妊娠期糖尿病饮食管理最佳证据总结

Evidence summary for dietary management of gestational diabetes

目的总结妊娠期糖尿病(GDM)饮食管理的最佳证据,为临床实践提供循证依据。方法应用循证方法,计算机检索美国糖尿病协会(ADA)网站、UpToDate、万方、知网等中英文数据库,汇总关于GDM饮食管理的所有证据。检索时年限从建库至2021年4月。结果最终纳入15篇文献,包括7篇指南,4篇系统评价,1篇推荐实践,1篇证据总结,1篇专家共识和1篇临床随机对照试验。总结最佳证据包括饮食评估、膳食指导、营养补充剂的选择、健康指导4个主题,共16条最佳证据,包括孕妇入院时的营养评估、三大营养物质的摄入量分配、根据孕前BMI推荐每日摄入量、补充营养素、遵循与无糖尿病妇女相同的矿物质和维生素摄入量,使GDM患者获得饮食方面的知识可提高其选择适合自身食物的能力,加之产后建立良好的健康饮食习惯,可降低远期2型糖尿病发生率。结论对GDM饮食管理的现有证据的汇总归纳,可帮助临床护理人员根据临床实际情况制定相关护理方案,以利于优化GDM孕妇的妊娠结局。

Objective To summarize the best evidence for dietary management of gestational diabetes mellitus(GDM)and provide evidence-based evidence for clinical practice.Methods Evidence-based methods were used to search the American Diabetes Association(ADA)website,UpToDate,Wanfang,CNKI and other Chinese and English databases,and all the evidence on GDM diet management was summarized.The search period was from the establishment of the database to April 2021.Results 15 articles were finally included,including 7 guidelines,4 systematic reviews,1 recommended practice,1 evidence summary,1 expert consensus,and 1 clinical randomized controlled trial.The best evidence included diet assessment,dietary guidance,choice of nutritional supplements,and health guidance.There were 16 best evidences in total,including the nutritional assessment of pregnant women,the distribution of three major nutrients,and pre-pregnancy BMI recommends daily intake,supplementation of nutrients,and following the same intake of minerals and vitamins as non-diabetic women,allowing GDM patients to acquire dietary knowledge,and build good health after delivery.Conclusion The summary of the existing evidence of GDM diet management can help clinical nurses formulate relevant nursing plans according to the actual clinical situation,so as to optimize the pregnancy outcome of GDM pregnant women.