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目的 探讨限制碳水化合物饮食(CRD)方案对妊娠期糖尿病(GDM)患者妊娠期胰岛素应用及血脂代谢的影响。方法 回顾性分析2018年7月至2020年1月于我院分娩的265例GDM孕妇的临床资料，根据其妊娠期是否接受过CRD干预及CRD干预方案的执行度分为两组：接受过CRD干预且执行度>50%的为CRD组(n=152)和未接受CRD干预或执行度<50%的为非CRD组(n=113),比较两组患者的一般资料、妊娠期胰岛素应用情况以及血脂代谢相关指标；采用二分类Logistic回归分析GDM孕妇妊娠期CRD干预联合胰岛素治疗的危险因素。结果 两组患者的年龄、体质量指数(BMI)、孕早期空腹血糖(FPG)、糖化血红蛋白(HbA1c)、孕期增重、产前腹围、分娩方式、新生儿出生体重和身长比较均无显著性差异(P>0.05);CRD组的经产妇占比显著高于非CRD组(P<0.05)。两组间胰岛素治疗率比较无显著性差异(P>0.05);CRD组应用胰岛素治疗的初始孕周显著晚于非CRD组(P<0.05)。孕中期两组间总胆固醇(TC)异常率、甘油三酯(TG)异常率和高密度脂蛋白胆固醇(HDLC)异常率比较均无显著性差异(P>0.05);CRD组的低密度脂蛋白胆固醇(LDLC)异常率显著低于非CRD组(P<0.05)。孕晚期，两组间TC异常率、TG异常率、HDLC异常率和LDLC异常率比较均无显著性差异(P>0.05)。二分类Logistic回归分析结果发现，年龄[OR=1.13,95%CI(1.01,1.27),P=0.03]、孕早期FPG[OR=8.20,95%CI(2.12,31.81),P<0.01]和产前腹围[OR=1.08,95%CI(1.01,1.14),P=0.02]是GDM患者妊娠期CRD干预联合胰岛素治疗的危险因素。结论 CRD干预对于延缓GDM患者妊娠期胰岛素的应用及改善孕中期LDLC代谢具有一定作用。GDM孕妇早期高血糖、高龄生产及产前腹围较高可能是CRD干预联合胰岛素治疗的危险因素。
Abstract：Objective:To explore the effect of carbohydrate-restricted dietary(CRD)pattern on insulin therapy and lipid metabolism in the patients with gestational diabetes mellitus(GDM).Methods:A retrospective study was conducted on 265 GDM women who delivered in our hospital from July 2018 to January 2020. According to whether they had received CRD intervention and the implementation degree of CRD intervention regimen during pregnancy, they were divided into two groups: the patients received CRD intervention and implementation degree >50% in CRD group(n=152),and the patients did not receive CRD intervention or implementation degree <50% in non-CRD group(n=113). The general information, insulin therapy during pregnancy, and indicators of blood lipid metabolism were compared between the two groups. The risk factors of CRD intervention combined insulin therapy in women with GDM were analyzed by binary logistic regression.Results:There were no significant differences in age, BMI,fasting blood glucose(FPG) in early pregnancy, HbA1 c, gestational weight gain, prenatal abdominal circumference, delivery mode, newborn birth weight and length between the two groups(P>0.05). The percentage of multiparous women in CRD group was significantly higher than that in non-CRD group(P<0.05). There was no significant difference in the insulin therapy rate between CRD group and non-CRD group(P>0.05). The initial gestational weeks of CRD combined with insulin therapy was significantly later than that of non-CRD group(P<0.05). There were no significant differences in abnormal rates of total cholesterol(TC),triglyceride(TG)and high density lipoprotein cholesterol(HDLC) between the two groups in the middle trimester(P>0.05),and the abnormal rate of low density lipoprotein cholesterol(LDLC)in CRD group was significantly lower than that in non-CRD group(P<0.05). There were no significant differences in abnormal rates of TC,TG,HDLC and LDLC between the two groups in the third trimester(P>0.05). Binary logistic regression analysis showed that age[OR=1.13,95%CI(1.01,1.27),P=0.03],fasting plasma glucose level in the first trimester[OR=8.20,95%CI(2.12,31.81),P<0.01] and prenatal abdominal circumference[OR=1.08,95%CI(1.01,1.14),P=0.02] were risk factors for CRD intervention combined insulin therapy in GDM patients during pregnancy.Conclusions:CRD intervention is effective in delaying the insulin therapy during pregnancy and improving the metabolism of LDLC in the second trimester. Early hyperglycemia, advanced age and larger prenatal abdominal circumference in pregnant women with GDM are the risk factors for CRD intervention combined with insulin therapy.
[1] Zhu WW,Yang HX,Wei YM,et al.Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in china[J].Diabetes Care,2013,36:586-590.
[2] 苏日娜，朱微微，魏玉梅，等.北京地区妊娠期糖尿病发病情况及妊娠结局的回顾性调查[J].中华围产医学杂志，2016,19:330-335.
[3] American Diabetes Association.Diabetes care in the hospital:standards of medical care in diabetes-2018[J].Diabetes Care,2018,41:S144-S151.
[4] Srichumchit S,Luewan S,Tongsong T.Outcomes of pregnancy with gestational diabetes mellitus[J].Int J Gynaecol Obstet,2015,131:251-254.
[5] Herrera E,Ortega-Senovilla H.Disturbances in lipid metabolism in diabetic pregnancy - Are these the cause of the problem?[J].Best Pract Res Clin Endocrinol Metab,2010,24:515-525.
