| Objective:Diabetes in pregnancy is one of the common complications of pregnancy,which will bring a series of risks to the health of mothers and babies in the short and long term.According to researches,the prevalence of diabetes in pregnancy is about 17.8%in China.The mechanism has not been fully elucidated so far.Therefore,the most effective measure is to control blood glucose in a reasonable range during pregnancy.Individualized medical nutrition therapy has been recommended by many scholars as the basic treatment plan for patients with various types of diabetes.So this study will compare IMNT intervention on the differences in adverse pregnancy outcomes of patients with pregnancy complicated with diabetes,and provide a scientific basis for the popularization of nutrition clinics.Methods:This research adopts quasi-experimental research methods.In the Obstetrics Department of Qujing Maternity and Child Health Hospital,641 pregnant women who had been diagnosed with gestational diabetes and gave birth in this hospital from October 1,2019 to September 30,2020 were selected as the research objects.Among them,237 pregnant women who received IMNT nutrition outpatient intervention during pregnancy were included in the intervention group,and 404 pregnant women who received other conventional traditions were included in the control group.Observing and recording the social demographic characteristics of pregnant women in the intervention group,the intervention time and other basic information.In addition,the previous history,marriage and childbirth history,personal disease history,biochemical indicators before childbirth,and pregnancy complications of the intervention group and the control group were colleced through the hospital’s inpatient medical record system according to the recorded general demographic characteristics information to retrieve and export the records,and the collected information is built into a database for entry and analysis.Using 1:1 PSM control factors,the obstetric quality evaluation index was used as the main outcome of this study,and the incidence of other pregnancy comorbidities was taken as the secondary outcome.Single factor and multiple factors were used to evaluate the intervention effects before and after matching.Results:(1)Before matching,in the intervention,group maternal OGTT-FBG,weight gain during pregnancy compared with the control group,there are significant differences between the two groups;the proportion of Arrhythmia between the two groups,there are significant differences(χ2=10.753,P=0.001).In the intervention group,the prevalence of complications during pregnancy with hepatobiliary disease,oligohydramnios,high-grade pollution of amniotic fluid,premature delivery,postpartum hemorrhage,fetal membrane defect,and low birth weight,the Apgar score of neonates and the rate of neonatal combined asphyxia were lower than those of the control group(P<0.05).(2)After matching,the two groups of pregnant women had no significant differences in sociodemographic characteristics,personal history,past history,blood glucose during pregnancy.The results of univariate analysis showed that the IMNT intervention was associated with adverse pregnancy outcomes.Meanwhile,the proportion of arrhythmia,hepatobiliary disease,kidney disease,and amniotic fluid volume,oligohydramnios,high pollution of amniotic fluid,premature delivery,low birth weight,1 Omin Apgar score of newborns,first degree perineum laceration,and asphyxia were all lower than those of the control group(P<0.05);the results of multivariate analysis showed that the IMNT intervention had a positive effction on liver and gallbladder disease,premature birth,and neonatal asphyxia(OR=0.227,95%CI:0.063～0.817;OR=0.595,95%CI:0.355～0.998;OR=0.101,95%CI:0.103-0.809).(3)Evaluation of intervention effect before and after matching,the intervention modle before matching included premature delivery,hemorrhage,low birth weight,megalo,with PIH,with abnormal heart rate,combined with hepatobiliary disease,polyhydramnios,oligohydramnios,and grade Ⅰ of amniotic fluid.,Ⅱ,Ⅲ degree pollution,fetal membrane defect,neonatal asphyxia in 14 regression models,as dependent variables;after matching intervention methods,in the other pregnancy complications except bleeding,polyhydramnios,and fetal membrane defects were included regression model.In addition,after matching,a regression model with the mode of delivery and combined kidney disease as the dependent variable is added.For pregnant women with hepatobiliary disease and neonatal asphyxia before matching,OR=0.265,95%CI:0.077～0.910,OR=0.187,95%CI:0.043～0.816;after matching,OR=0.227,95%CI,respectively:0.063～0.817;OR=0.101,95%CI:0.013～0.809;(4)Evaluation of different intervention timess.The incidence of maternal and neonatal complications in the second trimester intervention group and the third trimester intervention group was lower than the adverse pregnancy outcome rate in the control group.The rates of concurrent hepatobiliary diseases in pregnant women were 1.8%,1.0%,and 6.1%;the rates of oligohydramnios were 3.7%,7.0%,and 13.7%;the rates of preterm delivery were 12.3%,17.2%,and 24.%;newborns The birth rates of low birth weight were 4.4%,8.2%,and 14.7;the birth rates of macrosomia were 5.3%,13.3%,and 7.8%;the rates of first-degree perineal laceration were 16.7%,28.0%,and 52.5%;the rates of neonatal asphyxia were respectively 0.0%,1.0%,4.2%.Conclusion:Through propensity score matching,the confounding factors between the intervention group and the control group are effectively balanced.IMNT has an effective effect on pregnant women’s blood glucose control during pregnancy,thereby reducing the occurrence of adverse pregnancy outcomes for mothers and babies.In addition,pregnant women with diabetes mellitus during pregnancy have gallbladder stones,hydronephrosis,and stone should be deserved attention. |
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