体力活动及认知观点对孕妇血糖的影响研究

Effects of Physical Activity,Cognitive Views on Gestational Diabetes Mellitus

目的探索孕妇的体力活动及认知观点与妊娠期糖尿病(GDM)发生的关系。方法采用国际体力活动调查问卷和认知观点调查问卷对2011年10月—2012年6月在南方医科大学南方医院定期做孕期检查,并且在当天进行口服葡萄糖耐量试验(OGTT)的孕妇571例进行调查。共发放调查问卷571份,剔除不合格问卷32份,获得有效问卷539份,有效率为94.4%。参照2010年国际妊娠合并糖尿病研究组织(IADPSG)推荐的GDM诊断标准,将539例孕妇分为GDM组(69例)和非GDM组(470例);并根据18.5 kg/m2≤体质指数(BMI)<24.0 kg/m2为正常,24.0 kg/m2≤BMI<28.0 kg/m2为超重,BMI≥28.0 kg/m2为肥胖,将孕妇分为正常体质量组(492例),超重组(42例)和肥胖组(5例)。观察孕妇一般资料(包括年龄、孕前BMI、体质量增长);体力活动〔体力活动强度由代谢当量(MET)表示,计算1周能量消耗〕;不同体质量孕妇在不同程度体力活动(低体力活动、中等体力活动、重体力活动)下空腹及服糖后1、2 h的血糖水平变化;孕妇的认知观点。结果与非GDM组孕妇相比,GDM组孕妇年龄较大,孕前BMI较高,体质量增长较多,差异有统计学意义(P<0.05)。GDM组孕妇的能量消耗低于非GDM组〔(833.5±384.6)METs min/周vs.(966.3±455.9)METs min/周;t=6.320,P=0.022〕。不同体质量组孕妇进行不同程度的体力活动时,空腹及服糖后1、2 h血糖水平比较,差异有统计学意义(P<0.05)。组间比较显示,进行中等体力活动时超重组服糖后1 h血糖高于正常体质量组(P<0.05);组内比较显示,3组孕妇服糖后1、2 h血糖水平均高于空腹时(P<0.05)。GDM组孕妇糖尿病的发病率、不正确健康知识和信念的持有率、早孕反应后增加食物摄入的发生率均高于非GDM组(P<0.05);而健康教育接受率低于非GDM组(P<0.05)。结论 GDM孕妇妊娠期间体力活动不足,孕妇对孕期的认知观点及相关营养知识掌握情况较差。因此,改进和强化该地区人群的健康教育与孕期体力活动势在必行。

Objective To evaluate the relationship of physical activity（PA）,cognitive views to the risk of gestational diabetes mellitus（GDM） in pregnant women.Methods A survey using International Physical Activity Questionnaire and Cognitive Perspective Questionnaire was conducted in 571 pregnant women having regular pregnancy checks and oral glucose tolerance tests（OGTT） in this hospital from October 2011 to June 2012.A total of 539 questionnaires were valid（94.4%）.The 539 subjects were divided,referring to the 2010 GDM diagnostic criteria recommended by International Association of Diabetic Pregnancy Study Group（IADPSG）,into groups GDM（n=69）,non-GDM（n=470）,and according to BMI,into groups normal BMI（18.5 kg/m2≤BMI＜24.0 kg/m2,n=492）,overweight（24.0 kg/m2≤BMI＜28.0 kg/m2,n=52）,obesity（BMI≥28.0 kg/m2,n=5）.General data（age,pre-pregnancy BMI,BM growth）,PA[its intensity represented by metabolic equivalent of energy（MET）],the changes in blood glucose（BG） of pregnant women with different BM in different degrees of PA（low,moderate,heavy）,cognitive perspectives were observed.Results The patients were older,pre-pregnant BMI higher,BM increased more in GDM group than non-GDM group,the difference was significant（P＜0.05）,and energy consumption was lower[（833.5±384.6）METs min/week vs.（966.3±455.9）METs min/week;t=6.320,P=0.022].There was significant difference in BG at fasting and after 1,2 h of sugar in the 3 groups（P＜0.05）.Group comparison showed that BG after 1 h of sugar was higher in overweight group after moderate physical activity than in normal BMI group（P＜0.05）.Intra-group comparison showed that the BG level was higher after 1,2 h of sugar than at fasting,the difference was significant（P＜0.05）.The incidence of diabetes of GDM group,the incidence rate of health knowledge and beliefs hold not correct,the incidence of increased food intake after pregnancy reaction were higher than in non-GDM group（P＜0.05）;the incidence of receiving health education was lower than non- GDM group（P＜0.05）.Conclusion The pregnant women lack PA and have poor cognitive perspectives and nutritional knowledge.Therefore,improvement and strengthening of health education and PA during pregnancy are imperative.