妊娠期糖尿病孕妇的膳食情况及饮食指导对妊娠结局的影响

The effect of dietary guidance on pregnancy outcomesin pregnant women with gestational diabetes mellitus

目的 探究妊娠期糖尿病孕妇膳食情况、血脂分布特征及饮食指导对妊娠结局的影响,为改善妊娠结局提供参考。方法 比较妊娠期糖尿病(GDM)孕妇(观察组,600例)和同期产检的健康孕妇(对照组,600例)的临床资料,利用24 h膳食回顾调查法分析两组的饮食摄入情况。观察组600例GDM孕妇依据意愿分为专业饮食指导组340例、自行调整饮食组260例,跟踪随访3组孕期的血脂水平变化情况及妊娠结局。结果 与对照组比较,观察组分娩前体质量、空腹血糖(FPG)、餐后2 h血糖(2 hFPG)水平高,脂肪、肉类、水果摄入量多,碳水化合物、蔬菜摄入量少,差异均有统计学意义(均P<0.05)。比较3组的孕中期甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平及孕晚期总胆固醇(TC)、TG、LDL-C水平,均为自行调整饮食组>专业饮食指导组>对照组;而高密度脂蛋白胆固醇(HDL-C)水平则为自行调整饮食组<专业饮食指导组<对照组,差异有统计学意义(均P<0.05)。自行调整饮食组不良妊娠结局发生率(18.46%)高于专业饮食指导组(6.18%)及对照组(1.50%),差异有统计学意义(χ^(2)=21.848,P<0.05)。结论 GDM孕妇的血脂水平在孕中、晚期明显上升,且膳食结构不合理,临床上建议通过饮食指导、健康干预纠正血脂代谢紊乱情况,继而改善妊娠结局。

Objective To investigate the dietary status,blood lipid distribution characteristics,and the impact of dietary guidance on pregnancy outcomes in pregnant women with gestational diabetes mellitus(GDM),providing references for improving pregnancy outcomes.Methods The clinical data of pregnant women with gestational diabetes(GDM)(observation group,600 cases)and healthy pregnant women undergoing routine antenatal care during the same period(control group,600 cases)were compared.The 24-hour dietary recall method was used to analyze the dietary intake of both groups.The 600 GDM pregnant women in the observation group were divided into two subgroups based on their willingness:a professional dietary guidance group with 340 cases and a self-adjusted diet group with 260 cases.The blood lipid levels and pregnancy outcomes of the three groups throughout pregnancy were followed up and compared.Results Compared to the control group,the observation group had higher pre-delivery body mass,fasting plasma glucose(FPG),and 2-hour postprandial plasma glucose(2hFPG)levels,as well as higher intake of fats,meats,and fruits,and lower intake of carbohydrates and vegetables,with all differences being statistically significant(all P<0.05).The levels of triglycerides(TG)and low-density lipoprotein cholesterol(LDL-C)in mid-pregnancy,and total cholesterol(TC),TG,and LDL-C levels in late pregnancy were highest in the self-adjusted diet group,followed by the professional dietary guidance group,and lowest in the control group(all P<0.05).The levels of high-density lipoprotein cholesterol(HDL-C)were lowest in the self-adjusted diet group,followed by the professional dietary guidance group,and highest in the control group(all P<0.05).The incidence of adverse pregnancy outcomes in the self-adjusted diet group(18.46%)was higher than that in the professional dietary guidance group(6.18%)and the control group(1.50%),with all differences being statistically significant(χ^(2)=21.848,P<0.05).Conclusions Pregnant women with GDM exhibit a significant increase in blood lipid levels during mid and late pregnancy,along with an unreasonable dietary structure.Clinically,dietary guidance and health interventions can effectively correct the disorder of blood lipid metabolism,thereby improving pregnancy outcomes.