| Objective 1.To explore the dietary habits and dietary characteristics of patients with gestational diabetes mellitus(GDM)combined anemia,and influencing factors of gestational diabetes combined anemia.2.To explore the effect of nutritional therapy on the improvement of GDM combined anemia and the outcome of pregnancy,to provide a reasonable diet reference for patients with GDM combined anemia.Methods Study 1: Cross-sectional research study was used.1468 pregnant women who underwent obstetrical examination in the obstetrics department of the Affiliated Hospital of Qingdao University from June 2015 to June 2019 were collected.These subjects were divided into four groups according to the results of obstetric glucose tolerance test(OGTT)and hemoglobin(Hb),which named simple anemia group,simple GDM group,GDM combined anemia group and control group.Questionnaire surveys,dietary surveys and laboratory examinations were conducted in each group to obtain the basic situation,lifestyle and behavior habits,and dietary intake of the research subjects.Influencing factors were analyzed with multivariate logistic regression analysis,to calculate odds ratio(OR)and its 95% confidence interval(95% CI).Study 2: A completely randomized controlled study was used.137 patients with gestational diabetes combined anemia were recruited among the pregnant women who performed obstetrics and delivery in the obstetrics department of the Affiliated Hospital of Qingdao University from January 2018 to June 2019,and these subjects were randomly divided into an intervention group(n = 75)and a control group(n = 62).At the time of enrollment,all subjects did questionnaires,dietary surveys and laboratory examinations to obtain basic information of the patients,dietary intake and biochemical indicators such as blood glucose and hemoglobin.The intervention group received personalized nutritional treatment based on pre-pregnancy weight,weight gain,dietary intake,and blood glucose and hemoglobin levels,while the control group received only routine obstetric examination and general health education.All patients were followed up after childbirth.A dietary survey was conducted two weeks after treatment and the blood glucose and hemoglobin levels of the patients were detected.Related indicators such as weight gain during pregnancy and pregnancy outcome were collected during childbirth.Results Study 1: The average age,pre-pregnancy BMI,and the proportion of pregnant women with family history of diabetes,giant childbirth,and non-primary births in the simple GDM group and the GDM combined with anemia group were higher than those in the control group(p < 0.05).Compared with the control group,the intakes of cereals,fruits and edible oils as well as energy,carbohydrates and fats were higher in the simple GDM group and the GDM combined anemia group(p < 0.05).The intake of meat,protein,vitamin A and iron in the simple anemia group and the GDM combined anemia group was lower(p < 0.05),and the zinc intake in the simple anemia group was lower(p < 0.05).The GDM combined with anemia group had lower intakes of meat,protein,and iron than the simple GDM group alone(p < 0.05).Multivariate logistic regression results showed that age ? 35 years,overweight or obesity before pregnancy,non-initial birth,recurrent miscarriage,and a large history of childbirth can increase the risk of GDM with anemia(p < 0.05).Study 2: Before nutritional therapy,there was no statistically significant difference in age,gestational age,and BMI before pregnancy between the intervention group and the control group(p > 0.05).After nutritional treatment,the energy,carbohydrate and fat intake of the intervention group were 1828.9 ± 393.7 kcal,246.5 ± 90.4 g,56.4 ± 24.8 g,which were lower than before nutritional treatment(p < 0.05).Protein,dietary fiber,Vitamin A,niacin,calcium,iron,and zinc intake were 83.1 ± 16.3 g,22.8 ± 6.2 g,454.3 ± 101.6 ug RAE,19.8 ± 5.3 mg NE,753.7 ± 232.0 mg,24.7 ± 8.0 mg,9.7 ± 3.1 mg,higher than before nutritional therapy(p < 0.05),fasting blood glucose,blood glucose at 1 h after meal,and blood glucose at 2 h after meal were 4.6 ± 0.5 mmol/L,7.2 ± 1.7 mmol/L,5.6 ± 1.0 mmol/L,which were lower than before nutritional therapy(p < 0.05).After nutritional treatment,hemoglobin in the intervention group increased to 110.5 ± 8.3 g/L(p < 0.05).The weight gain during pregnancy in the intervention group was 13.5 ± 8.2 kg,which was lower than that in the control group(p < 0.05),and the incidence of premature rupture of membranes,cesarean section,and giant infants were low(p < 0.05).Conclusions 1.A high-energy,high-carbohydrate,high-fat,low-protein,and low-iron diet structure was the main cause of anemia in gestational diabetes patients.Low vitamin A and zinc intake may also be related to the occurrence of anemia during pregnancy.2.Nutritional therapy can help gestational diabetes patients combined anemia to correct the diet structure,promote nutritional balance,improve blood sugar and hemoglobin levels,maintain a reasonable weight gain for pregnant women,and reduce the incidence of adverse pregnancy outcomes. |
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