妊娠期营养干预对孕妇缺铁性贫血治疗效果评价及妊娠结局的影响

Effect of Nutritional Intervention on Iron Deficiency Anemia and Pregnancy Outcome

目的:探讨妊娠期个性化膳食营养干预对孕妇缺铁性贫血的治疗效果及其对妊娠结局的影响。方法:选取2018年1月—2020年1月来我院就诊的妊娠期缺铁性贫血孕妇180例,依据治疗原则并参照孕妇意愿随机分成个性化膳食营养干预组(57例)、铁剂治疗组(55例)、铁剂治疗联合个性化膳食营养干预组(68例)。另取同期间来我院产检的正常孕妇作为空白对照组(60例),分别给予相应的干预手段。8 w后检测孕妇血常规和铁代谢等相关指标,并统计分析妊娠结局。结果:干预前,个性化膳食营养干预组、铁剂治疗组、铁剂治疗联合个性化膳食营养干预组3组间血红蛋白(Hb)、红细胞数(RBC)、血细胞比容(Hct)、血清铁(SI)、血清铁蛋白(SF)、可溶性血清铁蛋白受体(sTfR)水平不存在显著差异(P>0.05),与空白对照组相比,存在显著差异(P<0.01)。干预后,3组血红蛋白(Hb)分别是(106.35±16.64)、(108.37±14.41)、(107.8±12.18)g/L,红细胞数(RBC)分别是(4.24±0.72)×1012/L、(4.31±0.66)×1012/L、(4.38±0.59)×1012/L,血细胞比容(Hct)分别是(0.41%±0.35%)、(0.42%±0.25%)、(0.43%±0.19%),血清铁蛋白(SF)分别是(57.83±10.41)、(58.33±11.03)、(59.28±12.18)μg/L,血清铁(SI)分别是(11.57±3.76)、(11.60±3.46)、(11.58±2.90)μmol/L,可溶性血清铁蛋白受体(sTfR)分别是(2.13±1.12)、(2.10±0.62)、(2.11±0.73)mg/L,与干预前相比存在显著差异(P<0.01)。治疗过程中不良反应的发生率,个性化膳食营养干预组为1.75%,铁剂治疗组为7.27%,铁剂治疗联合个性化膳食营养干预组为5.88%,各组间不良反应的发生率存在显著差异(P<0.05)。采用不同治疗方法,3组缺铁性贫血的治愈率分别为89.47%、94.55%、98.53%,3组间缺铁性贫血的治愈率存在显著差异(P<0.05)。不良妊娠结局的发生率,4组间妊娠期高血压疾病、早产和低体重出生儿发生率存在显著差异(P<0.05),妊娠期糖尿病、胎膜早破和产后出血发生率不存在显著差异(P>0.05)。结论:妊娠期单纯性营养干预对缺铁性贫血的治疗效果次于铁剂治疗效果,但不良反应的发生率较低,两种干预方法联合应用效果更佳,且有利于降低不良妊娠结局发生的风险。

【Objective】To investigate the effect of individualized dietary nutrition intervention on iron deficiency anemia in pregnant women and its influence on pregnancy outcome.【Method】Totally 180 pregnant women with iron deficiency anemia in pregnancy who came to our hospital from January 2018 to January 2020 were selected and randomly divided into individualized diet nutrition intervention group(57 cases),iron treatment group(55 cases),iron treatment combined with personalized dietary nutrition intervention group(68 cases)according to the treatment principles and the wishes of pregnant women.In addition,normal pregnant women who came to our hospital during the same period were selected as blank control group(60 cases),and were given corresponding intervention measures.After 8 weeks,the blood routine and iron metabolism of pregnant women were detected,and the pregnancy outcome was statistically analyzed.【Result】Before intervention,there were no significant differences in hemoglobin(Hb),red blood cell count(RBC),hematocrit(Hct),serum iron(SI),serum ferritin(SF)and soluble serum ferritin receptor(sTfR)among the three groups(P>0.05).Compared with the blank control group,there was significant difference(P<0.01).After the intervention,the hemoglobin(Hb)of the three groups were(106.35±16.64)g/L,(108.37±14.41)g/L and(107.8±12.18)g/L respectively,the red blood cell count(RBC)were(4.24±0.72)×1012/L,(4.31±0.66)×1012/L and(4.38±0.59)×1012/L,the hematocrit(Hct)were(0.41%±0.35%),(0.42%±0.25%)and(0.43%±0.19%)respectively.The serum iron(SI)was(11.57±3.76)μmol/L,(11.60±3.46)μmol/L and(11.58±2.90)μmol/L,and the soluble serum ferritin receptor(sTfR)were(2.13±1.12)mg/L,(2.10±0.62)mg/L and(2.11±0.73)mg/L,respectively.The difference was statistically significant(P<0.01).The incidence of adverse reactions was 1.75%in the individualized diet nutrition intervention group,7.27%in the iron treatment group,and 5.88%in the iron therapy combined with personalized dietary nutrition intervention group.There was significant difference in the incidence of adverse reactions among the groups(P<0.05).The cure rates of iron deficiency anemia in the three groups were 89.47%,94.55%and 98.53%,respectively.There were significant differences among the three groups(P<0.05).There were significant differences in the incidence of adverse pregnancy outcomes among the four groups(P<0.05),but there were no significant differences in the incidence of gestational diabetes mellitus,premature rupture of membranes and postpartum hemorrhage(P>0.05).【Conclusion】The effect of simple nutritional intervention on iron deficiency anemia during pregnancy is lower than that of iron,but the incidence of adverse reactions is low.The combined application of the two intervention methods has better effect,and is conducive to reduce the risk of adverse pregnancy outcomes.