低升糖指数饮食模式对妊娠期糖尿病妊娠结局影响的Meta分析

Effect of Low Glycemic Index Diet on Pregnancy Outcome of Gestational Diabetes Mellitus:A Meta-analysis

目的:系统评价低升糖指数饮食模式对妊娠期糖尿病妊娠结局的影响,为妊娠期糖尿病患者提供合理的饮食模式。方法:通过检索PubMed、Cochrane library、Embase及中国知网,采用随机对照试验(RCT)评估低升糖指数(GI)饮食对妊娠期糖尿病妊娠结局的影响。2位研究者独立地搜索文章,提取数据,并评估纳入研究的质量。1位研究者采用随机效应模型进行Meta分析。结果:10篇共计689例的RCT纳入Meta分析。较常规糖尿病饮食干预模式,低升糖指数的饮食干预模式可以显著降低妊娠期糖尿病患者空腹血糖水平[WMD=-0.58,95%CI(-0.98,-0.18),P=0.005],餐后2 h血糖水平[WMD=-1.01,95%CI(-1.54,-0.48),P<0.0002],胰岛素抵抗水平[WMD=-0.14,95%CI(-0.17,-0.10),P<0.0001]。就妊娠结局而言,可以降低孕期体重增加[RR=0.44,95%CI(0.27,0.73),P=0.002],巨大儿的发生率[RR=0.48,95%CI(0.25,0.91),P=0.02]。结论:对患有妊娠期糖尿病的孕妇在孕期使用低升糖指数的饮食模式可有助于改善其血糖、胰岛素抵抗水平以及围产期结局。

【Objective】To systematically evaluate the effect of low glycemic index diet on pregnancy outcome of gestational diabetes mellitus(GDM),and to provide a reasonable diet for patients with GDM.【Method】PubMed,Cochrane Library,EMBASE and CNKI were searched to evaluate the effect of low glycemic index(GI)diet on pregnancy outcome of gestational diabetes mellitus(GDM)by randomized controlled trials(RCTs).Two researchers independently searched for articles,extracted data,and assessed the quality of included stud⁃ies.One researcher used random effects model for meta-analysis.【Result】Ten RCTs involving 689 cases were included in the metaanalysis.Compared with the conventional diet intervention model,the diet intervention model with low glycemic index could significantly reduce the fasting blood glucose level[WMD=-0.58,95%CI(-0.98,-0.18),P=0.005],2-hour postprandial blood glucose level[WMD=-1.01,95%CI(-1.54,-0.48),P<0.0002],insulin resistance level[WMD=-0.14,95%CI(-0.17,-0.10),P<0.0001].In terms of pregnancy outcome,it can reduce the weight gain during pregnancy[RR=0.44,95%CI(0.27,0.73),P=0.002]and the incidence of macrosomia[RR=0.48,95%CI(0.25,0.91),P=0.02].【Conclusion】The low glycemic index diet can improve the blood glucose,insulin resistance and perinatal outcomes of pregnant women with gestational diabetes mellitus.