糖耐量试验结果对妊娠合并糖尿病孕妇饮食调理效果的预测价值

目的:探讨在对妊娠期糖尿病孕妇进行饮食调理过程中,糖耐量试验结果对饮食控制血糖效果的预测价值,并分析饮食治疗对改善妊娠糖尿病结局的作用。方法:收集2007～2009年在厦门市妇幼保健院营养室265例妊娠期糖尿病患者,并收集同期就诊的正常孕妇571例作为对照组,记录其年龄、体重、血压、糖尿病筛查、糖耐量试验结果等一般情况,并追踪其妊娠结局。结果:①两组孕妇孕前BMI指数、文化程度及孕期血压变化无统计学差异,妊娠期糖尿病组年龄高于正常对照组(t=4.389,P<0.05);②空腹血糖正常组的GDM孕妇饮食调理血糖的控制率高于空腹血糖超标组的孕妇(χ2=12.079,P<0.001);在空腹血糖正常的GDM孕妇中,血糖控制情况不佳的孕妇,其糖耐量试验餐后1h血糖(1hrBG)及餐后2h血糖(2hrBG)均高于血糖控制良好的孕妇(t=-5.097,P<0.01;t=-2.042,P<0.01);当OGTT中1hrBG>12.5mmol/L或2hrBG>11.0mmol/L时,血糖值越高,血糖控制情况不佳的风险越高,OR值(风险值)处在中等强度范围内(P<0.05)。③血糖控制不佳组的新生儿出生体重异常率高于正常对照组及血糖控制良好组,并且早产率高于正常对照组(P<0.01);妊娠期糖尿病患者的剖宫产率高于正常对照组(P<0.01)。结论:①年龄对妊娠期糖尿病的发生有影响;②当OGTT中1hrBG>12.5mmol/L或2hrBG>11.0mmol/L时,提示该孕妇饮食调理血糖的控制率较低,尤其是空腹血糖水平超过标准的妊娠糖尿病孕妇更应当引起临床医生的重视。③及时有效的进行合理的饮食管理并将血糖控制在理想范围内,能减少糖尿病对母婴的危害。

The predictive value of oral glucose tolerance test results on dietary control effect in pregnant women with gestational diabetes mellitus

Objective:To explore the predictive value of oral glucose tolerance test results on blood glucose control in the course of dietary control in pregnant women with gestational diabetes mellitus(GDM),analyze the improving effect of dietary therapy on outcomes of GDM.Methods:265 pregnant women with GDM were selected from department of nutrition,maternal and child health hospital of Xiamen from 2007 to 2009,571 normal pregnant women at the same time were selected as control group;general conditions including age,body weight,blood pressure,GDM screening and results of oral glucose tolerance test were recorded;and their pregnancy outcomes were followed up.Results:There was no significant difference in pregestational BMI,educational level and changes of blood pressure during pregnancy between the two groups,the age of GDM group was significantly older than that of control group(t=4.389,P<0.05).The control rate of blood glucose during dietary control in GDM women with normal fasting blood glucose was significantly higher than that in GDM women with high fasting blood glucose(χ2=12.079,P<0.001);among GDM women with normal fasting blood glucose,the levels of one hour postprandial blood glucose and two hours postprandial blood glucose in pregnant women with poorly controlled blood glucose were significantly higher than those in pregnant women with well controlled blood glucose(t=-5.097,P<0.01;t=-2.042,P<0.01);for the pregnant women with one hour postprandial blood glucose>12.5 mmol/L or two hours postprandial blood glucose>11.0 mmol/L,the risk of poorly controlled blood glucose increased with the increase of blood glucose,OR value was within middle range(P<0.05).The incidence of abnormal birth weight of neonates in poorly controlled blood glucose group was significantly higher than those in normal control group and well controlled blood glucose group,and the incidence of premature delivery in poorly controlled blood glucose group was significantly higher than that in normal control group(P<0.01);the rate of cesarean section in GDM women was significantly higher than that in normal control group(P<0.01).Conclusion:Age may affect the occurrence of GDM;the pregnant women with one hour postprandial blood glucose>12.5 mmol/L or two hours postprandial blood glucose>11.0 mmol/L have low control rate of blood glucose,more attention should be paid to GDM women whose levels of fasting blood glucose are higher than standard;timely,effective and reasonable dietary control may control blood glucose within ideal range,which can reduce the harm of GDM to mothers and their babies.