摘要：

目的·探討妊娠期糖尿?。╣estational diabetes mellitus，GDM）孕婦一日門診的餐次供能比例和總能量的個(gè)體化指導(dǎo)對其血糖控制、體質(zhì)量增速和妊娠結(jié)局的影響。方法·選擇2018年4月—2019年12月于上海交通大學(xué)醫(yī)學(xué)院附屬國際和平婦幼保健院GDM一日門診收治的孕婦490例。依據(jù)餐次供能比例不同，將其分為A組（207例，雞蛋于9：00即早點(diǎn)時(shí)食用，早餐和早點(diǎn)的供能比為15%和10%）和B組（283例，雞蛋于7：00即早餐時(shí)食用，早餐和早點(diǎn)的供能比為20%和5%），比較該2組孕婦的血糖控制水平。根據(jù)孕前體質(zhì)量指數(shù)（body mass index，BMI）和孕期增重不同，在調(diào)整飲食能量供應(yīng)后，將B組孕婦進(jìn)一步分為a組（132例，總能量無變化）和b組（151例，總能量減少1~2個(gè)交換份）。比較該2組孕婦的血糖控制水平、體質(zhì)量增速和妊娠結(jié)局。結(jié)果·早餐后2 h和午餐前，A、B組孕婦的血糖水平與標(biāo)準(zhǔn)值間差異均無統(tǒng)計(jì)學(xué)意義；與A組相比，B組孕婦午餐前的血糖水平已達(dá)到控制標(biāo)準(zhǔn)（<5.60 mmol/L）。午餐后，a組孕婦的血糖水平高于標(biāo)準(zhǔn)值（<6.70 mmol/L）（P=0.009），b組則與標(biāo)準(zhǔn)值間差異無統(tǒng)計(jì)學(xué)意義。b組孕婦經(jīng)干預(yù)后的體質(zhì)量增速低于干預(yù)前（P=0.004）。b組孕婦的妊娠期高血壓（P=0.015）、早產(chǎn)（P=0.032）和巨大質(zhì)量兒（P=0.032）的發(fā)生率均高于a組。結(jié)論·采用20%和5%的早餐和早點(diǎn)的供能比進(jìn)行進(jìn)食，有利于GDM孕婦控制午餐前的血糖水平；同時(shí)，適當(dāng)減少總能量的攝入，有利于孕前超重、肥胖或孕期增重過快的GDM孕婦控制午餐后的血糖水平及體質(zhì)量增速，但仍易發(fā)生不良妊娠結(jié)局，建議臨床上盡早干預(yù)。

關(guān)鍵詞: 妊娠期糖尿病, 妊娠期糖尿病一日門診, 調(diào)整餐次供能比例, 調(diào)整能量供給

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

中圖分類號: 

R459.3

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