摘要
目的 探讨孕期体重增长情况与妊娠期糖尿病（GDM）的关系,分析饮食治疗对改善GDM结局的作用.方法 2007-2009年,在厦门市妇幼保健院收集GDM患者265例,并以同期就诊的正常孕妇571名作为对照组.收集一般情况资料并于孕20周前、孕26～27周（孕中期）、孕35～36周（孕晚期）及分娩前监测体重,分析不同年龄段（＜25、25～、30～、≥35岁）两组孕妇不同孕周的体重增长情况及28周前体重增长对GDM发病的影响,同时对GDM患者给予营养治疗并评价血糖控制情况对妊娠结局的影响.结果 25～、30～、≥35岁年龄段GDM组孕期总体重增长分别为（16.9±6.3）、（16.8±6.1）、（16.5±6.0）kg,对照组分别为（13.9±3.0）、（13.8±2.7）、（13.3±2.7）kg（t值分别为6.259、5.885、3.533,P值均＜0.05）;孕20～27周间,＜25、25～、30～岁年龄段GDM组增长的体重分别为（5.2±1.0）、（5.4±1.7）、（4.8±1.3）kg,对照组分别为（3.3±1.3）、（3.7±1.6）、（3.5±0.7）kg（t值分别为5.026、9.659、11.19,P值均＜0.05）;孕26～36周间,≥35岁年龄段GDM组体重增长为（3.6±2.0）kg,低于对照组的（4.0±0.9）kg（t=-2.449,P＜0.05）.25～、30～岁年龄段GDM组孕28周前体重增长超过13 kg的暴露率分别为41.22%（54/131）及44.94%（40/89）,对照组分别为30.04%（76/253）及26.07%（55/211）（OR值分别为1.633、2.315,P值均＜0.05）.血糖控制良好组及对照组的新生儿出生体重异常率分别为6.6%（12/182）及9.4%（54/571）,均低于血糖控制不佳组的20.5%（17/83）（x2值分别为11.490、9.119,P值均＜0.0125）,血糖控制不佳组早产率为21.7%（18/83）,高于对照组的10.8%（62/571）（x2=7.945,P＜0.0125）.血糖控制良好组及血糖控制不佳组的剖宫产率分别为46.7%（85/182）及65.0%（54/83）,均高于对照组的25.4%（145/571）（x2值分别为29.540、53.860,P值均＜0.0125）.结论 孕中期体重增长对GDM的发病有影响,25～岁年龄段的孕妇孕28周前总体重增长不宜超过13 kg;及时对GDM孕妇进行营养治疗并控制血糖,能改善其妊娠结局.
Objective To study the relationship of bodyweight gain and the occurrence of gestational diabetes mellitus （GDM） during pregnancy, and analyze the effect of the nutritional therapy on the outcome of GDM. Methods We collected 265 pregnant women who were diagnosed to be GDM and 571 pregnant women as the control group in the Xiamen Maternal and Child Health Hospital during 2007 -2009. The general information of the subjects were collected. The bodyweight of the subjects were measured before the 20th week of pregnancy, 26 - 27th week （ mid-gestation ）, 35 - 36th week （ late-gestation ） of pregnancy and prior to delivery. The bodyweight gain of different pregnancy weeks of the two groups and the effect of bodyweight on GMD occurrence before 28th week of pregnancy were analyzed by ages （ ＜25,25 -,30-, ≥35）. Meanwhile,we prescribed the nutrition therapy to the GDM pregnant woman and the effect of the blood sugar control on the outcome of the pregnancy were evaluated. Results The bodyweight gain of 25 - ,30 - ,older than 35 year-old subjects of the GDM group were （ 16.9 ±6.3）, （ 16.8 ±6.1 ）, （ 16.5 ±6.0） kg,respectively, the bodyweight gain of the control group were （ 13.9 ± 3.0 ）, （ 13.8 ± 2.7 ）, （ 13.3 ±2.7 ） kg （ t = 6.259,5.885,3.533, respectively, all P values ＜ 0.05 ）. During the 20th to 27th week of the pregnancy,the bodyweight gain of the subjects younger than 25,25 -, 30 - year-old in GDM group were （5.2 ± 1.0）, （ 5.4 ± 1.7 ）, （ 4.8 ±1.3 ） kg, respectively, the bodyweight gain of the control group were （3.3±1.3）,（3.7 ±1.6） and （3.5 ±0.7）kg （t=5.026,9.659,11.19,respectively,all P values＜0.05 ）. During the period between 26th to 36th week, the bodyweight gain of subjects older than 35 year-old in GDP group was （ 3.6 ± 2.0 ） kg which was less than the control group （ （4.0 ± 0.9 ） kg, t = - 2.449, P ＜0.05 ）. 41.22% （ 54/131 ） and 44. 94% （ 40/89 ） of 25 - , 30 - year-old subjects in GDM group showed bodyweight gain more than 13 kg, but 30.04% （ 76/253 ） and 26.07% （ 55/211 ） in the control group （ OR values were 1.633 and 2.315, both P values ＜ 0.05 ）. The rate of the abnormal birth weight of the GDM group with blood sugar controlled and the control group were 6.6% （ 12/182 ）and 9.4% （54/571 ）which was lower than the GDP group with blood sugar control failure （20.5% （17/83）） （x2 values were 11.460,9.119,respectively, both P values ＜ 0.0125 ）. The rate of premature delivery was 21.7% （18/83）, higher than the control group （ 10.8% ,62/571 ） （ x2 = 7.945, P ＜ 0.0125 ）. The rate of the cesarean in the control group was 25.4% （ 145/571 ） which was lower than the two GDM groups, including the group which the blood sugar was well controlled （46.7% ,85/182） and not well controlled （65.0% ,54/83 ） （ x2 values were 29.540,53.860,respectively, both P values ＜ 0.0125 ）. Conclusion The bodyweight gain in the midgestation could affect the occurrence of GDM. The bodyweight gain should be less than 13 kg before 28th week of the pregnancy whose age was 25 - year-old. Nutritional therapy and blood sugar control in GDM pregnant women could improve the pregnancy outcome.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2010年第10期903-907,共5页
Chinese Journal of Preventive Medicine
关键词
孕妇
糖尿病
体重增长
营养疗法
Pregnant women
Diabetes mellitus
Weight gain
Nutrition therapy
