不同运动方式对妊娠期糖尿病患者代谢指标及妊娠结局的影响研究

背景妊娠期糖尿病（GDM）是妊娠期间常见疾病，可导致早产、巨大儿、剖宫产等并发症，严重影响母婴健康。目的探讨不同运动方式对GDM患者代谢指标及妊娠结局的影响，为GDM患者提供更适宜的运动方式。方法选取2019年8月至2020年12月于广西医科大学第一附属医院与广西医科大学第二附属医院收治的210例GDM患者为研究对象，采用Excel产生的随机数字序列将患者随机分为有氧运动（AT）组70例、抗阻运动（RT）组70例、RT+AT组70例。AT组患者进行中等强度步行运动，RT组患者采用坐位举重哑铃，RT+AT组采用中等强度步行+坐位哑铃联合方式。分别于干预前和干预后1个月、3个月及分娩时检测孕妇相关指标：空腹血糖（FBG）、餐后2 h血糖（2 hPBG）、糖化血红蛋白（HbA1c）、体质量、收缩压（SBP）、舒张压（DBP），并观察妊娠结局。结果AT组、RT组、RT+AT组最终有65例、64例、62例完成试验。各组干预1、3个月FBG、2 hPBG、SBP、DBP水平均低于同组干预前（P<0.05），RT组和RT+AT组干预3个月时HbA1c水平均低于同组干预前（P<0.05），RT组和RT+AT组干预3个月时DBP水平均低于同组干预1个月时（P<0.05）。干预3个月后，RT+AT组2 hPBG、HbA1c水平均低于AT组和RT组（P<0.05）。三组胎龄、早产发生率、妊娠期高血压综合征发生率、胰岛素使用人数、孕晚期体质量增长比较，差异均无统计学意义（P>0.05）。RT+AT组剖宫产发生率低于AT组和RT组，RT组和RT+AT组产后出血量均低于AT组（P<0.05）。三组新生儿出生体质量、1分钟Apgar评分、身长比较，差异均无统计学意义（P>0.05）；RT+AT组巨大儿发生率低于AT组（P<0.05）。结论AT、RT、RT+AT均能改善GDM患者的代谢指标，RT+AT更适宜；RT+AT改善GDM患者母婴结局优于AT、RT。

Effects of Different Exercise Modalities on Metabolic Indices and Pregnancy Outcomes in Patients with Gestational Diabetes Mellitus

Background Gestational diabetes mellitus(GDM)is a common pregnancy disease,which can cause complications such as preterm delivery,macrosomia and cesarean section,seriously affecting maternal and infant health.Objective To investigate the effects of different exercise modalities on metabolic indices and pregnancy outcomes in GDM patients,providing a reference for choosing an appropriate exercise modality for GDM patients.Methods Two hundred and ten GDM patients were recruited from the First Affiliated Hospital of Guangxi Medical University and the Second Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020.By use of a random number sequence generated in Excel,they were equally divided into aerobic training(AT)group(moderate-intensity walking),resistance training(RT)group(lifting dumbbell while sitting)and RT+AT group(moderate-intensity walking plus lifting dumbbell while sitting).Metabolic indices were measured at baseline,1 and 3 months after the intervention,and at delivery,respectively,including fasting blood glucose(FBG),two-hour postprandial blood glucose(2 hPBG),glycosylated hemoglobin(HbA_1c),body weight,systolic blood pressure(SBP)and diastolic blood pressure(DBP).Pregnancy outcomes were also observed.Results AT group,RT group and RT+AT group finally completed the test in 65 cases,64 cases and 62 cases.(1)Significant decreases were found in average levels of FBG,2 hPBG,SBP,and DBP in all groups at 1 and 3 months post-intervention(P<0.05).The average level of HbA_1c in RT and RT+AT groups showed a successive decrease over the period from baseline to 1,and 3 months post-intervention(P<0.05).The average level of DBP also demonstrated a successive decrease in these two groupsover the period from baseline to 1,and 3 months post-intervention(P<0.05).The average levels of 2 hPBG and HbA_1c in RT+AT group were lower than those of other two groups at 3 months post-intervention(P<0.05).(2)The average gestational age,incidence of preterm delivery and pregnancy-induced hypertension,number of insulin users,and average weight gain in late pregnancy showed no significant intergroup differences(P>0.05).The incidence of cesarean delivery in RT+AT group was lower than that of other two groups,the average amount of postpartum bleeding in RT and RT+AT groups were lower than that of AT group(P<0.05).(3)The average neonatal birth weight and length,and 1-minute Apgar score had no significant intergroup differences(P>0.05).The incidence of macrosomia varied significantly accross the groups(P<0.05).In particular,RT+AT group had a lower incidence of macrosomia than AT group(P<0.05).Conclusion All of AT,RT and RT plus AT could improve the metabolic indices of GDM patients,but RT plus AT may be more effective.Furthermore,RT plus AT may also be more effective in improving maternal and infant outcomes of GDM patients.