Exploratory Study On The Preventive Effect Of Nutrition Guidance During Pregnancy On Gestational Diabetes Mellitus

OBJECTIVE:To explore the effect of experiential education of individualized and quantitative nutritional standard meal in early pregnancy(≤12^thweeks)on weight management during the second trimester of pregnancy(13^th to 24^th weeks)and prevention of gestational diabetes mellitus（GDM）;and to analyze compliance of dietary intervention and physical exercise guidance in overweight and obese pregnant women.METHODS:Overweight and obese pregnant women who had established files(≤12^thweeks)for prenatal examination in Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine&Health Sciences from June 2017 to January 2019 with informed consent were randomly divided into intervention group and control group,with 100 cases in each group.The control group received collective health education in nutrition class in early pregnancy,and the intervention group received experiential education such as individualized and quantitative nutritional standard meal on this basis.The weight gain at 13^thto 16^thweeks,17^thto20^thweeks and 21^thto 24^th weeks,the incidence of gestational diabetes mellitus and compliance to dietary intervention and physical activity guidance were compared between the two groups.RESULTS:1.Comparison of weight gain in the second trimester of pregnancy(13^th to 24^thweeks)between two groupsThe weight gain in the intervention group（4.08±1.37）kg was less than that in the control group（4.98±1.61）kg in the second trimester of pregnancy(13^th to 24^th weeks)（t=4.207,P<0.001）.The variation of weight gain between two groups was statistically significant（F=3.595,P=0.028）.2.Comparison of the incidence of GDM between two groupsThe incidence of GDM in the intervention group（16.49%）was lower than that in the control group（38.54%）（χ²=11.773,P=0.001）.There was no significant difference in 0-h plasma glucose from OGTT between two groups（t=1.609,P=0.110）,while 1-h plasma glucose（t=3.267,P=0.001）and 2-h plasma glucose（t=2.272,P=0.024）from OGTT in the intervention group were lower than those in the control group.3.Comparison of dietary compliance between two groupsFor compliance to dietary,the difference between the intervention group and the control group was statistically significant（χ²=8.816,P=0.003）.4.Comparison of physical activity compliance between two groupsFor compliance to physical activity,the difference between the intervention group and the control group was no statistically significant（χ²=1.763,P=0.184）.5.The effect of compliance to dietary and physical activity on weight gain in the second trimester of pregnancy(13^th to 24^th weeks).Those who fully followed dietary in the intervention group and the control group gained the least weight,while those who did not followed dietary gained the most weight.Those who followed physical activity gained less weight than those who did not.Compared with the control group,those who did not follow dietary at 13^th to 16^thweeks,17^th to 20^th weeks and 21^th to 24^th weeks gain less weight in the intervention group.Stratified analysis results of overweight and obese pregnant women were similar to above.However,there was no significant difference in the interaction between different groups and gestational weeks of overweight and obese pregnant women on weight gain during 13^th to 24^th weeks（P>0.05）.There was no significant difference in 0-h plasma glucose and 2-h plasma glucose from OGTT between two groups（P>0.05）,while 1-h plasma glucose from OGTT in the intervention group were lower than those in the control group（P<0.05）.CONCLUSIONS:The intervention of individualized and quantitative nutrition standard meal in early pregnancy for overweight and obese pregnant women can help maintain appropriate weight gain in the second trimester of pregnancy(13^th to 24^thweeks)and reduce the incidence of GDM.Continuous monitoring and follow-up can effectively improve their dietary compliance.