膳食及运动干预对母婴结局的影响研究

目的探讨降低孕妇孕期增重及巨大儿发生率的膳食和运动干预方法。方法选择末次月经2010年7月1日～2011年3月1日,2011年10月之前分娩,共计1355例。其中能接受每周电话随访及膳食指导,并定期监测体重的孕妇为实验组,纳入研究对象681例,失访55例,剩余626例。同期于我院分娩,未做以上指导者743例作为对照组。自孕16～20周始,孕妇按孕前体重指数,根据公式计算每日能量需要量,按照膳食宝塔中所标示的各类食物建议量,及碳水化合物55%～65%,蛋白质20%～30%,脂肪20%～30%的原则,从中选择适当的食物重量及种类搭配制定一天能量摄入及运动量,并分为4组:偏瘦型:BMI<19.8;适中型:BMI19.8～26;轻度肥胖型BMI26～29及肥胖型BMI>29,按食物交换份法,据能量摄入需求,严格计算食物种类及重量,随时调整方案。结果当BMI分组为19.8～26时,指导组与对照组巨大儿发生率(P=0.037)、孕期增重(P<0.001)差异均有统计学意义。当BMI分组为>26～29时,指导组与对照组巨大儿发生率(P=0.049)、孕期增重(P=0.026)差异均有统计学意义。总体比较,指导组与对照组巨大儿发生率(P=0.007)、孕期增重(P<0.01)差异均有统计学意义。结论孕期全程膳食及运动指导可以降低巨大儿发生率,减少孕妇孕期体重增长。该方法简单可行。

Objective To explore the intervention methods of dietary and exercise to reduce the weight gain of pregnant women and lower the incidence giant baby during pregnancy. Methods Totally 1355 cases were selected at the last menstrual period July 1, 2010 to March 1,2011, birth before October 2011.All cased will accept the weekly telephone follow-up and dietary guidance, and regular monitoring of body weight of pregnant women for the experimental group included in the study of 681 cases, 55 cases lost to follow, and the remaining 626 cases. 743 cases in hospital will be taken as control group. Select proper weighted and balanced type of food to formulate energy intake and activity per day according to different level of pre-pregnancy BMI, the formula of energy intake, and in accordance with recommended levels of various types of food in the pagoda of diet, which on grounds of principle of 55%-65% carbohydrate, 20%-30% protein and 20%-30% fat at the beginning of the 16-20 weeks of pregnancy. Choose the proper food weight and type with the development of day energy intake and physical activity, and divided into four groups： underweight Type： BMI 〈19.8; moderate 6jpe： BMI 19.8 - 26; mildly obese BMI 26 - 29 and obese BMI〉 29, weekly monitoring of weight, diet and exercise, such as weeks of weight gain excessive exchange portion, food, according to the demand for energy intake, the exact computation of the types of food and weight, at any time adjustment programs. Results Intervention of dietary and exercise was conducted during all pregnancy period, significant difference was found between intervention group and control group for the incidence of giant baby （P = 0.037）, also for weight gain during pregnancy （P〈0.001） when BMI group was 19.8- 26. Also significant difference was found when BMI group was 〉26- 29. Conclusion Intervention of dietary and exercise could lower the occurrence of giant baby and reduce pregnant women＇s weight gain during pregnancy. This method is simple and feasible.