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目的 探讨强化营养干预对妊娠期糖尿病(GDM)孕妇不良妊娠结局及新生儿出生体重的影响.方法 将2014年1—12月在首都医科大学附属北京友谊医院营养科门诊就诊的518例单活胎GDM孕妇按年龄、身高、体质指数(BMI)等进行分层,按照计算机软件随机生成的数字,分为对照组(260例)和观察组(258例).对照组仅给予常规饮食指导,观察组接受强化营养干预,详细记录进食、体重及血糖变化,坚持随访,并记录妊娠结局及新生儿情况.结果 两组孕妇基本资料差异无统计学意义.观察组妊娠期体重增长幅度[(12.2±4.7)kg]、新生儿出生体重[(3 406.4±495.4)g]均明显低于对照组[(13.9±5.0)kg、(3 494.9±484.7)g](P<0.01),而妊娠期体重增加(GWG)达标率(60.9%)明显高于对照组(51.9%)(χ2=4.2,P<0.05);观察组空腹血糖、餐后2 h血糖水平分别从(5.21±0.71)mmol/L、(6.68±0.90)mmol/L降至干预后(4.71±0.73)mmol/L(P<0.01)、(6.21±0.71)mmol/L(P<0.05);观察组与对照组非瘢痕子宫剖宫产率(44.6%vs. 53.8%)、产后出血(2.3%vs. 6.2%)、羊水过多(7.8%vs. 13.5%)、新生儿低血糖(3.1%vs. 6.5%)及巨大儿的发生率(8.1%vs. 13.8%)比较,差异有统计学意义(P<0.05).结论 强化营养干预可有效提高GWG达标率,改善GDM孕妇的糖代谢和妊娠结局.

Objective To explore the impacts of intensive nutritional intervention on maternal and infant outcomes in women with gestational diabetes mellitus(GDM). Methods From January 2014 to ecember 2014, a total of 518 women with GDM were stratified by age, height, body mass index (BMI), and were divided into treatment group (n=258) and control group (n=260) according to the random number generated by the computer software. Women in control group underwent conservative treatment while those in treatment group were given intensive nutritional intervention including keeping records of eating habits, measurement of blood glucose and regular follow-up. The incidence of pregnancy-related complications and newborn outcomes in both groups were compared. Results Women of the two groups were similar in basic clinical data. The range of gestational weight gain (GWG) [(12.2 ± 4.7) vs. (13.9 ± 5.0)kg] and birth weight of infants [(3 406.4±495.4) vs. (3 494.9±484.7)g] in the intervention group was significantly lower than those in the control group (P<0.01). The rate of reaching recommended target of GWG was significantly higher in the intervention group (60.9%) than in the control group (51.9%, χ2=4.2, P<0.05). There was a significant reduction in glucose-related parameters in both groups (P<0.01). In the intervention group, fasting blood glucose and postprandial blood glucose were reduced from (5.21 ± 0.71) mmol/L, (6.68 ± 0.90) mmol/L to (4.71 ± 0.73) mmol/L,(6.21 ± 0.71) mmol/L (P<0.01), respectively in comparison with the control group, the intervention group had lower incidence of cesarean section (44.6% vs. 53.8%), postpartum hemorrhage (2.3%vs. 6.2%), polyhydramnios (7.8%vs. 13.5%), neonatal hypoglycemia (3.1%vs. 6.5%) and macrosomia (8.1%vs. 13.8%, P<0.05). Conclusions Strengthening nutritional intervention in women with GDM could increase the rate of reaching recommended target of GWG, improve the glucose-related parameters and reduce the incidence rate of pregnancy complications.