孕期营养素摄入与妊娠期糖尿病孕妇血糖控制效果的相关性研究

Relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus

目的:探究孕期营养素摄入与妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血糖控制效果的相关性。方法:2015年10月至2017年10月之间招募北京某两家三甲医院进行产前检查且完成GDM诊断试验的孕妇(妊娠25~35周)参与队列研究,分别于入组、入组后2周、分娩时进行调查。本研究选取入组后2周的横断面调查数据进行分析,其中采用24 h膳食回顾问卷进行膳食调查,并根据《中国食物成分表》计算能量、宏量营养素及微量营养素的摄入量。利用临床信息系统收集的空腹血糖数据,参考中国《妊娠合并糖尿病诊治指南(2014)》,将GDM孕妇中空腹血糖≤5.3 mmol/L者划分为血糖控制较好组,>5.3 mmol/L者则划分为血糖控制较差组,并将正常糖耐量孕妇作为正常组。采用二元Logistic回归分析营养素摄入对GDM孕妇血糖控制效果的影响。结果:共纳入孕妇227例,GDM孕妇104例,正常孕妇123例,其中血糖控制较好组76例(73.1%,76/104),血糖控制较差组28例(26.9%,28/104)。与血糖控制较好组和正常组比较,血糖控制较差组的蛋白质摄入量及其供能比显著较高,碳水化合物供能比则显著较低。微量营养素方面发现血糖控制较好组和血糖控制较差组之间的差异无统计学意义。调整年龄、孕周和体力活动水平后,以血糖控制较好组为对照组,二元Logistic回归模型显示,较高的蛋白质供能比与GDM孕妇血糖控制较差呈正相关(OR=6.12,95%CI:1.44~25.98),较高的碳水化合物供能比则与血糖控制较差呈负相关(OR=0.54,95%CI:0.32~0.91)。结论:蛋白质摄入减少、碳水化合物摄入增加与血糖控制较好有关,建议GDM孕妇进一步调整膳食结构以达到良好的血糖控制效果。

Objective:To explore the relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus(GDM).Methods:Pregnant women for 25-35 gestational weeks who underwent prenatal examination and completed GDM diagnostic test in two third-class hospitals in Beijing from October 2015 to October 2017 were recruited to participate in the cohort study,and were investigated at enrollment,2 weeks after enrollment,and delivery.The cross-sectional survey data 2 weeks after enrollment was used for this study.Among them,dietary survey used the 24 h dietary records to collect the food intake of the subjects for the past day,and the intake of energy,macronutrients and micronutrients,was calculated according to the Chinese Food Composition Table.Using the data of fasting blood glucose(FBG)collected by clinical information system and referring to the Chinese Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes(2014),the GDM patients with FBG≤5.3 mmol/L were divided into the well-control group,those with FBG>5.3 mmol/L were divided into poorly-control group,and pregnant women with normal glucose tolerance were consi-dered as the normal group.Binary Logistic regression was used to analyze the association between the nutrients intake and glycemic control effect in pregnant women with GDM.Results:A total of 227 pregnant women were enrolled,including 104 GDM patients and 123 normal pregnancy women.Among them,76 subjects in the well-control group(73.1%,76/104)and 28 subjects in the poorly-control group(26.9%,28/104).Compared with the well-control group and the normal group,the protein intake and its energy ratio of the poorly-control group were significantly higher,while carbohydrate energy ratio was significantly lower.In terms of micronutrients,there was no significant difference between the well-control group and the poorly-control group.After adjusting for age,gestational age and physical activity level,with the well-control group as the control group,binary Logistic regression model showed that higher protein energy ratio was positively correlated with poorly glycemic control effect in pregnant women with GDM(OR=6.12,95%CI:1.44-25.98),while higher carbohydrate energy ratio was negatively correlated with poorly glycemic control(OR=0.54,95%CI:0.32-0.91).Conclusion:Reduced protein intake and increased carbohydrate intake were associated with better glycemic control in pregnant women with GDM.It is suggested that GDM patients should adjust their dietary pattern further to achieve good glycemic control effect.