营养科参与妊娠期糖尿病一日门诊管理对妊娠结局的影响:一项倾向性评分匹配研究

The pregnancy outcomes in women with gestational diabetes mellitus in one-day outpatient management with or without nutrition specialist involvement:a propensity score matching study

目的探讨营养科医师在妊娠期糖尿病(gestational diabetes mellitus,GDM)一日门诊中的特殊作用,为加强GDM一日门诊的规范化建设提供依据。方法采用回顾性观察研究,选取2017年11-12月笔者医院无营养科参与GDM一日门诊孕妇为对照组(177例),2018年1-2月笔者医院有营养科参与GDM一日门诊孕妇为观察组(307例),分析对比倾向性评分匹配前后两组患者的妊娠结局差异。结果通过1:1对比倾向性评分成功匹配176对患者。观察组GDM孕妇巨大儿发生率(2.8%)显著低于对照组(8.5%),P=0.036;观察组孕妇孕期体重增长、分娩孕周和使用胰岛素、妊娠期高血压、子痫前期、剖宫产、早产儿、胎膜早破、脐带绕颈、胎儿窘迫发生率与对照组相比,差异均无统计学意义(P>0.05)。结论营养科医师在GDM一日门诊多学科合作中的作用不可替代,对显著降低GDM孕妇分娩巨大儿发生率有较大辅助。

Objective Objective To explore the special role of nutrition specialists in the one-day-care clinic of gestational diabetes mellitus(GDM),and provide a basis for strengthening the standardized construction of one-day-care clinic.Methods It was a retrospective observation study that the pregnant women who participated in the one-day-care clinic of GDM in our hospital without nutrition specialists in November and December 2017 were divided into control group(177 cases),and who participated in the one-day-care clinic of GDM in our hospital with nutrition specialists in January and February 2018 were divided into observation group(307 cases).The differences of pregnancy outcomes between the two groups were compared after the propensity score matching.Results 176 pairs of patients were successfully matched with a 1:1 propensity score.The incidence of macrosomia in pregnant women with GDM in the observation group(2.8%)was significantly lower than that in the control group(8.5%)(P=0.036).There were no significant differences in the weight gain during pregnancy,the gestational week of delivery and the incidences of insulin use,hypertension during pregnancy,preeclampsia,cesarean section,premature infants,premature rupture of membranes,umbilical cord around the neck,and fetal distress between the two groups(P>0.05).Conclusion Nutrition specialists are indispensable in the multidisciplinary cooperation of one-day-care clinic of GDM,and they play a key role in considerably lowering the prevalence of macrosomia in GDM pregnant women.