医学营养干预后血糖分层对妊娠期糖尿病妊娠结局的影响

Effect of blood glucose stratification on pregnancy outcome of gestational diabetes mellitus after medical nutrition intervention

目的:探讨医学营养干预后妊娠期糖尿病(GDM)孕妇不同血糖水平对胎儿生长及妊娠结局的影响。方法:将某院经医学营养干预后GDM孕妇中FBG<5.3 mmol/L,6.7 mmol/L≤2 hPG<8 mmol/L的65例纳入GDM组。随机选择非GDM孕妇并进行医学营养干预的44例纳入非GDM组。比较两组孕妇在干预后1个月(孕28^(+1)~32周)、干预后2个月(孕32^(+1)~37周)、干预后3个月(孕37^(+1)周~分娩)3个阶段血糖变化、胎儿生长及母婴并发症。结果:GDM组与非GDM组孕妇干预前后孕各阶段FBG、2 hPG相比,差异均有统计学意义(P<0.05);两组孕妇干预后孕各阶段胎儿腹围增长、胎儿股骨长增长正常率比较,差异均无统计学意义(P>0.05);两组缺铁性贫血、低蛋白血症、妊高症、巨大儿、早产、胎膜早破、剖腹产、新生儿窘迫、新生儿窒息的发生率相比,差异均无统计学意义(P>0.05)。结论:对妊娠期糖尿病孕妇进行医学营养干预,将餐后2 h血糖控制不能达标的患者血糖控制在8 mmol/L以下,可以使母婴并发症的发生率降低,并使患者获益。

Objective:After medical nutrition intervention,the blood glucose levels of GDM(gestational diabetes mellitus)patients were stratified to evaluate the effects of different blood glucose levels on fetal growth and pregnancy outcome.Methods:According to the FBG and 2 hPG levels at this time,FBG<5.3 mmol/L,6.7 mmol/L≤2 hPG<8 mmol/L(65 cases)in GDM pregnant were included in the GDM group.Non-GDM pregnant women(44 cases)who were randomly selected and received medical nutrition intervention.At the same time,were included in the non-GDM group.The blood glucose changes,fetal growth and maternal and infant complications were compared between the two groups at three stages:1 months after intervention(28^(+1)-32 weeks),2 months after intervention(32^(+1)-37weeks),and 3 months after intervention(37^(+1)weeks-delivery).Results:There were significant differences in FBG,2 hPG in all stages of pregnancy between GDM group and non-GDM group before and after intervention(P<0.05).There was no significant difference in the normal rates of fetal abdominal circumference growth and fetai femur length growth between the two groups after intervention(P>0.05).There was no significant difference in the incidence of iron deficiency anemia,hypoproteinemia,hypertension,macrosomia,premature delivery,premature rupture of membranes,caesarean section,neonatal distress and neonatal asphyxia between the two groups(P>0.05).Conclusion:Medical nutrition intervention was carried out for pregnant women with diabetes,and the nutrition adjustment was carried out regularly.The 2 h postprandial blood glucose of the patients could not reach the standard which control below 8 mmol/L,The incidence of maternal and infant complications was low,which could benefit the patients.