention can reduce the risk of gestational diabetes:a meta-analysis of randomized controlled trials[J].Obes Rev,2016,17(10):960-969.
[9]Kim C,Berger DK,Chamany S.Recurrence of gestational diabetes mellitus:a systematic review[J].Diabetes Care,2007,30(5):1314-1319.
[10]Riskin-Mashiah S,Damti A,Younes G,et al.First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus[J].Eur J Obstet Gynecol Reprod Biol,2010,152(2):163-167.
[11]Riskin-Mashiah S,Younes G,Damti A,et al.First-trimester fasting hyperglycemia and adverse pregnancy outcomes[J].Diabetes Care,2009,32(9):1639-1643.
[12]柳亚芬,吕艳丽,王秀云,等.孕期规范化综合营养干预对妊娠期糖尿病孕妇妊娠结局的改善作用观察[J].中国医刊,2018,53(1):57-60.
[13]Shi M,Liu ZL,Steinmann P,et al.Medical nutrition therapy for pregnant women with gestational diabetes mellitus-A retrospective cohort study[J].Taiwan J Obstet Gynecol,2016,55(5):666-671.
[14]黄岩.孕前及孕期体重增长对妊娠期糖尿病发病及妊娠结局的影响[J].中国民康医学,2018,30(21):70-72.
[15]Badon SE,Enquobahrie DA,Wartko PD,et al.Healthy lifestyle during early pregnancy and risk of gestational diabetes mellitus[J].Am J Epidemiol,2017,186(3):326-333.
[16]魏玉梅,杨慧霞.妊娠期糖尿病不同诊断标准适宜性的比较[J].中华妇产科杂志,2011,46(8):578-581.
[17]李海龙,井路路,朱赛楠,等.中国糖尿病患者医学营养治疗知识调查及影响因素分析[J].中国医刊,2017,52(6):71-74.
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