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目的探索通过营养干预对妊娠期糖尿病(GDM)患者的妊娠结局影响。方法随机选取2013-2014年在常州市妇幼保健院产前检查门诊确诊为GDM并完成随访的孕妇作为研究对象:自愿接受个性化医学营养治疗(MNT)的281例作为干预组(A组),只接受常规营养指导,未进行医学营养治疗的304例作为对照组(B组)。同时根据葡萄糖耐量结果分别将A组、B组划分为A1组[(口服葡萄糖耐量试验(OGTT)血糖值1项异常)]、B1组,A2组(OGTT血糖值2项异常)、B2组,A3组(OGTT血糖值3项异常)、B3组,通过对照研究的方法来比较母儿并发症的发生率,评估不同类型的GDM孕妇的妊娠结局。结果与B组相比,A组胰岛素使用率及巨大儿、贫血的发生率更低(P<0.05),但A组剖宫产率高于B组(P<0.05)。A1组和A2组经过MNT后效果明显,与B1、B2组相比,发生母婴并发症的概率较低(P<0.05);而A3组MNT效果不明显,与B3组相比,差异无统计学意义(P>0.05)。结论在妊娠期糖尿病患者中,OGTT血糖值不大于两项异常时,运用个性化医学营养治疗可获得较好的妊娠结局;而OGTT血糖值3项均异常时,应及时运用胰岛素治疗,从而有效减少GDM围产期母婴并发症。
Objective To explore the effect of nutritional intervention on gestational outcome in patients with gestational diabetes mellitus (GDM). METHODS: Pregnant women who were diagnosed as GDM and were followed up at antenatal examination and outpatient clinics of Changzhou MCH were randomly selected from 2013 to 2014. A total of 281 pregnant women who received voluntary personalized medical nutrition (MNT) as intervention group (A) Only received regular nutrition guidance, did not carry out medical nutrition treatment of 304 cases as a control group (B group). At the same time, group A and group B were divided into group A1 [(1 glucose abnormality in oral glucose tolerance test (OGTT)], group B1 and group A2 (2 abnormalities of blood glucose of OGTT), group B2, Group A3 (OGTT blood glucose value of 3 abnormalities), B3 group, by comparison study to compare the incidence of maternal complications, to assess the different types of GDM pregnant women pregnant outcome. Results Compared with group B, the incidence of insulin and the incidence of macrosomia and anemia in group A were lower than those in group B (P <0.05). However, the cesarean section rate in group A was higher than that in group B (P <0.05). The effect of MNT in group A1 and group A2 was significantly lower than that in group B1 and B2 (P <0.05), while the effect of MNT in group A3 was not obvious. Compared with group B3, the difference was not significant Statistical significance (P> 0.05). Conclusion In patients with gestational diabetes, OGTT blood glucose levels of not more than two abnormalities, the use of personalized medical nutrition treatment can get better pregnancy outcomes; and OGTT abnormal blood glucose 3, insulin treatment should be promptly, and thus effective Reduce the perinatal maternal and neonatal complications of GDM.