妊娠早中期生活方式干预对妊娠期糖尿病发病率的影响

Effect of life-style intervention in the first and second trimester of pregnancy on the incidence rate of gestational diabetes mellitus

目的探讨妊娠早中期生活方式干预对妊娠期糖尿病(GDM)发病率的影响。方法选取2015年8月至2016年2月于内蒙古自治区人民医院产科门诊进行产检并建档的孕妇(孕周<14周)1746例,以2∶1比例随机分为强化组(1164例)和常规组(582例)。强化组给予产科常规管理联合强化生活方式干预,常规组仅进行产科常规管理。所有受试者于妊娠24~28周行75 g葡萄糖糖耐量试验(OGTT),比较两组GDM的发病率。结果两组年龄、一级亲属糖尿病家族史、孕前体质指数、首检血糖、首检孕周差异均无统计学意义(P>0.05)。强化组脱落率为29.90%(348/1164),常规组脱落率为1.20%(7/582)差异有统计学意义(P<0.01)。经两种方式管理至两组对象孕24~28周行OGTT试验时进行评价,强化组每日摄入热量低于常规组[(1598.46±208.68)kcal vs(1974.15±337.42)kcal],体重增长低于常规组[(9.86±3.63)kg vs(10.64±5.40)kg],运动时间长于常规组[(134.38±30.70)min/周vs(105.02±38.50)min/周],差异有统计学意义(P<0.01);且GDM发病率强化组15.44%,常规组16.00%,两组比较差异无统计学意义(P>0.05)。结论妊娠早中期生活方式干预不能降低GDM发病率。

Objective To investigate the effect of life-style intervention in early and middle trimester of pregnancy on the incidence of gestational diabetes mellitus(GDM).Methods A total of 1746 pregnant women(gestational age<14 weeks)having antenatal examination and file in obstetric clinic of the People's Hospital of Inner Mongolia Autonomous Region from August 2015 to February 2016 were selected and randomly divided into intensive group(n=1164)and routine group(n=582).The routine obstetric management combined with life style intervention was performed in intensive group,while only routine obstetric management was given in routine group.All subjects underwent 75 g oral glucose tolerance test(OGTT)at 24-28 weeks of gestation,and the incidences of GDM were compared between two groups.Results There were no significant differences in age,family history of diabetes mellitus,body mass index(BMI)before pregnancy,blood glucose and gestational age between two groups(P>0.05).The rate of loss to follow-up for 4-6 week was 29.90%(348/1164)in intensive group and 1.20%(7/582)in routine group(P<0.01).Compared with routine group,the average daily calorie intake[(1598.46±208.68)kcal vs(1974.15±337.42)kcal]and the average weight gain[(9.86±3.63)kg vs(10.64±5.40)kg]significantly decreased and the exercise time each week[(134.38±30.70)min vs(105.02±38.50)min]increased in intensive group(P<0.01).There was no significant difference in the incidence of GDM between two groups(15.44%vs 16.00%,P>0.05),even though it was slightly lower in intensive group.Conclusion Life-style intervention in the early and middle trimester of pregnancy can not reduce the incidence of GDM.