昆明市产妇孕期营养干预和代谢性危险因素对妊娠结局的影响分析

Analysis on the effects of maternal gestational nutritional intervention and metabolic risk factors on pregnancy outcomes in Kunming city

目的探讨昆明市产妇孕期营养干预和代谢性危险因素对妊娠结局的影响。方法以昆明市妇幼保健院营养科2014年1月-2016年3月接受的营养咨询、常规体检的孕妇作为研究对象,回顾性分析将采用新妊娠期糖尿病诊断标准确诊患有妊娠期糖尿病(gestational diabetes mellitus,GDM)的孕妇,根据是否进行营养干预分为研究组和对照组,研究组孕妇采用了营养干预,比较两组孕妇妊娠结局差异,将巨大儿列为代谢性危险因素Logistics逐步回归分析各项指标和巨大儿发生风险的关系。结果研究组新生儿出生体重为(3 256.00±30.00)g,对照组为(3 487.00±35.00)g;研究组巨大儿的发生率为4.57%,孕妇高血压的发生率为11.36%,对照组分别为11.71%和21.71%,两组比较,差异有统计学意义(P<0.05);两组患者在孕中晚期体重增长量、FBS含量、TG含量以及CHOL含量等方面比较,差异有统计学意义(P<0.05);孕20周时体重和是否患有GDM与有无代谢性因素无关(P>0.05)。结论采取营养干预可有效降低高危孕妇妊娠不良结局的发生率,通过膳食管理对孕妇的体重进行有效的控制可以降低巨大儿的发生风险,该干预值得在孕期推广使用。

Objective To explore the effects of maternal gestational nutritional intervention and metabolic risk factors on pregnancy outcomes in Kunming city. Methods The pregnant women receiving nutritional counseling and routine physical examination in Department of Nutrition in Kunming Maternal and Child Health Care Hospital from January 2014 to March 2016 were selected as study objects, then the pregnant women diagnosed as gestational diabetes mellitus （GDM） according to new GDM diagnostic criteria were analyzed retrospectively and divided into study group and control group according to receiving nutritional intervention or not. The women in study group received nutritional intervention, the pregnancy outcomes in the two groups were compared, macrosomia was included in metabolic risk factors, Logistic stepwise regression analysis was used to analyze the relationships between indexes and risk of macrosimia. Results The birth weights in study group and control group were （3 256. 00±30. 00） g and （3 487. 00±35.00） g, respectively. The incidence rates of macrosomia and hypertension in study group were 4. 57% and 11.36%, respectively; the incidence rates of macrosomia and hypertension in control group were 11.71% and 21.71%, respectively. There were statistically significant differences in body weight gain, FBS, TG, and CHOL levels during the second and the third trimesters of pregnancy between the two groups （ P〈0. 05 ） . There was no correlation between body weight at 20 gestational week, suffering from GDM or not and metabolic factors （P〉0.05） . Conclusion Nutritional intervention can effectively reduce the incidence rates of adverse pregnancy outcomes of high-risk pregnant women, effective weight control through dietary management can reduce the risk of macrosomia, nutritional intervention is worthy of clinical promotion and application during pregnancy.