生活方式干预对高风险孕妇发生妊娠糖尿病的预防作用

Preventive Effects of Lifestyle Interventions on Gestational Diabetes Mellitus of High Risk Pregnant Women

目的:探讨生活方式干预对高风险孕妇发生妊娠糖尿病是否具有预防作用。方法:将272名GDM高风险孕妇(有GDM病史和/或BMI≥28Kg/m2)随机分为干预组(n=150)和对照组(n=122),于入组时至妊娠结束对两组孕妇进行生活方式干预。干预组进行强化的个体化饮食管理和运动干预;对照组进行适合当前身体状况的生活方式干预措施。GDM的诊断依据妊娠24周后75g口服葡萄糖耐量试验。结果:最终有218名孕妇完成研究。干预组GDM的发生率为12.9%,对照组为20.6%(P=0.042,校正年龄、孕前体重指数、是否有GDM和孕周病史后),OR=0.62(95%CI 0.36~0.94);干预组相对于对照组妊娠体重增加量减少了0.51(95%CI 0.06~0.92),P<0.001。干预组相对于对照组孕妇运动量增加,饮食质量改善。结论:通过控制饮食和增加运动的生活方式干预可减少高风险孕妇妊娠糖尿病的发生,推荐对这部分人群进行饮食和运动干预。

Objective:To explore whether gestational diabetes mellitus(GDM)can be prevented by lifestyle interventions in pregnant women who are at high risk for the disease.Methods:272high-risk women with a history of GDM and/or BMI≥28kg/m2 had been enrolled in the study and been randomly allocated to the intervention group(n=150)or the control group(n=122).Two groups had been treated with lifestyle interventions from the time of entering the group to the end of gestation.Individualized counseling on diet and physical activities had been applied to the subjects in the intervention group,the lifestyle interventions appropriate for the current physical conditions in the control group.The diagnosis of GDM had been based on a 75-g oral glucose tolerance test after 24weeks of gestation.Results:A total of 218women were finally included in the analysis.The incidence of GDM was 12.9%in the intervention group and 20.6%in the control group(P=0.042,after adjustments for age and prepregnant BMI and detection on whether suffering from GDM and gestational history),and OR=0.6(95%Cl 0.36~0.94);Gestational weight gain was lower in the intervention group by 0.51(95%Cl 0.06~0.92)(P<0.001).Physical activities were strengthened and dietary quality was improved in the intervention group compared with the control group.Conclusion:The incidence of GDM in high-risk pregnant women can be reduced by individualized lifestyle interventions such as controlling diet and strengthening physical activities,which should be recommended highly.