摘要
目的探讨限制碳水化合物饮食(CRD)方案对妊娠期糖尿病(GDM)患者妊娠期胰岛素应用及血脂代谢的影响。方法回顾性分析2018年7月至2020年1月于我院分娩的265例GDM孕妇的临床资料,根据其妊娠期是否接受过CRD干预及CRD干预方案的执行度分为两组:接受过CRD干预且执行度>50%的为CRD组(n=152)和未接受CRD干预或执行度<50%的为非CRD组(n=113),比较两组患者的一般资料、妊娠期胰岛素应用情况以及血脂代谢相关指标;采用二分类Logistic回归分析GDM孕妇妊娠期CRD干预联合胰岛素治疗的危险因素。结果两组患者的年龄、体质量指数(BMI)、孕早期空腹血糖(FPG)、糖化血红蛋白(HbA1c)、孕期增重、产前腹围、分娩方式、新生儿出生体重和身长比较均无显著性差异(P>0.05);CRD组的经产妇占比显著高于非CRD组(P<0.05)。两组间胰岛素治疗率比较无显著性差异(P>0.05);CRD组应用胰岛素治疗的初始孕周显著晚于非CRD组(P<0.05)。孕中期两组间总胆固醇(TC)异常率、甘油三酯(TG)异常率和高密度脂蛋白胆固醇(HDLC)异常率比较均无显著性差异(P>0.05);CRD组的低密度脂蛋白胆固醇(LDLC)异常率显著低于非CRD组(P<0.05)。孕晚期,两组间TC异常率、TG异常率、HDLC异常率和LDLC异常率比较均无显著性差异(P>0.05)。二分类Logistic回归分析结果发现,年龄[OR=1.13,95%CI(1.01,1.27),P=0.03]、孕早期FPG[OR=8.20,95%CI(2.12,31.81),P<0.01]和产前腹围[OR=1.08,95%CI(1.01,1.14),P=0.02]是GDM患者妊娠期CRD干预联合胰岛素治疗的危险因素。结论CRD干预对于延缓GDM患者妊娠期胰岛素的应用及改善孕中期LDLC代谢具有一定作用。GDM孕妇早期高血糖、高龄生产及产前腹围较高可能是CRD干预联合胰岛素治疗的危险因素。
Objective:To explore the effect of carbohydrate-restricted dietary(CRD)pattern on insulin therapy and lipid metabolism in the patients with gestational diabetes mellitus(GDM).Methods:A retrospective study was conducted on 265 GDM women who delivered in our hospital from July 2018 to January 2020. According to whether they had received CRD intervention and the implementation degree of CRD intervention regimen during pregnancy, they were divided into two groups: the patients received CRD intervention and implementation degree >50% in CRD group(n=152),and the patients did not receive CRD intervention or implementation degree <50% in non-CRD group(n=113). The general information, insulin therapy during pregnancy, and indicators of blood lipid metabolism were compared between the two groups. The risk factors of CRD intervention combined insulin therapy in women with GDM were analyzed by binary logistic regression.Results:There were no significant differences in age, BMI,fasting blood glucose(FPG) in early pregnancy, HbA1 c, gestational weight gain, prenatal abdominal circumference, delivery mode, newborn birth weight and length between the two groups(P>0.05). The percentage of multiparous women in CRD group was significantly higher than that in non-CRD group(P<0.05). There was no significant difference in the insulin therapy rate between CRD group and non-CRD group(P>0.05). The initial gestational weeks of CRD combined with insulin therapy was significantly later than that of non-CRD group(P<0.05). There were no significant differences in abnormal rates of total cholesterol(TC),triglyceride(TG)and high density lipoprotein cholesterol(HDLC) between the two groups in the middle trimester(P>0.05),and the abnormal rate of low density lipoprotein cholesterol(LDLC)in CRD group was significantly lower than that in non-CRD group(P<0.05). There were no significant differences in abnormal rates of TC,TG,HDLC and LDLC between the two groups in the third trimester(P>0.05). Binary logistic regression analysis showed that age[OR=1.13,95%CI(1.01,1.27),P=0.03],fasting plasma glucose level in the first trimester[OR=8.20,95%CI(2.12,31.81),P<0.01] and prenatal abdominal circumference[OR=1.08,95%CI(1.01,1.14),P=0.02] were risk factors for CRD intervention combined insulin therapy in GDM patients during pregnancy.Conclusions:CRD intervention is effective in delaying the insulin therapy during pregnancy and improving the metabolism of LDLC in the second trimester. Early hyperglycemia, advanced age and larger prenatal abdominal circumference in pregnant women with GDM are the risk factors for CRD intervention combined with insulin therapy.
作者
崔铭萱
李雪宁
卢露露
赵世隆
郭倩颖
CUI Ming-xuan;LI Xue-ning;LU Lu-lu;ZHAO Shi-long;GUO Qian-ying(Department of Clinical Nutrition,Peking University People’s Hospital,Beijing100044)
出处
《生殖医学杂志》
CAS
2022年第8期1061-1066,共6页
Journal of Reproductive Medicine
基金
北京大学人民医院研究与发展基金(RDX2019-10)。
关键词
妊娠期糖尿病
碳水化合物
胰岛素
妊娠期
脂质代谢
Gestational diabetes mellitus
Carbohydrate
Insulin
Gestation period
Lipid metabolism
