医学营养治疗对妊娠期糖尿病围生期结局的影响

Effect of medical nutritional therapy on perinatal outcome of patients with gestational diabetes mellitus

目的:探讨一种新的医学营养治疗方法 (medicine nutrition treatment,MNT)在妊娠期糖尿病(gestational diabe-tes mellitus,GDM)治疗中的作用。方法:选择2009年2～7月在泰安市中心医院确诊为妊娠期糖尿病的单胎孕妇207例,随机分为实验组(110例)和对照组(97例),两组孕妇均由产科医师定期随诊,实验组孕妇采用固定营养食谱比例增减法,进行医学营养治疗;对照组则采用对产妇进行口头营养指导。结果:治疗前两组孕妇的空腹血糖及餐后2 h血糖水平间差别均无统计学意义(P>0.05);治疗后两组孕妇的空腹血糖及餐后2 h血糖水平间比较均有显著性差异(P<0.05);两组孕妇孕期体重总增加量和体重指数(BMI)的增长间差别均有显著性差异(P<0.05);新生儿出生平均体重两组比较差异有显著性意义(P<0.05);妊娠期高血压疾病共28例(13.53%),两组差异有显著性意义(P<0.05);实验组孕妇孕期血糖控制良好率及巨大儿的发生率和对照组比较均有显著性意义(P<0.05)。实验组孕妇羊水过多发生率为6.8%,低于对照组,但差别无统计学意义(P>0.05)。结论:采用固定营养食谱比例增减法,可较好的控制孕妇孕期血糖和孕期体重的增加,降低母婴并发症,改善围生期结局。

Objective：To explore the effect of one new medical nutritional therapy on the treatment of gestational diabetes mellitus（GDM）. Methods：207 women of single pregnancy who were diagnosed as GDM in the hospital from February to July in 2009 were selected and divided into experimental group（110 women） and control group（97 women） randomly,all the pregnant women in the two groups were followed up by obstetricians regularly,the pregnant women in experimental group were treated with medical nutritional therapy,while the pregnant women in control group received nutritional guidance orally. Results：Before treatment,there was no significant difference in fasting glucose level and postprandial 2-hour blood glucose level between the two groups（P〈0.05）;while after treatment,there was significant difference（P〈0.05）.There was significant difference in the total weight gain during pregnancy and body mass index between the two groups（P〈0.05）.There was significant difference in the average birth weight of neonates between the two groups（P〈0.05）.28 women were found with hypertensive disorder complicating pregnancy,accounting for 13.53%,there was significant difference between the two groups（P〈0.05）.There was significant difference in the good rate of blood control and the incidence of macrosomia between experimental group and treatment group（P〈0.05）.The incidence of polyhydramnions in experimental group was lower than that in control group,but there was no significant difference（P〈0.05）. Conclusion：Medical nutritional therapy can control blood glucose and the increase of body weight of pregnant women,reduce maternal and infantile complications and improve perinatal outcome.