孕期全程营养管理对孕期并发症和妊娠结局的影响

Effects of Pregnant Nutrition Management on Pregnancy Complications and Pregnancy Outcome

目的:评价孕期全程营养管理对孕期营养相关并发症和妊娠结局的影响。方法:选取北京清华长庚医院产科建档的单胎妊娠妇女,营养干预组为预产期2019年2—5月产科建档孕妇,选取2018年同月份生产孕妇作为历史对照组。收集研究对象的基本信息,制定孕期全程营养管理流程,干预组孕妇在产科随访的基础上,分别在孕早期(8周前)、孕中期(12周)、孕晚期(28周)接受孕期营养随访共3次。历史对照组接受产科常规管理。全程监测和记录两组孕妇孕期增重,出现胎儿生长受限(IUGR)、妊娠高血压、妊娠糖尿病(GDM)等并发症的发生率,以及分娩方式、胎儿体重的情况。结果:营养干预组孕妇GDM的发病率为10.8%,低于历史对照组的22.9%(P<0.01);孕28周贫血率为19.7%,明显低于历史对照组的30.2%(P<0.05);干预组孕期增重(14.4±3.5)kg,明显低于对照组的(17.1±4.4)kg(P<0.05)。干预组孕妇剖宫产的比例为36.1%,虽低于对照组的38.1%,但未见显著性(P=0.529)。干预组和对照组孕妇胎儿生长受限、妊娠高血压的发生率对比分别为0 vs 0.7%、3.3%vs 5.2%(P>0.05),两组胎儿为低体重儿的比例为3.8%vs 3.2%,胎儿巨大儿比例为4.9%vs 5.9%(P均>0.05)。结论:孕期全程营养管理可以明显降低妊娠糖尿病和孕期贫血的发病率,有利于控制孕期增重,而胎儿生长受限、妊娠高血压和巨大儿的比例虽然有下降趋势,但差异未见统计学意义,可能需要更多临床研究数据的支持。

[Objective]To evaluate the effect of nutrition management during pregnancy on nutrition-related complications and pregnancy outcome.[Method]Singleton pregnant women from antenatal care department in Beijing Tsinghua Changgung hospital were selected.The nutrition management group was pregnant women with the due date from February to May 2019,and pregnant women with the due date in the same month of 2018 were selected as the historical control group.The basic information of all objects was collected.Women in intervention group received nutritional intervention by nutritionist for three times based on antenatal examination,respectively in the first trimester(8 th week),midtrimester(12 th week),last trimester(28 th week).The historical control group received routine prenatal care from obstetrics department.Besides gestational weight gain(GWG),the incidence of intrauterine growth retardation(IUGR),gestational hypertension,gestational diabetes mellitus(GDM)and other complications of pregnant women in both groups were monitored and recorded during the whole process,as well as the delivery mode and fetal weight.[Result]The incidence of GDM in nutritional intervention group was 10.8%,lower than that in historical control group(22.9%,P<0.01).The rate of anemia at 28 th week was 19.7%,which was significantly lower than that of control group(30.2%,P<0.05).The nutritional intervention also increased GWG to(14.4±3.5)kg,which was significantly lower than that of of control group[(17.1±4.4)kg,P<0.05].The proportion of caesarean section in pregnant women in the intervention group was 36.1%,lower than that in the control group(38.1%),but no significant difference was observed(P=0.529).The incidence of IGFR,gestational hypertension in intervention group and control group were respectively 0 vs 0.7%,3.3%vs 5.2%(P>0.05),the ratio of low birth weight of fetus was 3.8%vs 3.2%,ratio of macrosomia was 4.9%vs 5.9%,but the difference of birth weight was not significant by chi-square test(P>0.05).[Conclusion]Nutrition management during pregnancy could significantly reduce the incidence of GDM,anemia and decrease GWG.While the proportion of IUGR,gestational hypertension and macrosomia had a decreasing trend,but the difference was not significant,which may need more clinical data to verify.