个体化医学营养治疗对妊娠糖尿病血糖控制有效率及妊娠结局影响的研究

发布时间：2018-06-17 10:41

本文选题：糖尿病 + 妊娠　；参考：《青岛大学》2013年硕士论文

【摘要】：目的：①分析妊娠糖尿病(GDM)孕妇的饮食习惯、饮食结构特点,为妊娠糖尿病孕妇合理饮食提供参考。 ②探讨个体化医学营养治疗对妊娠糖尿病孕妇的血糖控制及妊娠结局的影响,为GDM孕妇合理饮食提供参考。方法：①选择确诊的妊娠糖尿病孕妇96例为病例组,另选正常孕妇96例为对照组,以问卷调查孕妇饮食习惯,采用食物频率法和24小时膳食回顾法相结合调查妊娠糖尿病孕妇的饮食结构、能量及三大营养素的摄入和其食物来源。 ②选择我院确诊的妊娠糖尿病(GDM)孕妇48例为治疗组,给予个体化医学营养治疗,另选同期只接受口头饮食指导不愿接受个体化医学营养治疗的GDM孕妇48例为对照组,治疗组制订个体化食谱并全程监督指导直至分娩,观察两组前后血糖、胰岛素值变化,孕期体重增长的情况,新生儿出生体重及早产,剖宫产、巨大胎儿、等母婴并发症的发生率。结果：①GDM孕妇的薯芋类、畜肉类、水果和坚果的摄入量高于正常孕妇(P0.05),粗杂粮、禽肉、深海鱼类和豆浆的摄入低于正常孕妇(P0.05);GDM孕妇每日总能量、脂肪和蛋白质的摄入高于对照组(P0.05),GDM孕妇膳食中脂肪占总能量比高于正常孕妇(P0.05);GDM孕妇碳水化合物占总能量比低于正常孕妇,(P 0.05).GDM孕妇的畜肉类来源的脂肪多于对照组(P0.05),鱼类来源的脂肪少于对照组P0.05)；粗杂粮来源的碳水化合物低于对照组(P0.05)；薯类和水果来源的碳水化合物高于对照组(P0.05)。 ②GDM孕妇治疗组血糖在治疗1周后空腹血糖、三餐后1小时血糖和三餐后2小时血糖恢复正常的人数多于对照组,有统计学意义(P0.05),GDM孕妇治疗组在治疗6周、12周和分娩前,空腹血糖、餐后1小时血糖、餐后2小时血糖均小于对照组(P0.05),GDM孕妇治疗组经过治疗后,空腹胰岛素、餐后1小时胰岛素、餐后2小时胰岛素、餐后3小时胰岛素均低于对照组(P0.05),经过治疗GDM孕妇治疗组的胰岛素抵抗系数和分泌系数较对照组比较有明显改善,治疗组孕妇体重增长为11.53±2.89kg(对照组14.92±3.4kg),两组有明显差异(P0.05),治疗组新生儿出生体重控制在正常范围(3000～4000g),对照组平均出生偏大,达到3735.25±355.58g,两组比较有明显差异(P0.05)；治疗组巨大儿的发生率较对照组低(P0.05),胎儿宫内情况正常,在积极监护下43例孕妇在38周左右自然顺产。早产、剖官产、巨大儿发生率明显低于对照组,差异有统计学意义(P0.05)。结论：①GDM孕妇饮食习惯、饮食结构及能量和三大营养素摄入不合理。孕妇在怀孕期间应调整不合理的饮食结构,预防妊娠糖尿病的发生。 ②对GDM孕妇实施个体化医学营养治疗有助于控制其血糖,使其在保证充足营养供给的情况下,控制血糖,减小血糖波动,改善胰岛素抵抗,孕期体重增长控制在理想范围,新生儿出生体重理想,有利于获得良好的妊娠结局。
[Abstract]:Objective to analyze the dietary habits and dietary structure of pregnant women with gestational diabetes mellitus (GDM). To provide reference for rational diet of pregnant women with gestational diabetes mellitus. 2 to explore the effect of individualized medical nutrition therapy on blood glucose control and pregnancy outcome of pregnant women with gestational diabetes mellitus, and to provide reference for rational diet of pregnant women with GDM. Methods: a total of 96 pregnant women with gestational diabetes mellitus were selected as case group and 96 normal pregnant women as control group. The dietary structure of pregnant women with gestational diabetes mellitus was investigated by the method of food frequency and 24 hours diet review. Energy intake and intake of three major nutrients and their food sources. (2) 48 pregnant women with gestational diabetes mellitus (GDM) diagnosed in our hospital were selected as treatment group and were given individualized medical nutrition therapy. In addition, 48 GDM pregnant women who received oral dietary guidance and were not willing to receive individualized medical nutrition were selected as control group. The treatment group made individualized diet and supervised the whole course until delivery, and observed the changes of blood glucose and insulin before and after delivery. Pregnancy weight gain, neonatal birth weight and premature delivery, cesarean section, macrosomia, and maternal and infant complications. Results the intake of tuber taro, animal meat, fruit and nut in 1 GDM pregnant women was higher than that in normal pregnant women (P 0.05), and the intake of crude cereals, poultry, deep-sea