Effects Of Medical Nutrition Therapy On Maternal-fetal Complications With Gestational Diabetes Mellitus Under The Model Of MDT

Objective:Medical nutrition therapy(MNT)is priority for the treatment of Gestational diabetes mellitus(GDM),while the traditional MNT is usually involved only by obstetricians.However,the scientifical management of GDM patients includes the health-care of maternalfetal,nutritional intervention,exercise guidance,blood glucose controlling,drug therapy,neonatal nursing and even long-term follow-up of mothers and children,which covers the knowledge of multiple disciplines.First feature of our study is to introduce the model of multidisciplinary treatment(MDT)into the GDM management.Set up a team for MDT outpatient which cares all aspects of GDM patients,including a registered dietitian for MNT,an obstetrician for maternal-fetal health-care,an endocrinologist for blood glucose monitoring and medication guidance,even a sport specialist for movement instruction and a nurse for follow-up.The second feature of our study is to create a new mode of doctorpatient co-participation in GDM management which replaces the previous physician-led mode.We guide patients to monitor blood glucose and weight by themselves,to adjust frequency and cycle of visit,and so on.In addition,we place the emphasis on nutritional assessment before intervention,the elaboration of diet and the recording of individual diet,which are superior to traditional MNT.To investigate the effectiveness of MNT on maternal-fetal complications and outcomes in patients with GDM under the model of MDT.Methods:We retrospectively studied the electronic medical files of 1297 GDM cases treated between January 2016 and June 2020 in Changhai hospital.According to the therapy,the patients were divided into MNT group accepted MNT under the model of MDT and control group accepted routine pregnancy check-ups.1.We understood the importance and clinical significance of MDT outpatient by the incidence of GDM and the rate of MDT visit.We also compared the incidence of maternalfetal complications and outcomes between the two groups.2.Logistic regression was performed to analyze the risks of macrosomia,premature birth,primary cesarean,neonatal complications,others maternal-fetal complications and outcomes between the two groups.We also explored other risk factors for the four main outcomes.3.To control the confounding factors of the two groups,we used the other two methods—propensity score matching(PSM)and propensity weighting(PSW)—to reduce the bias of the results before logistic regression analysis.Then investigate whether the results changed and the degree of the change to evaluate the robustness by comparing the three odds ratios(OR).This was the sensitivity analysis of our study.4.After controlling the confounding factors,we did the MANOVA of repeated measuring for gestational weight and blood glucose(FBG and 2h-PBG)between the two groups.The proportion of abnormal blood glucose during pregnancy was analyzed between the two groups.Results:1.In this retrospective cohort study,330 cases were MNT group and 967 cases were control group.26.8% of the women were diagnosed as GDM,and the incidence was basically consistent from 2018 to 2020(χ2=3.331,P=0.189).25.4% of the GDM patients received MNT by MDT,with a same ratio from 2017 to 2020(χ2=0.871,P=0.832).2.Logistic regression showed that MNT by MDT reduced the risks of macrosomia(OR=0.45,95%CI= 0.26～0.77),preterm delivery(OR=0.50,95%CI= 0.30～0.84),primary cesarean(OR=0.57,95%CI= 0.41～0.79),neonatal complications(OR=0.59,95%CI=0.40～0.87),hospitalization for abnormal blood glucose(OR=0.26,95%CI= 0.08～0.86),hospitalization for tocolysis(OR=0.06,95%CI= 0.01～0.45),entering Neonatal Intensive Care Unit(OR=0.57,95%CI= 0.41～0.80),and increased risks of uric ketone positive(OR=1.81,95%CI=1.39～2.37),insulin use during pregnancy(OR=3.49,95%CI=1.48～8.19),prolonged gestational weeks(OR=1.48,95%CI=1.11～1.96)and perinatal infection(OR=2.38,95%CI=1.04～5.43).3.Comparing the ORs obtained after PSM and PSW,the ORs of three statistical methods were as follows: macrosomia(0.45,0.49,0.61),premature birth(0.50,0.54,0.61),primary cesarean(0.57,0.59,0.61),neonatal complications(0.59,0.62,0.72),hospitalization for abnormal blood glucose(0.26,0.27,0.29),hospitalization for tocolysis(0.06,0.06,0.07),entering Neonatal Intensive Care Unit(0.57,0.55,0.76),uric ketone positive(1.81,1.79,1.75),and the ORs were consistent(<1 or >1).4.The study also indicated that MNT by MDT could keep the weight gain gradually and control the blood glucose at a normal and relatively low level during pregnancy.The proportion of abnormal values of blood glucose in MNT group was higher than that in the control group at early stage,and gradually approached that after treatment,which have indicated the effectiveness of MNT.Conclusions:MNT by MDT can reduce the risks of macrosomia,preterm delivery,primary cesarean,neonatal complications,hospitalization for abnormal blood glucose,hospitalization for tocolysis,entering Neonatal Intensive Care Unit,etc.Sensitivity analysis shows the results are robust and reliable.In addition,the MNT can control the blood glucose and weight during pregnancy preferably.In conclusion,MNT by MDT plays a vital role in the management of GDM patients.