孕期营养评价及干预措施对妊娠结局的影响

Effect of nutritional evaluation and intervention measures during pregnancy on pregnancy outcome

目的:了解厦门市孕妇孕期营养状况,分析日常饮食对体内营养素的影响,评价营养干预措施的效果,为制定合理的孕期膳食计划提供科学依据。方法:2006年1月～2008年8月间,在厦门市妇幼保健院营养科接受营养咨询的孕妇571例,分别在孕20周前、孕26～27周、孕35～36周进行3次前3天的膳食调查,同时检测体内营养素水平,探讨日常饮食与体内营养素变化的关系,评价孕期营养。随机选取同一时期在本院分娩、孕20周前正常者,但未接受孕期营养指导的产妇254例,作为对照组。追踪随访两组孕妇的妊娠结局,评价营养干预措施的效果。结果:①两组孕妇在日常膳食中,脂肪摄入占总能量的比例均达营养素推荐摄入量(RNI)的要求,88.3%的孕妇摄入过高,超过了RNI的要求。孕中、后期,孕妇钙、铁的摄入不足,尤其是孕末期,钙、铁摄入量达到RNI的孕妇分别占29.8%及8.5%。孕中、晚期,锌、维生素C、维生素A、维生素B1、维生素B2摄入量达到RNI的孕妇分别占40.9%、36.2%、44.8%、22.7%、45.9%。②孕期同时增加补充铁及维生素C,能较好地延缓血清铁蛋白浓度下降的趋势(P<0.05),增加维生素B2的摄入是孕期胆固醇水平升高的保护因素(P<0.05),而脂肪摄入过高,则是危险因素(P<0.05)。③孕期能量摄入水平控制在1900～2600kCal/d,蛋白质摄入水平控制在70～115g/d时,新生儿出生体重异常的发生比例最低。④孕期接受过营养知识健康教育和指导的孕妇,其孕期营养相关并发症发生率、剖宫产率、新生儿出生体重异常率均低于对照组(P<0.05)。结论:厦门市孕妇膳食结构有待于进一步改进,建议孕妇注重蛋白质、各类矿物质和维生素补充,减少脂肪摄入,能量与蛋白质摄入应在适宜范围内。同时大力提倡孕期营养咨询与指导,要加大孕期营养知识健康教育力度,普及营养知识,提高孕妇营养知识水平,改善妊娠结局。

Objective： To understand the nutritional status of pregnant women in Xiamen, analyze the effect of daily diet on nutrient, evaluate the effect of nutritional intervention measures and provide a basis for making a reasonable dietary plan during pregnancy. Methods： 571 pregnant women receiving nutritional counseling in Maternal and Child Health Hospital of Xiamen from January 2006 to August 2008 were selected and received dietary survey about the first three days before 20 gestational week, during 26 - 27 gestational weeks and 35 -36 gestational weeks, the levels of nutrients were detected at the corresponding period, 254 pregnant women who didnt receive nutritional counseling were selected as control group, the pregnancy outcomes in the two groups were followed up, and the effect of nutritional intervention measures were evaluated. Results ： In daily diet of the two groups, the poportion of fat intake in total energy reached the claim of recommended nutrient intake （ RNI）, 88.3% of the pregnant women ingested more than the claim of RNI. The intakes of calcium and iron were not sufficient during mid - pregnancy and late pregnancy, especially during late pregnancy, the proportions of calcium and iron intakes reaching the claim of RNI were 29. 8% and 8.5% ; during mid - pregnancy and late pregnancy, the proportions of zinc, vitamin C, vitamin A, vitamin B1 and vitamin B2 intakes reaching the claim of RNI were 40. 9%, 36. 2% , 44. 8% , 22.7% and 45.9%, respectively. The supplementation of iron and vitamin C during pregnancy could relieve the downtrend of serum feiTitin concentration （ P 〈 0. 05 ）, the increase of vitamin B2 intake was a protective factor of increase of cholesterol during pregnancy （ P 〈 0. 05） , but the high intake of fat was a risk factor （ P 〈 0. 05 ） . The incidence of abnormal birth weight of neonates was the lowest when the intake of energy during pregnancy was controlled in 1 900 -2 600 kCal/d and the intake of proteins was controlled in 70 - 115 g/d, respectively. For the pregnant women receiving health education and guidance of nutritional knowledge, the incidence of nutrition related complications, rate of cesarean section and incidence of abnormal birth weight of neonates were significantly low than those in control group （ P 〈 0.05 ） . Conclusion： The dietary pattern of pregnant women in Xiamen needs improvement, pregnant women should pay more attention to supplementation of proteins, many kinds of minerals and vitamin, the intake of fat should be reduced and the intakes of energy and proteins should be controlled within suitable range. Meanwhile, nutritional counseling and guidance during pregnancy should be promoted, the health education of nutritional knowledge during pregnancy should be enhanced, the nutritional knowledge should be propagated and the level of nutritional knowledge of pregnant women should be improved in order to improve pregnancy outcomes.