营养干预模式降低妊娠期糖尿病孕妇血糖及并发症的研究

Effect of nutritional intervention model on reducing blood glucose and complication in gestational diabetes mellitus patients

目的探讨两种不同的营养干预模式对妊娠期糖尿病孕妇的血糖及产科并发症的影响。方法 220名妊娠期糖尿病孕妇按1:1随机分为连续性医学营养治疗组(研究组)和传统营养健康教育组(对照组),研究组给予个性化医学营养治疗及自我血糖监测方法,整个孕期连续性营养监测指导不少于6次,对照组给予传统饮食指导和健康教育,整个孕期只进行1次指导,2周监测一次餐后2h血糖直至妊娠结束。观察两组血糖控制情况及产科并发症。结果两组孕妇在教育前餐后2h血糖无统计学意义(t=0.87,P=0.39)。而两组干预后餐后2h血糖均有下降,两组干预前后均有统计学意义(t=15.78,P<0.01;t=9.04,P<0.01)。研究组干预前后的下降值明显高于对照组,组间比较差异有统计学意义(t=4.71,P<0.01)。两组的产科并发症比较中发现,在早产儿发生率、产时失血量方面差异没有统计学意义;在羊水过多、妊高征、巨大儿、新生儿体重、分娩方式、胎膜早破等方面,研究组低于对照组,差异有统计学意义。结论连续性医学营养治疗模式更有助于妊娠期糖尿病孕妇控制血糖和降低产科并发症,值得临床推广。

Objective To compare the effect of nutrition intervention models on blood glucose control and obstetrics complication in patients with gestational diabetes.Methods The 220 GDM women were randomly divided into medical nutrition therapy group （the research group） and traditional nutrition health education group （the control group）. Individualized MNT, self-monitoring of blood glucose and nutritional monitoring for no less than six times during pregnancy were performed in the research group; meanwhile traditional nutrition health education for only one time during pregnancy were conducted in the control group.Then 2-hour postprandial blood glucose level in two groups were observed every two weeks until the end of pregnancy. The level of blood glucose and pregnant outcomes were compared between two groups. Results There was no significant difference in blood glucose levels before meal and two hours after meal between the two groups before the intervention （t=0.87,P=0.39）. 2-bout postprandial blood glucose level of both groups after the intervention were significantly decreased （t=-15.78, P〈0.01, t=-9.04, P〈0.01）. And the 2-hour postprandial glucose level of research group decreased significantly than the control group after the intervention （t=4.71,P〈0.01）. There were no significant differences in the incidence of premature birth and intrapartum hemorrhage between two groups. The incidences of polyhydramnios, pregnancy-induced hypertension, macrosomia, high birth weight, cesarean delivery and premature rupture of membrane in the research group were significantly lower than the control group. Conclusions The continuous MNT model is effective for controlling blood glucose and preventing＇obstetrical complications.