配偶同步的饮食联合运动干预对孕前超重合并妊娠糖尿病孕妇及其新生儿的影响

Effect of spousal synchronous exercise and diet intervention on maternal and neonatal outcomes in overweight pregnant women with gestational diabetes mellitus

目的探讨配偶同步的饮食联合运动干预对孕前超重合并妊娠糖尿病(GDM)的孕妇及其新生儿的影响。方法将120例孕前超重合并GDM的孕妇根据妊娠期间配偶是否同步进行饮食联合运动干预,随机分为干预组(60例)和对照组(60例),孕妇均接受常规药物和胰岛素治疗,记录并比较2组孕妇初次产检时的年龄、体质量指数、空腹血糖(FPG)、餐后2 h血糖(2 h-PG)和糖化血红蛋白(HbA1c)水平,确诊为GDM和妊娠28周时的FPG、2 h-PG和HbA1c水平,分娩方式、分娩相关并发症(包括早产和产褥感染)发生率。采用抑郁自评量表(SDS)和焦虑自评量表(SAS)评估孕妇分娩后的情绪状态。比较2组新生儿体质量、血糖、新生儿并发症(包括巨大儿、低血糖、窒息)发生率、Apgar评分。结果2组比较,孕妇初次产检时的年龄、体质量指数、FPG、2 h-PG和HbA1c均无统计学差异(P>0.05)。妊娠28周时,2组孕妇的FPG、2 h-PG和HbA1c水平均较确诊为GDM时明显降低(P<0.05),且干预组上述3项指标均明显低于对照组(P<0.05)。分娩后2组比较,干预组自然分娩的比例明显高于对照组,分娩相关并发症的发生率明显低于对照组(均P<0.05)。干预组孕妇的焦虑和抑郁改善程度优于对照组(P<0.05)。干预组巨大儿数量和血糖水平低于对照组,Apgar评分高于对照组。结论配偶同步的饮食联合运动干预可以有效降低孕前超重合并GDM孕妇的血糖和HbA1c水平,并能有效降低分娩相关并发症和新生儿并发症的发生率,改善孕妇情绪状态。

Objective To analyze the effect of spousal synchronous exercise and diet intervention on maternal and neonatal outcomes in overweight pregnant women with gestational diabetes mellitus(GDM).Methods We divided 120 overweight pregnant women with GDM into intervention and control groups(n=60 per group),who received spousal synchronous and routine exercise and diet interventions,respectively.The age,body mass index(BMI),and levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h-PG),and glycosylated hemoglobin(HbA1c)at the first prenatal examination were recorded.The levels of FPG,2 h-PG,and HbA1c at the diagnosis of GDM and gestational week 28,delivery mode,and incidence of complications during the delivery were compared between the groups.The self-rating depression scale and self-rating anxiety scale were used to evaluate the women’s mental status after delivery.The body weight,blood glucose level,Apgar score,and incidence of complications including macrosomia,hypoglycemia,and asphyxia in the newborns were compared between the groups.Results The groups did not differ significantly in term of age,BMI,FPG,2 h-FPG,or HbA1c at GDM diagnosis(P>0.05).At gestational week 28,the FPG,2 h-FPG,and HbA1c levels were significantly lower than those before the intervention in both groups,and were also significantly lower in the intervention group than in the control group(P<0.05).Compared with the control group,the proportion of natural delivery was significantly higher and the incidence of complications was significantly lower in the intervention group(P<0.05).The anxiety and depression status were significantly better in the intervention group than in the control group(P<0.05).Compared with the control group,the frequency of macrosomia and blood glucose levels were significantly lower and the Apgar scores were significantly higher in the intervention group(P<0.05).Conclusion Spousal synchronous exercise and diet intervention may effectively decrease the blood glucose and HbA1c levels in overweight pregnant women with GDM,decrease the incidence of maternal and neonatal complications,and improve pregnant women’s mental status.