个体化医学营养治疗对妊娠期糖尿病妊娠结局的影响

INFLUENCE OF INDIVIDUALIZED MEDICAL NUTRITION THERAPY ON PREGNANCY OUTCOME OF PATIENTS WITH GESTATIONAL DIABETES MELLITUS

目的 探讨个体化医学营养治疗（MNT）对妊娠期糖尿病（GDM）的孕妇及其胎儿的影响.方法 将2011年1月～2012年12月在我院确诊GDM的病情相似的孕妇随机分成干预组（n=193）和对照组（n=233）,干预组由营养科门诊实行个体化营养指导与跟踪,对照组由产科进行常规的饮食指导.观察两组孕妇的胰岛素使用率及其妊娠结果.结果 干预组的胰岛素使用率、孕产妇并发症、胎儿并发症、新生儿并发症及巨大儿、胎儿生长受限（FGR）、新生儿低血糖的发生率低于对照组,差异有统计学意义（p＜0.05）.两组孕产妇的子痫前期、胎膜早破、羊水过多、羊水过少、产后出血、阴道炎、早产的发生率差异均无统计学意义（p＞0.05）.两组胎儿窘迫、死胎、新生儿肺炎、新生儿湿肺、新生儿呼吸窘迫综合征的发生率差异无统计学意义（p＞0.05）.结论 由营养科专业人员对妊娠期糖尿病孕妇实行个体化医学营养治疗能降低胰岛素的使用率及对降低孕产妇、胎儿、新生儿并发症方面有积极意义,能改善妊娠结局,值得推广.

Objeetlve To investigate the influence of individualized medical nutrition therapy on pregnant women with gestational diabetes mellitus and fetuses. Methods 426 similar patients with gestational diabetes mellitus from January 2011 to December 2012 were randomly divided into treatment group （n = 193 ） and control group （n = 233 patients）. Treatment group was under the individualized nutrition guidance of nutritionists; the control group was under the regular diet guidance of obstetrician. Observe the pregnancy outcomes of pregnant women in two groups. Resuits The rate of maternal, fetal, and neonatal complications, macrosomia, fetal growth restriction and neonatal hypoglycemia in treatment group were significantly lower than those in control group （p 〈 0. 05 ）. There was no significant difference in the rate of preeclampsia, premature rupture of membrane, polyhydramnios, oligohydramnios, postpartum hemorrhage, vaginitis and premature delivery between two groups （p 〉 0. 05 ）. The rate of fetal distress, fetal death, neonatal pneumonia, wet lung of the newborn and neonatal respiratory distress syndrome showed no statistically differences between two group（p 〉0. 05 ）. Conclusion The individualized medical nutrition therapy guided by clinical nutrition professionals influencing on the gestational diabetes mellitus may reduce the incidence of complications of pregnant women, neonates and fetuses, also reduce the usage rate of insulin. It can improve pregnancy outcomes and is worthy of spreading.