以助产士为主体的保健指导对妊娠期合并糖尿病孕妇心身影响的研究

Study on the psychosomatic effect of midwife-led health care guidance on pregnant women with gestational diabetes mellitus

目的探讨以助产士主导的孕期保健对妊娠期合并糖尿病(GDM)孕妇血糖控制、产前焦虑、体质管理及妊娠结局的影响,为摸索GDM孕妇孕期保健新型模式提供临床参考。方法采用便利抽样法选取2022年4—8月于新乡医学院第五临床学院定期产检并分娩的GDM孕妇60例,采用随机数表法分为观察组和对照组,每组各30例。观察组接受助产士主导的孕期保健,对照组同期接受常规定期产检,比较两组血糖控制情况、孕妇焦虑程度、分娩结局及自我管理得分。结果观察组妊高征、剖宫产、早产、羊水异常、羊水污染、胎膜早破、产后出血及胎儿宫内窘迫发生率均明显低于对照组,差异有统计学意义(P<0.05)。两组前置胎盘发生率比较,差异无统计学意义(P>0.05)。干预前两组焦虑自评量表(SAS)评分比较,差异无统计学意义(P>0.05);干预后两组孕妇SAS评分均明显降低,且观察组明显低于对照组,差异有统计学意义(P<0.05)。干预后孕28~38周两组孕妇空腹血糖逐渐降低,且观察组明显低于对照组,差异有统计学意义(P<0.05)。两组患者干预前GDM相关知识、管理方法与行为、态度与信念及社会支持四个维度得分比较,差异无统计学意义(P>0.05);干预后观察组上述四个维度得分明显高于对照组,差异有统计学意义(P<0.05)。结论助产士主导的孕期保健可降低初孕妇产前焦虑,提高血糖控制水平及GDM孕妇自我管理能力,进而改善妊娠结局和生活质量,临床应用和推广价值较高。

Objective To explore the influence of midwife-led pregnancy care on blood glucose control,prenatal anxiety,physical management,and pregnancy outcome of pregnant women with gestational diabetes mellitus(GDM),and to provide a clinical reference for exploring a new model of GDM pregnant women’s health care.Methods A total of 60 GDM pregnant women who underwent regular prenatal examinations and delivered at the Fifth Clinical College,Xinxiang Medical University from April to August 2022 were selected using the convenience sampling method.The subjects were divided into an observation group and a control group using the random number table method,with 30 cases in each group.The observation group received prenatal care led by midwives,while the control group received regular prenatal examinations during the same period.The blood glucose control status,the anxiety level of pregnant women,delivery outcomes,and self-management scores were compared between the two groups.Results The incidence rates of pregnancy induced hypertension,cesarean section,premature delivery,abnormal amniotic fluid,amniotic fluid pollution,premature rupture of membranes,postpartum hemorrhage,and fetal distress in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of placenta previa between the two groups(P>0.05).There was no statistically significant difference in self-rating anxiety scale(SAS)scores between the two groups before intervention(P>0.05).After intervention,the SAS scores of both groups of pregnant women significantly decreased,and the observation group was significantly lower than the control group,with statistically significant difference(P<0.05).After intervention,the fasting blood glucose of the two groups of pregnant women gradually decreased from 28 to 38 weeks of pregnancy,and the observation group was significantly lower than the control group,with statistically significant difference(P<0.05).There was no statistically significant difference in GDM related knowledge,management methods and behaviors,attitudes and beliefs,and social support scores between the two groups of patients before intervention(P>0.05).After intervention,the scores of the four dimensions mentioned above in the observation group were significantly higher than those in the control group,with statistically significant differences(P<0.05).Conclusion The midwife-led prenatal care reduces prenatal anxiety inprimipara,and improves blood glucose control levels and GDM pregnant women’s self-management ability,thereby improving pregnancy outcomes and quality of life.Therefore,it has high clinical application and promotion value.