医学营养干预对妊娠期糖尿病孕产妇糖脂代谢和新生儿免疫功能的影响

Effects of medical nutrition intervention on glycolipid metabolism of pregnant women with GDM and neonatal immune function

目的观察个体化医学营养干预(medical nutrition intervention,MNT)联合进餐顺序调整,对妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇糖脂代谢和新生儿免疫功能的影响。方法136例GDM孕妇随机分为MNT组和对照组各68例,分别接受医学营养干预和传统饮食指导。对比2组孕前、孕期增加、产后3个月的体质量及新生儿出生体质量,记录干预前后2组血糖血脂相关指标、妊娠并发症、新生儿Apgar评分及围生儿结局、脐血的免疫相关指标。结果MNT组患者孕期增加体质量、产后3个月的体质量和新生儿出生体质量均低于对照组,差异均有统计学意义(P<0.05)。干预后3个月和产后3个月,MNT组的血糖、血脂相关指标均低于对照组,Ca^(2+)高于对照组,差异均有统计学意义(P<0.05)。MNT组子痫前期、先兆流产、羊水过少、剖宫产等妊娠并发症发生率低于对照组,新生儿Apgar评分高于对照组,围产儿结局和新生儿脐血的免疫相关指标优于对照组,差异均有统计学意义(P<0.05)。结论MNT干预联合进餐顺序调整可动态评估、指导、分析患者,最大限度保证妊娠发育安全,确保母婴营养充足摄入,提高新生儿免疫功能。

Objective To observe the effects of individualized medical nutrition intervention combined with adjustment of meal sequence on glycolipid metabolism of pregnant women with GDM and neonatal immune function.Methods 136 pregnant women with GDM were randomly divided into MNT group(n=68)and control group(n=68).The two groups received medical nutrition intervention and traditional dietary guidance respectively.The body weight before conception,gained during pregnancy and 3 months after delivery and the neonatal birth weight were compared between the two groups.The related indicators of blood glucose and lipid,pregnancy complications,neonatal Apgar scores and perinatal outcomes,and indexes related to immunity of cord blood of both groups were recorded before and after intervention.Results The increased body weight during pregnancy,postpartum weight at 3 months and neonatal birth weight of the MNT group were lower than those of the observation group,and the differences were statistically significant(P<0.05).3 months after intervention and 3 months after delivery,the related indexes of blood glucose and blood lipid of the MNT group were lower than those of the control group,Ca^(2+) was higher than that of the control group,and the differences were statistically significant(P<0.05).The incidence of pregnancy complications such as preeclampsia,threatened abortion,oligohydramnios and cesarean section of the MNT group was lower than that of the control group,the neonatal Apgar score was higher than that of the control group,the perinatal outcomes and indexes related to immunity of neonatal cord blood were better than those of the control group,and the differences were statistically significant(P<0.05).Conclusions MNT intervention combined with adjustment of meal order could dynamically evaluate,guide and analyze patients,maximize the safety of pregnancy and development,ensure adequate nutrition intake for mothers and infants,and improve neonatal immune function.