社区孕早期干预对妊娠期糖尿病高危因素人群的影响

Effects of early intervention in community on pregnant women at high risk of gestational diabetes mellitus

目的探讨社区卫生服务中心在孕早期对有妊娠期糖尿病(gestational diabetes mellitus,GDM)高危因素的孕妇进行饮食运动干预,观察干预措施对GDM发病及妊娠结局的影响。方法选取2017年8月-2018年8月在北京市大兴区青云店镇社区建立北京市母子健康档案的438例有GDM高危因素的孕妇为研究对象,随机分为干预组、对照组。干预组215例孕早期予以饮食运动干预,对照组223例予以常规孕期管理。追踪孕期并发症发生情况和分娩结局。比较两组GDM、妊娠期高血压、羊水过多、羊水过少、早产、剖宫产、巨大儿、低出生体重儿、胎儿窘迫、产后出血的发病情况。结果干预组GDM、妊娠期高血压、胎儿窘迫、剖宫产、产后出血发生率均低于对照组,差异有统计学意义(P<0.05)。两组羊水过多、羊水过少、早产、巨大儿、低出生体重儿的发生情况差异无统计学意义(P>0.05)。结论社区卫生服务中心在孕早期对GDM高危人群进行饮食运动干预,能有效降低GDM发病率,并减少与其相关部分产科并发症的发生。

Objective To investigate the affect of intervention of diet and exercise on pregnancy outcome in the first trimester of those with high risk of gestational diabetes mellitus(GDM)in community.Method From August 2017 to August 2018,438 pregnant women who had established Beijing maternal and child health manual in qingyundian town were randomly divided into the intervention group and control group.In intervention group,215 cases were given individualized guidances of diet and exercise intervention on early stage.223 cases in control group were treated with routine management during pregnancy.Follow up the occurrence of complications during pregnancy and the outcome of delivery in the two groups.After the delivery,the complete pregnancy and the delivery of the medical record could not be considered as a case-out,and in the end,183 cases of the intervention group and 185 cases of the control group were obtained.The incidence of GDM,gestational hypertension,polyhydramnios,oligohydramnios,preterm birth,cesarean section,macrosomia,low birth weight infant,fetal distress and postpartum hemorrhage were compared between the two groups.Result The incidence of GDM,gestational hypertension,fetal distress,cesarean section and postpartum hemorrhage in intervention group was lower than that in control group,the difference were statistically significant(P<0.05).There was no significant difference in the incidence of polyhydramnios,oligohydramnios,preterm birth,macrosomia and low birth weight infant between the two groups(P>0.05).Conclusion Carry out dietary and exercise intervention in first trimester by community health service centers can effectively reduce the incidence of GDM in high-risk groups and reduce the incidence of some related obstetric complications.