| BACKGROUND & OBJECTIVES:Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy, which is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. It affects about 5-10% of Asian (including Chinese) pregnant women with increasing trend, according to the 2007 Asian survey. Risk factors of GDM include ethnicity, age≥25y at the time of conception, overweight or obesity (BMI>25Kg/m2), GDM in a previous pregnancy or a family history of type 2 diabetes, physical activity and diet pattern. Although obesity is well recognized as GDM and type 2 diabetes risk factors, almost half of the patients with GDM with normal BMI (BMI<24 kg/m2). Some researches have indicated that GDM is a result of the combined action of genetic and environmental factors. GDM is associated with the controllable factors, including diet and physical activity for the women without genetic factors. With the national standard of living and quality of life pursuit, the incidence of chronic non communicable diseases, especially type 2 diabetes generally increased. High refined sugar, high fat, high calorie and high cholesterol dietary pattern has gradually replaced high dietary fiber, suitable for fat and cholesterol dietary pattern, leading to excess of energy and increase the burden of pancreas and cardiovascular. With the pressure of life and work increased, physical activity level and energy consumption is declining, and sedentary lifestyle has become the main way of life of young people.Although there have been studies related to the risk factors of GDM, but the research on the lifestyle relatively shortage. Hence, this study aims to (1) identify the risk factors for GDM based on nutrition and lifestyle, so as to provide references for (1) health management; (2) formulating the tertiary prevention for GDM early screening, early diagnosis, early prevention and early intervention to reduce the incidence of type 2 diabetes and neonatal complications.METHODS:Subjects were selected with multi-stages continuous randomized sampling from the women who visited Department of Obstetrics of Peking Union Medical College Hospital and received glucose tolerance test in 24-28 gestational weeks during the period from December 2014 to May 2015. A total of 150 confirmed GDM cases were enrolled, and 150 non-GDM gravida were selected into control group. General condition and dietary status of the GDM group and the control group were investigated using a questionnaire. The questionnaire was designed based on relevant data with review of foreign and domestic literature, the Chinese women of childbearing age dietary characteristics and physical activity level. Before the formal investigation, the 5%-10% of the total study population was selected to carry out pilot study to adjust the questionnaire.The Epidata3.0 database was used for data entry and management, and SPSS 17.0 was used for statistical ananlysis. The mean and standard deviation (x±s) was used to describe quantitative data. The rate (%) was used to indicate qualitative data. Independent samples T test was used to compare the two groups of independent sample, the qualitative data of the two groups were compared with the chi square test and logistic regression was used to build an evaluation model for screening the related risk factors of GDM. Test level of alpha (α)=0.05, and P<0.05 indicate the difference was statistically significant.RESULTS:There is no significant difference in maternal age, current body weight and body weight change between the group (P<0.05). However, the difference of height, prepregnancy weight, prepregnancy BMI, family history of type 2 diabetes mellitus and history of GDM shown statistically significant.Univariate analysis showed that GDM was significantly associated with family history of type 2 diabetes mellitus, preconception body mass index (BMI), history of GDM, fruits intake, proportion of refined grains, daily meat intake, frequency of high fat diet consumption, daily salt intake, daily oil intake, daily nuts intake, frequency of eating out, consumption of sugary drinks, and physical activity (P<0.05).Multiple Logistic regression analysis indicated that preconception BMI (OR= 1.628, 95%CI:1.079-2.456), family history of type 2 diabetes mellitus (OR= 1.761,95%CI: 1.001-3.096), history of GDM (OR=7.855,95%CI:1.982-31.125), fruits intake (OR=1.457,95%CI:1.148-1.849), refined grains (OR=1.350,95%CI:1.008-1.808), high fat diet (OR=1.398,95%CI:1.066-1.833), and physical inactivity (OR=1.257,95%CI: 1.111-1.422) were related to GDM (P<0.05).CONCLUSIONS:High preconception BMI, family history of type 2 diabetes mellitus, history of GDM, over intake of fruits, high proportion of refined gains, frequent intake of high fat diet, and physical inactivity may increase the risk of GDM.Objective:To evaluate the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus.Methods:A meta-analysis of randomised controlled trials was conducted. PubMed, EMBASE, OVID, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Chinese WanFang Database were searched for the literatures related to the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus from January 2005 to January 2015. At the same time, manual searching and reference review were conducted. Strict screening of the searched literatures was performed based on inclusion and exclusion criteria. All the included trails were divided into two groups based on whether the intervention involved insulin or not. The tool which Cochrane Handbook recommended was used to assess the risk of bias for includes literatures. All the studies were graded and extracted by two researchers independently after reading research method in detail. Meta-analysis was conducted using RevMan5.2 software. The effect of medical nutritional intervention was described in terms of fasting blood glucose, birth body mass, the incidences of macrosomia, cesarean section, postpartum glucose intolerance and neonatal long-term chronic disease.Results:Totally 27 trials were found, of which 13 trails met inclusion and exclusion criteria.1 trail was excluded because the outcomes were using different sample sizes, and finally 12 trails were included in the final meta-analysis, involving 1392 patients. Among the 12 included trials,7 only administered nutritional intervention, while the other 5 added insulin with nutritional intervention. The result showed that in the nutritional intervention group, medical nutritional intervention decreased the incidence of macrosomia [risk difference (RD):-0.35,95%CI:-0.55--0.15, P<0.001, one trial], birth body mass [mean difference (MD):-581.27,95%CI:-790.3--372.22, P<0.001,0two trials], the rate of cesarean section (RD:-0.40,95%CI:-0.58--0.21, P<0.00l, two trials), fasting blood glucose (MD:-0.32,95%CI:-0.58--0.21, P-=0.02, five trials), and the incidence of postpartum glucose intolerance(RD):-0.34,95%C7:-0.44--0.23, P<0.001, one trial). However, in the multiple intervention group (nutrition plus insulin), no significant differences were shown in the incidence of macrosomia (RD:-0.02,95%CI:-0.07-0.03,P-0.39, three trials),birth body mass(MD:86.06,95%CI:-104.97-277.09, P=0.38, two trials), the rate of cesarean section(RD:0.02,95%CI:-0.05～0.08, P=0.64, five trials), and fasting blood glucose (MD:-0.03,95%CI:-0.16-0.11, P=0.71, three trials).Conclusion:Medical nutritional intervention may be a protective measure against gestational diabetes mellitus, which could help to maintain serum glucose levels within the normal range and improve maternal and neonatal outcomes. |
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