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目的探讨医学营养治疗在妊娠期糖代谢异常治疗中的作用。方法2007年7—12月在广东省人民医院确诊为妊娠期糖代谢异常的单胎孕妇83例,按照其孕中期有无看营养门诊分为研究组40例和对照组43例,两组孕妇均由产科医师定期随诊,研究组孕妇同时有专业营养医师随访,并采用食物交换份法(FEL)联合食物血糖负荷法(GL)进行医学营养治疗,比较两组孕妇的孕期血糖、体质量和围生期结局。结果妊娠期糖代谢异常的发生率为5.76%(83/1440),其中妊娠糖尿病(GDM)发生率为2.43%(35/1440),妊娠糖耐量减低(GIGT)发生率为3.33%(48/1440)。治疗前两组孕妇的空腹血糖及餐后2 h血糖水平间差别均无统计学意义(P>0.05),治疗后两组孕妇的空腹血糖及餐后2 h血糖水平间差别均有统计学意义(P<0.05)。两组孕妇孕期体质量总增加量和每周体质量增加量间差别均有统计学意义(P<0.05)。两组新生儿出生体质量间差别无统计学意义(P>0.05)。研究组早产、巨大儿、胎儿窘迫的发生率分别为12.5%、2.5%和7.5%,低于对照组,但差别无统计学意义(P>0.05)。结论科学的营养治疗可改善妊娠期糖代谢异常者的餐后血糖,对其孕期体质量增加的管理有指导作用。
Objective To explore the role of medical nutrition therapy in the treatment of abnormal glucose metabolism during pregnancy. Methods 83 cases of singleton pregnancies diagnosed as abnormal glucose metabolism during pregnancy in Guangdong Provincial People ’s Hospital from July 2007 to December 2007 were divided into study group (40 cases) and control group (43 cases) All obstetricians were followed up regularly by the obstetrician. The pregnant women of the study group were also followed up by professional nutritionists at the same time. FEL and GL were used to treat the patients. The blood glucose, body weight And perinatal outcomes. Results The incidence of abnormal glucose metabolism in gestation was 5.76% (83/1440). The incidence of gestational diabetes mellitus (GDM) was 2.43% (35/1440) and the incidence of gestational impaired glucose tolerance (GIGT) was 3.33% (48 / 1440). There were no significant differences in fasting blood glucose and postprandial 2-h blood glucose levels between the two groups before treatment (P> 0.05). There was significant difference in fasting blood glucose and postprandial 2-h blood glucose levels between the two groups after treatment (P <0.05). The difference between the two groups of pregnant women during pregnancy total weight gain and weekly body weight increase were statistically significant (P <0.05). There was no significant difference in birth weight between the two groups (P> 0.05). The incidence of preterm birth, macrosomia and fetal distress in the study group was 12.5%, 2.5% and 7.5%, respectively, lower than that in the control group, but the difference was not statistically significant (P> 0.05). Conclusion Scientific nutritional therapy can improve postprandial blood glucose in patients with abnormal glucose metabolism during pregnancy, which can guide the management of the increase of body weight during pregnancy.