妊娠期糖尿病孕妇一日门诊饮食个体化指导对血糖控制、体质量增速和妊娠结局的影响分析

摘要：

目的·探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）孕妇一日门诊的餐次供能比例和总能量的个体化指导对其血糖控制、体质量增速和妊娠结局的影响。方法·选择2018年4月—2019年12月于上海交通大学医学院附属国际和平妇幼保健院GDM一日门诊收治的孕妇490例。依据餐次供能比例不同，将其分为A组（207例，鸡蛋于9：00即早点时食用，早餐和早点的供能比为15%和10%）和B组（283例，鸡蛋于7：00即早餐时食用，早餐和早点的供能比为20%和5%），比较该2组孕妇的血糖控制水平。根据孕前体质量指数（body mass index，BMI）和孕期增重不同，在调整饮食能量供应后，将B组孕妇进一步分为a组（132例，总能量无变化）和b组（151例，总能量减少1~2个交换份）。比较该2组孕妇的血糖控制水平、体质量增速和妊娠结局。结果·早餐后2 h和午餐前，A、B组孕妇的血糖水平与标准值间差异均无统计学意义；与A组相比，B组孕妇午餐前的血糖水平已达到控制标准（<5.60 mmol/L）。午餐后，a组孕妇的血糖水平高于标准值（<6.70 mmol/L）（P=0.009），b组则与标准值间差异无统计学意义。b组孕妇经干预后的体质量增速低于干预前（P=0.004）。b组孕妇的妊娠期高血压（P=0.015）、早产（P=0.032）和巨大质量儿（P=0.032）的发生率均高于a组。结论·采用20%和5%的早餐和早点的供能比进行进食，有利于GDM孕妇控制午餐前的血糖水平；同时，适当减少总能量的摄入，有利于孕前超重、肥胖或孕期增重过快的GDM孕妇控制午餐后的血糖水平及体质量增速，但仍易发生不良妊娠结局，建议临床上尽早干预。

关键词: 妊娠期糖尿病, 妊娠期糖尿病一日门诊, 调整餐次供能比例, 调整能量供给

Abstract:

Objective·To investigate the effects of individual guidance of the energy contribution ratio of meals and total energy on glycemic control, body weight gain rate and pregnancy outcome in pregnant women with gestational diabetes mellitus (GDM) in one-day outpatient.Methods·A total of 490 pregnant women admitted to one-day outpatient for GDM of The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from April 2018 to December 2019 were included. According to the energy contribution ratio of meals, they were divided into group A [207 cases, eggs were consumed at mid-morning snack (9:00), and the energy contribution ratio of breakfast and mid-morning snack was 15% and 10%, respectively] and group B [283 cases, eggs were consumed at breakfast (7:00), and the energy contribution ratio of breakfast and mid-morning snack was 20% and 5%, respectively], and the glycemic control levels of the group A and group B were compared. According to the difference of pre-pregnancy body mass index (BMI) and weight gain during pregnancy, after adjusting the dietary energy supply, pregnant women in the group B were further divided into group a (132 cases, no change in total energy) and group b (151 cases, total energy reduced by 1-2 exchange parts). The glycemic control level, body weight growth rate and pregnancy outcome were compared between the group a and group b.Results·At 2 h after breakfast and before lunch, there was no significant difference between the blood glucose levels and standard values of pregnant women in the group A and group B. Compared with the group A, the blood glucose level of pregnant women in the group B before lunch had reached the control standard (< 5.60 mmol/L). After lunch, the blood glucose level of pregnant women in the group a was higher than the standard value (< 6.70 mmol/L) (P=0.009), but there was no significant difference between the group b and the standard value. The body weight gain rate of pregnant women in group b after intervention was lower than that before intervention (P=0.004). The incidence of gestational hypertension (P=0.015), premature delivery (P=0.032) and huge mass baby (P=0.032) in the group b was higher than that in the group a.Conclusion·Using 20% and 5% energy contribution ratio of breakfast and mid-morning snack for eating is helpful for GDM women to control the blood glucose levels before lunch. At the same time, appropriately reducing the intake of total energy is conducive to GDM women who are overweight or obese before pregnancy, or who gain too much weight during pregnancy to control the blood glucose levels and body weight growth rate after lunch, but they are still prone to adverse pregnancy outcomes. It is suggested that clinical intervention should be carried out as soon as possible.

Key words: gestational diabetes mellitus (GDM), one-day outpatient for GDM, adjust the energy contribution ratio of meals, adjust the dietary energy supply

中图分类号: 

R459.3

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