fish and soybean milk was lower than that of normal pregnant women. The intake of fat and protein was higher than that of the control group (P0.05 / GDM). The ratio of fat to total energy in the diet of pregnant women with GDM was higher than that of normal pregnant women (P 0.05 / GDM). The ratio of carbohydrate to total energy of pregnant women with GDM was lower than that of normal pregnant women (P 0.05). GDM pregnant women had more fat than the control group. The fat of fish was less than that of control group (P 0.05). Carbohydrates from crude grains were lower than those from control group (P 0.05), carbohydrates from potato and fruit were higher than those from control group (P 0.05). 2 fasting blood glucose of pregnant women treated with GDM was 1 week after treatment. The number of patients who returned to normal at 1 hour after three meals and 2 hours after three meals was significantly higher than that in the control group. There were significant differences in fasting blood glucose and 1 hour postprandial blood glucose between 6 weeks and 12 weeks and before delivery in the pregnant women treatment group with P0.05 and GDM. 2 hours postprandial blood glucose was lower than that of control group (P 0.05). After treatment, fasting insulin, 1 hour postprandial insulin and 2 hour postprandial insulin were observed in the treatment group. Insulin at 3 hours after meal was lower than that in control group (P 0.05). The insulin resistance coefficient and secretion coefficient of treated GDM pregnant women were significantly improved compared with those of control group. The weight gain of pregnant women in the treatment group was 11.53 卤2.89 kg (control group 14.92 卤3.4 kg / kg), there was significant difference between the two groups (P 0.05). In the treatment group, the birth weight of newborns was controlled in the normal range of 3 000 ~ 4 000 g / g, and the average birth weight in the control group was 3735.25 卤355.58 g, there was significant difference between the two groups (P0.05). The incidence of macrosomia in the treatment group was lower than that in the control group (P 0.05), and the fetal intrauterine condition was normal. The incidence of premature delivery, anatomic delivery and macrosomia was significantly lower than that of the control group (P 0.05). Conclusion the dietary habits, dietary structure, energy and the intake of three nutrients are not reasonable for the pregnant women with 1: 1 GDM. Pregnant women should adjust their unreasonable diet during pregnancy to prevent gestational diabetes. 2 individualized medical nutrition therapy for pregnant women with GDM can help to control their blood sugar and ensure adequate nutrition supply. Control of blood sugar, decrease of blood sugar fluctuation, improvement of insulin resistance, control of weight gain during pregnancy in ideal range, ideal birth weight of newborns, good outcome of pregnancy.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R153.1;R714.256

【参考文献】