产后随访管理对妊娠期糖尿病患者人体成分体脂变化的影响

Effect of postpartum follow-up management on body fat changes in patients with gestational diabetes mellitus

目的探讨产后延续的随访管理对妊娠期糖尿病(GDM)患者人体成分体脂指标变化的影响,为建立GDM患者管理模式提供依据。方法选取2015年8月-2016年8月在南方医科大学附属佛山市妇幼保健院进行产前检查、妊娠24~28周时诊断为GDM并在营养门诊就诊且接受妊娠期糖尿病健康教育指导的孕妇300例为研究对象,延续随访管理至产后12个月。产后42 d及12个月进行人体成分测定,比较患者自身随访管理前、后人体成分体脂指标:体质指数(BMI)、体脂百分比(BF%)、腰臀脂肪比率(WHR)、内脏脂肪面积(VFA)的变化;观察和比较健康行为依从性对人体成分体脂指标的影响。结果GDM患者产后42 d与12个月人体成分测定人体成分体脂指标比较差异均有统计学意义(P<0.05),健康行为依从性好与依从性差两组人群产后12个月人体成分体脂指标比较差异无统计学意义(P>0.05);GDM患者在产后12个月体脂肥胖指标的比率均低于产后42 d。结论对GDM患者实施从孕期至产后延续随访管理模式能有效提高患者产后随访率和健康行为依从性,明显改善患者产后人体成分体脂的分布,降低肥胖的发生率。

Objective To explore the effect of postpartum follow-up management on changes of body fat indexes in patients with gestational diabetes mellitus（ GDM）,provide a basis for establishment of GDM management model. Methods A total of 300 pregnant women underwent prenatal examination in Foshan Women and Children＇s Hosptial,Affiliated to Southern Medical University from August 2015 to August 2016,then they were diagnosed as GDM,treated in Nutrition Outpatient of the hospital,and given GDM health education guidance,all the women were followed up till 12 months after delivery. Body composition measurement was carried out on the 42 nd day and during the twelfth month after delivery. The changes of body fat indexes [body mass index（ BMI）,body fat percentage（ BF%）,waist hip ratio（ WHR）,visceral fat area（ VFA） ]before and after postpartum follow-up management were compared. The effect of healthy behavior compliance on body fat indexes was observed and compared. Results There were statistically significant differences in body fat indexes between the 42 nd day after delivery and the twelfth month after delivery（ P〈0. 05）. During the twelfth month after delivery,there was no statistically significant difference in body fat indexes between the women with high healthy behavior compliance and the women with low healthy behavior compliance（ P〈0. 05）. During the twelfth month after delivery,the ratio of obesity index was lower than that on the 42 nd day after delivery. Conclusion Postpartum follow-up management mode can effectively improve postpartum follow-up rate and health behavior compliance of GDM patients,significantly improve body fat distribution,and reduce the incidence rate of postpartum obesity.