孕早期基础上强化孕中期营养教育模式对妊娠期血糖的影响  

The effect of strengthening nutrition education in the second trimester on the basis of the first trimester on blood glucose

作　　者：吉琳琳 杨勤兵[1] 张欣悦 金超[1] 李世阳 班凌伟 Ji Linlin;Yang Qinbing;Zhang Xinyue;Jin Chao;Li Shiyang;Ban Lingwei(Department of Clinical Nutrition,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院临床营养科,清华大学临床医学院,北京102218

出　　处：《中华医学杂志》2023年第33期2614-2618,共5页National Medical Journal of China

摘　　要：目的探讨在孕早期基础上强化孕中期营养教育模式对妊娠期血糖的影响。方法回顾性选择2021年10月至2022年12月于清华大学附属北京清华长庚医院行口服葡萄糖耐量试验(OGTT)后至临床营养科就诊的398名孕妇,年龄(31.79±3.48)(23~41)岁,根据孕中期是否复诊分成两组,常规组只进行孕早期营养教育的孕妇,共205名,年龄(31.49±3.36)(24~41)岁;强化组孕早、中期均进行营养教育的孕妇,共193名,年龄(31.92±3.97)(23~41)岁。再根据孕前体质指数(BMI)分为BMI正常(18.5 kg/m^(2)≤BMI<24 kg/m^(2))和超重(24 kg/m^(2)≤BMI<28 kg/m^(2)),分层比较两组孕前不同体型孕妇OGTT血糖水平、妊娠期糖尿病(GDM)阳性率及孕期增重情况,分析孕中期强化营养教育模式对妊娠期血糖的影响。结果两组孕妇年龄及≥35岁人数占比、孕前BMI及超重人数占比、胎次和孕早期血糖间的差异均无统计学意义(均P>0.05)。强化组OGTT 0、1、2 h血糖水平分别为(4.57±0.37)、(8.41±1.70)和(7.28±1.51)mmol/L,低于常规组[分别为(4.74±0.48)、(9.44±1.55)和(8.27±1.58)mmol/L,均P<0.001]。强化组孕妇GDM阳性率为35.23%(68/193),低于常规组的91.71%(188/205)(P<0.001)。BMI分层后,强化组孕妇OGTT 0、1、2 h血糖水平、GDM阳性率仍均低于常规组(均P<0.05)。常规组中BMI正常的孕妇孕早期增重高于强化组(P=0.003);不同孕周增重的超重孕妇差异均无统计学意义(均P>0.05)。结论对孕期妇女在孕早期基础上强化1次孕中期营养教育,能有效改善孕期血糖水平、降低GDM的阳性率。Objective To explore the effect of strengthening individualized nutrition education in the second trimester based on first trimester on blood glucose.Methods A retrospective study was conducted on 398 pregnant women aged(31.79±3.48)(23-41)years old who underwent an oral glucose tolerance test(OGTT)from October 2021 to December 2022 at Beijing Tsinghua Changgung Hospital.They were divided into two groups according to whether the women were re-visited in second trimester or not.The routine group consisted of 205 pregnant women aged between 24 and 41(31.49±3.36)years old who only received the first trimester nutrition education and the strengthening group consisted of 193 pregnant women aged(31.92±3.97)(23-41)years old who received both the first and second trimester nutrition education.Then according to pre pregnancy body mass index(BMI),they were divided into normal(18.5 kg/m^(2)≤BMI<24 kg/m^(2))and overweight(24 kg/m^(2)≤BMI<28 kg/m^(2)).The OGTT blood glucose level,the positive rate of gestational diabetes(GDM)and the weight gain during pregnancy were compared between the two groups with different BMI,in order to analyze the effect of strengthening nutrition education in the second trimester of pregnancy on blood glucose.Results The differences between the two groups were not statistically significant in terms of the pregnant women′s age,proportion of pregnant women aged≥35,proportion of pre-pregnancy BMI and overweight,parity and early pregnancy blood glucose(all P>0.05).The blood glucose levels of OGTT at 0,1,and 2 hour were(4.57±0.37),(8.41±1.70),and(7.28±1.51)mmol/L,respectively,lower than those in the routine group[(4.74±0.48),(9.44±1.55),and(8.27±1.58)mmol/L,respectively,all P<0.001].The positive rate of GDM in the strengthening group was 35.23%(68/193),which was lower than that in the routine group(91.71%,188/205)(P<0.001).After the BMI stratification,the OGTT blood glucose levels and the positive rate of GDM in the strengthening group were still lower than those in the routine group(all

关 键 词：糖尿病 妊娠 血糖 孕期 营养教育 体重 

分 类 号：R715.3[医药卫生—妇产科学]