| Objective : To investigate the effect of individualized medical nutrition therapy on the changes in nutrition metabolism indicators and pregnancy outcome in gestational diabetic patients during late pregnancy and lactation periods.The purpose is to reduce pregnancy complications and fatality rates among patients,promoting postpartum health of pregnant women with GDM,preventing or reducing the occurrence of diabetes and its related complications,reducing medical expenses and providing the basis for clinical treatment by the individualized medical nutritional therapy.Methods : A randomized controlled study of patients with gestational diabetes mellitus in the Department of Endocrinology and Obstetrics,the Second Hospital of Hebei Medical University.Female patients diagnosed with GDM from June 2014 to September 2015 were selected,and were divided into two groups: the study group and the control group,according to the principles of randomization.The study group received the individualized medical nutritional therapy(IMNT)and the control group received the traditional oral nutritional intervention model.IMNT was organized into the following five stages: 1.nutrition assessment,2.health education,3.IMNT plan making,4.IMNT curative effect monitoring and evaluation,and 5.IMNT scheme adjustment.Additionally,centralized teaching,smart-phone App tracking,consultation and combined forms of online guidance and counselling were also used.After the 3rd and 6th months of the intervention,the patients compliance scores,the blood sugar,the nutritional knowledge score,daily dietary standards and MNT recommend energy,pregnancy outcomes and nutrition metabolism at different periods,including W,FBG,PBG,HbA1 c,Ca+,K~+,TG,TC,HDL-C,LDL-C,TP,ALB,G,RBC,and HGB werecompared among the groups.Descriptive analysis of data was done by SPSS17.0 statistical software,which was used for the database creation and the data entry.Descriptive statistics were used to describe the basic features of the data.Measurement data is said with the mean ± standard deviation(X ± S).Paired t test and independent sample t-test were used for the statistical analysis.Count data were analyzed using the chi-square test.Inspection level of ?= 0.05,P?0.05 for the difference were considered to be statistically significant.Results:1 111 Pregnant women with GDM were chosen from our hospital,and were divided into study group(n=56)and control group(n=55).At the end,because of the increased insulin therapy and the consequent termination of some pregnancies during the study process,the study group was eventually completed with 51 subjects after 5 cases were eliminated.The control group was also eventually completed with 47 cases after the elimination of 8 cases.2 Before the intervention,the relevant laboratory indicators(blood glucose,blood lipid,protein)and the general sociological data(course of the disease,gestational age,and weight)indicated no significant difference(P ?0.05)between the study group and the control group.3 After the intervention,the compliance scores were higher in the study group than the control group;and the difference was statistically significant(P?0.05).Patients' compliance showed an upward trend in both groups after the intervention.4 The daily energy intake success rate of the study group was better than that of the control group after the 3 month and the 6 month interventions(X~2=9.618? X~2=22.395).5 After the intervention,The study group's intake of rice,millet flour,eggs,milk than the control group,were no statistically significant(P?0.05).The study group's intake of coarse grains,potatoes,green vegetables,poultry,fish,soy products were higher than the control group(P ? 0.05);The study group's intake of other vegetables,fruits,meat,edible oil,and nuts were lower than the control group(P?0.05).6 A total of 56 chat or group links were launched from the established We-Chat group,three loops were conducted,and a total of 356 questions were answered by the We-Chat group.On the basis of disease knowledge,the study group's score(43.10±3.01)and the control group's score(37.38±4.12)after the intervention,showed statistically significant difference(P ? 0.05).The difference between the two groups before and after the interventions was statistically significant(P?0.05).7 There were statistically significant difference(P ? 0.05)in the nutritional metabolic indices(FBG,PBG,HbA1 c,Ca+,CHOL,TG,HDL-C,LDL-C,TP,and G)between the study group and the control group after the 3month and the 6 month interventions.Other indicators such as the number of RBC,HGB,and K~+,showed no statistically significant difference between the two groups(P?0.05).8 The Cesarean delivery rate among the study group was significantly lower than that of the control group(X~2=5.742).The rate of pregnancy-induced hypertension syndrome,polyhydramnios and other complications was also significantly lower in the study group than the control group(P?0.05).9 Macrosomia,hypoglycemia,asphyxia,high blood bilirubin,fetal distress,premature birth rate after postpartum among the study group were significantly lower(P ? 0.05).The neonatal Apgar score(? 8points)ratio of the study group was 96.98%,it is significantly higher than the score of the control group 82.97%(c 2=-8.733).10 The average weight gain among the pregnant women in the study group was up by 11.92±4.70 kg and that of the control group was up by14.68±4.11 kg,the difference was statistically significant(P ? 0.05).The postpartum maternal weight recovery showed obvious difference between two groups 3 months after the intervention(P?0.05).The neonatal average birth weight for the study group was 3379.26±420.25 g and that of the control group was 3628.37±460.12g;and the difference between the two groups was statistically significant(P?0.05)Conclusion:1 Individualized medical nutritional therapy can help the gestational diabetes patients to adjust inappropriate dieting behaviors,ensure quality and adequate nutrition,improve compliance,and change medical practice.It can effectively prevent GDM maternal and infant complications to promote healthy outcomes during pregnancy and lactation.2 Individualized medical nutritional therapy can help to effectively control blood glucose,reduce the content of triglyceride and cholesterol,ensure right content of albumin and calcium in patients with gestational diabetes.It is very effective in ensuring good pregnancy outcome and maternal recovery to avoid complications.It is a safe and important non-drug intervention to ensure the safety of the mothers and their fetus.3 Individualized medical nutritional therapy can reduce the incidence of macrosomia and other complications,can ensure reasonable growth and weight gain in both pregnant women and their fetus,and can promote quick postpartum weight gain.4 Individualized medical nutritional therapy can improve the pregnancy outcome by improving the health of GDM patients,which also assist in economizing medical resources.It is an active method of treatment and its effects help to achieve good social health benefits. |
PDF Full Text Request