妊娠期糖尿病孕妇个体化管理和营养治疗效果研究

Effect of individualized management and nutrition therapy on pregnant women with GDM

目的研究个体化管理和营养治疗对妊娠期糖尿病(GDM)孕妇的治疗效果。方法选取2012年7至12月确诊为GDM的孕妇90例和同期血糖正常的孕妇92例为研究对象,通过个体化管理和营养治疗后,比较GDM孕妇和对照组孕妇血糖、妊娠并发症和新生儿并发症的发生率。结果治疗前GDM组孕妇空腹及餐后1h和2h血糖分别为(5.25±0.44)mmol/L,(8.30±0.89)mmol/L和(7.75±1.51)mmol/L;治疗后分别为(4.78±0.30)mmol/L,(7.22±0.46)mmol/L和(6.44±0.59)mmol/L,较治疗前均有明显降低,差异有统计学意义(t值分别为8.286、10.204和7.604,均P<0.05)。治疗前后,GDM组孕妇HbA1c值分别为(4.91±0.58)%和(4.69±0.83)%,差异有统计学意义(t=2.044,P<0.05)。个体化营养治疗后,GDM组和对照组孕妇空腹及餐后1h和2h血糖分别为(4.78±0.30)mmol/L,(7.22±0.46)mmol/L,(6.44±0.59)mmol/L和(4.80±0.32)mmol/L,(7.16±0.42)mmol/L,(6.29±0.44)mmol/L;差异均无统计学意义(t值分别为-0.419、0.962和1.967,均P>0.05)。两组孕妇剖宫产率、早产率及胎膜早破的发生率差异也均无统计学意义(x～2值分别为0.194、0.122和0.000,均P>0.05),两组巨大儿的出生率差异无统计学意义(Fisher确切概率法得出P=0.275)。结论个体化管理和营养治疗可有效降低GDM孕妇的血糖,并减少母婴并发症的发生。

Objective To investigate the effect of individualized management and nutrition therapy on pregnant women with gestational diabetes mellitus （ GDM） .Methods Ninety pregnant women diagnosed with GDM were selected to use the individualized management and nutrition therapy （GDM group）, and 92 women without GDM at the same period were selected （control group）.Blood glucose, incidence of gestational complications and neonatal complications of two groups were compared .Results The fasting blood glucose and the 1h and 2h postprandial glucose were 5.25 ±0.44 mmol/L, 8.30 ±0.89 mmol/L and 7.75 ±1.51 mmol/L before treatment, and they were 4.78 ± 0.30 mmol/L, 7.22 ±0.46 mmol/L and 6.44 ±0.59 mmol/L after treatment,which were significantly lower than those before treatment （t value was 8.286,10.204 and 7.604,respectively,all P〈0.05）.HbA1c was 4.91 ±0.58% before treatment and 4.69 ±0.83% after treatment in GDM group, and the difference was significant （t=2.044,P〈0.05）.After individualized nutrition therapy the fasting blood glucose and the 1h and 2h postprandial glucose were 4.78 ±0.30 mmol/L, 7.22 ±0.46 mmol/L and 6.44 ±0.59 mmol/L, respectively, in GDM group, and 4.80 ±0.32 mmol/L, 7.16 ±0.42 mmol/L and 6.29 ±0.44 mmol/L, respectively in control group .There were no significant differences （t value was -0.419,0.962,and 1.967 ,respectively,all P〉0.05）.The cesarean section rate, the incidence of premature birth and premature rupture of membrane were not significantly different （χ^2 value was 0.194,0.122,and 0.000,respectively , all P〉0.05）.There was no significant difference in the birth rate of macrosomia between two groups （Fisher P=0.275）.Conclusion Individualized management and nutrition therapy can reduce the blood glucose of pregnant women with GDM and the incidence of maternal and infantile complications .