微信平台宣教对妊娠期糖尿病患者血糖控制和妊娠结局的影响

Education via WeChat improves glucose control and pregnant outcomes in women with gestational diabetes meilitus

目的评价应用微信对妊娠期糖尿病（gestational diabetes mellitus，GDM）孕妇加强营养干预的效果，分析微信干预对GDM患者血糖及妊娠结局的影响。方法选择2015年10月至2016年4月间在上海市第一人民医院确诊为GDM，并就诊于本院临床营养科门诊的410例孕妇。随机将孕妇分为干预组和对照组，每组205例。对照组进行营养科门诊宣教；干预组在营养科门诊宣教基础上加用微信进一步强化宣教。分别在不同干预的1、2及4周后，对孕妇的血糖及胰岛素治疗情况进行随访；产后42 d，对孕妇的妊娠结局及微信加强宣教模式的满意情况进行调查。采用独立样本t检验、χ2检验及非参数检验对数据进行统计学分析。结果（1）干预2周后，干预组孕妇服糖后1 h血糖低于对照组[（7.46±1.01）与（7.68±1.06） mmol/L，t=2.243，P=0.025]。干预4周后，干预组孕妇与对照组相比服糖后1及2 h血糖均较低[分别为（7.03±0.65）与（7.33±0.63） mmol/L，（6.00±0.65）与（6.21±0.62） mmol/L，t值分别为4.629和3.153，P值均〈0.05]，血糖达标率较高[79.9%（151/189）与60.8%（113/186），χ2=16.483，P〈0.001]。（2）干预组孕妇阴道分娩率高于对照组[50.5%（95/188）与38.7%（72/186），χ2=5.288，P=0.021]，且产后并发症较少[2.1%（4/188）与9.1%（17/186），χ2=7.394，P=0.007]。所有接受微信干预的孕妇，除1例失访外，满意率达99.5%（203/204）。 结论微信加强营养干预模式较单纯进行营养门诊宣教能有效地控制GDM孕妇的血糖水平，改善妊娠结局。孕妇对这一模式接受程度高，可在营养门诊中进一步推广应用。

ObjectiveTo evaluate the effect of strengthening nutrition intervention in gravidas with gestational diabetes mellitus （GDM） with WeChat on blood glucose control and pregnant outcomes. MethodsA total of 410 gravidas, diagnosed with GDM and treated in the Department of Clinical Nutrition of Shanghai General Hospital from October 2015 to April 2016, were enrolled and randomly divided into two groups （n=205）. The control group received traditional nutrition clinic education only, while the intervention group was given strengthened nutrition education through WeChat in addition to traditional education. Blood glucose level and insulin dosage were followed up after one, two and four weeks of intervention. Pregnant outcomes and patient satisfaction were investigated on 42 d after delivery. T test, Chi-square test and non-parametric test were used for statistical analysis. Results（1） Two weeks after the intervention, the average 1-hour postprandial blood glucose in the intervention group was lower than in the control group [（7.46±1.01） vs （7.68±1.06） mmol/L, t=2.243, P=0.025]. After 4 weeks, both 1- and 2-hour postprandial blood glucose levels of the intervention group were lower than those of the control group [（7.03±0.65） vs （7.33±0.63） mmol/L, t=4.629, P〈0.05; （6.00±0.65） vs （6.21±0.62） mmol/L, t=3.153, P〈0.05] and more gravidas achieved euglycemia [79.9% （151/189） vs 60.8% （113/186）, χ2=16.483, P〈0.001]. （2） Compared with the control group, the intervention group had a higher vaginal delivery rate [38.7% （72/186） vs 50.5% （95/188）, χ2=5.288, P=0.021] and a lower rate of postpartum complications [9.1% （17/186） vs 2.1% （4/188）, χ2=7.394, P=0.007]. All of the gravidas in the intervention group were satisfied with the WeChat intervention except one lost to follow up [99.5% （203/204）]. ConclusionsStrengthening nutrition education through WeChat is much more effective than traditional nutritional outpatient education alone in order to achieve a better control of blood glucose and improve pregnant outcomes in GDM women. This intervention is highly acceptable to gravidas and can be further extensively applied in nutrition clinic.