妊娠期糖尿病与孕妇饮食及生活方式的病例-对照研究

Gestational diabetes mellitus and the lifestyle and dietary structure of pregnant women: a case-control study

目的探讨与妊娠期糖尿病(GDM)相关的饮食和生活方式。方法采用1∶2病例-对照研究,选取450例孕妇作为研究对象,包括150例确诊为GDM的孕妇和300例正常孕妇,用问卷调查其一般情况、妊娠情况及饮食生活情况等,并进行t检验和条件Logistic回归分析。结果两组妇女平均每日总能量、蛋白质、脂肪和碳水化合物的摄入量差异均有统计学意义(P≤0.01)。经单因素条件Logistic回归分析共有23个变量与GDM的发生有关,最终进入多因素Logistic回归模型的有7个变量,其中危险因素6个,包括血压高(OR=28.50)、不良孕产史(OR=3.10)、孕前肥胖(OR=2.80)、过量摄入水果(OR=2.40)、糖尿病家族史(OR=1.86)及喜欢吃甜食(OR=1.68);1个保护因素为进食白肉频率较高(OR=0.62)。结论多种饮食生活方式不合理与GDM发病有关;对孕妇应积极开展营养教育,合理选择食物,调整饮食结构,以减少GDM的发病率。

Objective To explore the life style and diet of pregnant women related to gestational diabetes mellitus （ GDM） in order to provide scientific evidences for the prevention of GDM. Method A total of 450 subjects were recruited in a 1∶ 2 matched case-control study including 150 pregnant women diagnosed as GDM and 300 normal pregnant women. All subjects participated in a questionnaire survey on socio-demographic characteristics,pregnancy relevant status,dietary structure and lifestyle. Conditional logistic regression analysis and t-test were used for the evaluation of relevant factors. Result There was a statistic significance of the difference between the two groups on total calorie,carbohydrate,fat and protein intakes per day （ P≤0. 01）. Twenty-three factors based on univariate analysis were associated with the occurrence of GDM. Seven factors were entered into the last logistic multivariate regression model. High blood pressure （ OR = 28. 50）,adverse pregnant history （ OR = 3. 10）,obesity before pregnancy （OR = 2. 80）,too much consumption of fruits （OR = 2. 40）,family history of DM （OR = 1. 86） and favorite of sweets （OR = 1. 68） were risk factors for GDM,while the consumption of more white meat was a protective factor （ OR = 0. 62）. Conclusion The occurrence of GDM was influenced by some adverse lifestyles,unreasonable dietary structure and other factors,such as hypertension,over weight before gestation and family history of DM. Measures should be taken to avoid and eliminate these risk factors.