[6] Schaefer-Graf UM,Meitzner K,Ortega-Senovilla H,et al.Differences in the implications of maternal lipids on fetal metabolism and growth between gestational diabetes mellitus and control pregnancies[J].Diabet Med,2011,28:1053-1059.
[7] 中华医学会糖尿病学分会.中国糖尿病医学营养治疗指南(2013)[J].中华糖尿病杂志，2015,7:73-88.
[8] 刘乐融，欧阳冬生，周栋，等.妊娠期糖尿病的医学营养治疗进展[J].中国糖尿病杂志，2017,25:376-380.
[9] Standards of medical care in diabetes--2015:summary of revisions[J].Diabetes Care,2015,38(Suppl):S4.
[10] 中华医学会妇产科学分会产科学组，中华医学会围产医学分会.妊娠期高血糖诊治指南(2022)[第一部分][J].中华妇产科杂志，2022,57:3-12.
[11] Moreno-Castilla C,Mauricio D,Hernandez M.Role of medical nutrition therapy in the management of gestational diabetes mellitus[J].Curr Diab Rep,2016,16:22.
[12] Dolatkhah N,Hajifaraji M,Shakouri SK.Nutrition therapy in managing pregnant women with gestational diabetes mellitus:a literature review[J].J Family Reprod Health,2018,12:57-72.
[13] 杨慧霞.2011年妊娠期糖尿病国际诊断标准解读[J].中国医学前沿杂志(电子版),2011,3:19-20.
[14] International Association of Diabetes and Pregnancy Study Groups Consensus Panel,Metzger BE,Gabbe SG,et al.International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J].Diabetes Care,2010,33:676-682.
[15] Kratz A,Pesce MA,Basner RC,et al.Harrison’s principles of internal medicine,18th ed[M].New York:McGraw-Hill,2012:Appendix 1,pA-1.
[16] Henry CJ.Basal metabolic rate studies in humans:measurement and development of new equations[J].Public Health Nutr,2005,8:1133-1152.
[17] Institute of Medicine(US) and National Research Council(US) Committee to Reexamine IOM Pregnancy Weight Guidelines.Weight gain during pregnancy:reexamining the guidelines[M].Washington(DC):National Academies Press(US),2009.
[18] T/CNSS-009-2021,中国妇女妊娠期体重监测与评价[S].北京：中国营养学会，2021.
[19] Reader D,Splett P,Gunderson EP.Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes[J].J Am Diet Assoc,2006,106:1426-1433.
[20] Metzger BE,Buchanan TA,Coustan DR,et al.Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus[J].Diabetes Care,2007,30 Suppl 2:S251-S260.
[21] Salto R,Manzano M,Giron MD,et al.A slow-digesting carbohydrate diet during rat pregnancy protects offspring from non-alcoholic fatty liver disease risk through the modulation of the carbohydrate-response element and sterol regulatory element binding proteins[J].Nutrients,2019,11:844.
[22] Mustad VA,Huynh DTT,Lopez-Pedrosa JM,et al.The role of dietary carbohydrates in gestational diabetes[J].Nutrients,2020,12:385.
[23] Louie JC,Markovic TP,Ross GP,et al.Timing of peak blood glucose after breakfast meals of different glycemic index in women with gestational diabetes[J].Nutrients,2012,5:1-9.
[24] Hernandez TL,Van Pelt RE,Anderson MA,et al.A higher-complex carbohydrate diet in gestational diabetes mellitus achieves glucose targets and lowers postprandial lipids:a randomized crossover study[J].Diabetes Care,2014,37:1254-1262.
[25] Wan CS,Nankervis A,Teede H,et al.Dietary intervention strategies for ethnic Chinese women with gestational diabetes mellitus:A systematic review and meta-analysis[J].Nutr Diet,2019,76:211-232.
[26] ACOG practice bulletin No.190:gestational diabetes mellitus[J].Obstet Gynecol,2018,131:e49-e64.
[27] Mahajan A,Donovan LE,Vallee R,et al.Evidenced-based nutrition for gestational diabetes mellitus[J].Curr Diab Rep,2019,19:94.
[28] Krispin E,Ashkenazi Katz A,Shmuel E,et al.Characterization of women with gestational diabetes who failed to achieve glycemic control by lifestyle modifications[J].Arch Gynecol Obstet,2021,303:677-683.
[29] Barnes RA,Wong T,Ross GP,et al.A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus[J].Diabetologia,2016,59:2331-2338.
[30] Ryckman KK,Spracklen CN,Smith CJ,et al.Maternal lipid levels during pregnancy and gestational diabetes:a systematic review and meta-analysis[J].BJOG,2015,122:643-651.
[31] Son GH,Kwon JY,Kim YH,et al.Maternal serum triglycerides as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus[J].Acta Obstet Gynecol Scand,2010,89:700-704.
[32] Wang HK,Cheng DC,Yang YM,et al.The role of high-content complex dietary fiber in medical nutrition therapy for gestational diabetes mellitus[J].Front Pharmacol,2021,12:684898.
基本信息:
中图分类号:R714.256
引用信息:
[1]崔铭萱,李雪宁,卢露露,等.限制碳水化合物饮食方案对妊娠期糖尿病患者妊娠期胰岛素应用及血脂代谢的影响[J].生殖医学杂志,2022,31(08):1061-1066.
基金信息:
北京大学人民医院研究与发展基金(RDX2019-10)
2022-08-15
2022-08-15