个体化管理对门诊妊娠期糖尿病母婴结局的影响

摘要

Objective To investigate the effects of individual management on maternal and infant out-comes of gestational diabetes mellitus(GDM).Methods A total of 413 pregnant patients with GDM deliv-ered in Shenzhen Luohu People′s Hospital from January 2012 to June 2014 were included in the study,and divided into two groups,which were randomly divided into 208 cases in the control group,and 205 cases in the study group.The control group used conventional intervention, such as nutrition education, sports and blood glucose monitor;the study group used conventional intervention plus individualized management . Weight gain,fasting plasma glucose and 2-hour postprandial blood glucose,obstetric complications,cesarean section rate of the two groups were compared.Results The weight gain of patients with body mass index from 18.5 to 24.9,25 to 29.9,>30 kg/m2 during pregnancy of the study group were lower than the control group [(12 ±5) kg vs (16 ±7) kg,(8 ±6) kg vs (11 ±7) kg,(6 ±3) kg vs (10 ±4) kg],the differ-ences were statistical significant(P <0.01 or P <0.05).After the intervention,fasting blood glucose and postprandial 2 h blood glucose levels of the study group were lower than the control group [ ( 4.2 ± 0.8) mmol/L vs (4.5 ±0.6) mmol/L,(6.0 ±0.8) mmol/L vs ( 6.4 ±0.7) mmol/L],the difference was statistically significant (P<0.01).The pregnancy induced hypertension,fetal growth restriction,macro-somia,premature birth,neonatal hypoglycemia and cesarean section rates of the study group were significantly lower than the control group(all P<0.05).Conclusion Individual management of gestational diabetes,can effectively control the growth of body weight and blood glucose levels,and significantly improve the maternal and infant outcome.%目的：探讨个体化管理对妊娠期糖尿病（ GDM）母婴结局的影响。方法选择2012年1月至2014年6月于深圳市罗湖区人民医院产科分娩的413例GDM患者，依据随机数字表法分为两组，研究组（205例）和对照组（208例）。对照组采用常规干预，如营养宣教、运动及血糖监测；研究组在对照组常规干预的基础上实施个体化管理。分别对两组孕妇干预前后体质量增长、空腹血糖及餐后2h血糖的变化、产科并发症、剖宫产率及围生儿结局等情况进行比较。结果研究组体质指数18.5～24.9、25.0～29.9、＞30 kg／m2的患者孕期增重均低于对照组[（12±5） kg 比（16±7） kg、（8±6） kg 比（11±7） kg、（6±3） kg比（10±4） kg]，差异均有统计学意义（P＜0.01或 P＜0.05）。干预后，研究组空腹血糖和餐后2 h 血糖水平均低于对照组[（4.2±0.8） mmol／L 比（4.5±0.6） mmol／L、（6.0±0.8） mmol／L比（6.4±0.7） mmol／L]，差异有统计学意义（P＜0.01）。研究组妊娠期高血压、胎儿生长受限、巨大儿、早产、新生儿低血糖发生率及剖宫产率均显著低于对照组（均P＜0.05）。结论个体化管理应用于GDM孕妇，可有效控制体质量增长及血糖水平，显著改善母婴结局。