运动干预对妊娠期糖尿病患者血糖和妊娠结局影响的meta分析

Meta Analysis of Effects of Exercise Intervention on Blood Glucose and Pregnancy Outcome in Patients with Gestational Diabetes

目的:采用系统评价的方法研究运动干预对妊娠期糖尿病患者血糖和妊娠结局影响的效果。方法:应用RevMan5.3对纳入的12篇文献,2074名研究对象的空腹血糖、餐后2h血糖、巨大儿、早产、剖腹产、婴儿长度、子痫前期症状等指标进行Meta分析;依照排除与纳入标准,完成文献纳入和数据提取,采用Cochrane偏倚风险评估工具对文献质量进行评估分析。结果:(1)运动具有显著降低妊娠期糖尿病患者餐后2H血糖水平的作用,[MD=-1.33,95%CI(-2,-0.66),P<0.0001];(2)运动可以显著减少妊娠期糖尿病孕妇巨大儿发生率[OR=0.5,95%C(0.33,0.77),P=0.001]和剖腹产率[OR=0.46,95%CI(0.35,0.62),P<0.00001]。亚组分析显示:(1)有氧运动和抗阻运动对妊娠期糖尿病患者PBG均有显著性作用;(2)抗阻运动、有氧运动和抗阻联合运动均对巨大儿发生率有显著性作用;(3)低强度运动对降低剖腹产率有显著性作用。结论:(1)运动可显著降低妊娠期糖尿病患者餐后2H血糖水平,降低妊娠期糖尿病患者巨大儿发生率及剖腹产率;(2)有氧运动和抗阻运动均可降低妊娠期糖尿病孕妇餐后2H血糖水平,其中有氧运动效果最佳;(3)抗阻运动和有氧联合抗阻运动干预均可以降低妊娠期糖尿病患者巨大儿发生率,其中抗阻运动效果最佳;(4)低强度运动可以降低妊娠期糖尿病患者的剖腹产率,但由于纳入的文献数量偏少,这一结论存在一定的争议。

To study the effects of exercise intervention on blood glucose and pregnancy outcome in patients with gestational diabetes by systematic review,RevMan 5.3 was used to analyze the 12 Chinese and foreign papers and 2074 subjects with fasting blood glucose,2h postprandial blood glucose,fetal macrosomia,premature delivery,caesarean section,infant length,eclampsia symptoms and other indicators.With inclusion criteria,literature inclusion and data extraction were completed,and the quality of the literature was assessed using the Cochrane bias risk assessment tool.Results:(1)Exercise has a significant effect on reducing 2h postprandial blood glucose levels in patients with gestational diabetes,[MD=-1.33,95%CI(-2,-0.66),P<0.0001].(2)Exercise can significantly reduce the incidence of fetal macrosomia[OR=0.5,95%C(0.33,0.77),P=0.001]and caesarean section[OR=0.46,95%CI(0.35,0.62),P<0.00001]in patients with gestational diabetes.Subgroup analysis shows:(1)Aerobic exercise and resistance exercise have significant effects on PBG in patients with gestational diabetes;(2)Resistance exercise,aerobic exercise and resistance combined exercise have significant effects on the incidence of fetal macrosomia.(3)Low-intensity exercise has a significant effect on reducing caesarean section rate.Conclusion:(1)Exercise can significantly reduce 2h postprandial lood glucose levels in patients with gestational diabetes,reduce the incidence of fetal macrosomia and caesarean section in patients with gestational diabetes;(2)Aerobic exercise and resistance exercise can reduce 2h postprandial blood glucose in patients with gestational diabetes,in which aerobic exercise has the best effect;(3)Resistance exercise and aerobic combined resistance exercise intervention can reduce the incidence of fetal macrosomia in patients with gestational diabetes,and the effect of resistance exercise is the best;(4)Low-intensity exercise can reduce the caesarean section rate of patients with gestational diabetes,but this conclusion is controversial due to the small number of papers included.