| Objective:To investigate the pre-pregnancy body mass index,pregnancy weight gain and pregnancy outcome of pregnant women with gestational diabetes.To explore the role of group cognitive behavioral therapy in pregnancy outcomes of pregnant women with gestational diabetes mellitus,and to provide reference for improving pregnancy outcomes and developing effective multidisciplinary management of gestational diabetes mellitus.Methods:A total of 878 pregnant women with gestational diabetes who received individualized medicine nutrition therapy and gave birth in Shanxi Maternal and Child Health Hospital from January 1,2020 to December 31,2021 were retrospectively selected as the study objects.The pregnant women who received group cognitive behavioral therapy were included in the observation group(141 cases),and the pregnant women who did not receive group cognitive behavioral therapy were included in the control group(737 cases).The general demographic characteristics of pregnant women with gestational diabetes were collected by systematically trained outpatient nurses.Pregnancy outcomes were followed up using electronic medical records.Epidata3.1software was used for data entry,and SPSS 26.0 software was used for data analysis and processing.Chi-square test or Fisher’s exact probability method were used to analyze the effects of group cognitive behavioral therapy on pregnancy outcomes,such as gestational age,pregnancy weight gain,delivery mode,oligoamnios,and neonatal birth weight.Univariate and multivariable Logistic regression were used to further analyze the influencing factors of pregnancy outcome in pregnant women with gestational diabetes.Results:1.The number of pregnant women with preconception BMI≤18.4kg/m~2was the least,accounting for 4.2%(n=37)of the total number.55.5%(n=487)of the pregnant women had BMI of 18.5-23.9 kg/m~2before pregnancy.The preconception body mass index of pregnant women was 24-27.9kg/m~2,accounting for 29.0%(n=255)of the total number;11.3%(n=99)of pregnant women had BMI≥28kg/m~2before pregnancy.430pregnant women with GDM had excessive weight gain during pregnancy,accounting for49.0%of the total number.91 patients had insufficient weight gain during pregnancy,accounting for 10.4%of the total number.357 women with GDM gained normal weight during pregnancy,accounting for 40.7%of the total.417 women with GDM had cesarean delivery,accounting for 47.5%of the total number.Of the GDM women with full-term pregnancies,273(31.1%)were early term and 530(60.4%)were late term or late term.The incidence of oligoamnios was 14.5%.The incidence of premature rupture of membranes was the highest(20.6%).The incidence of fetal distress was 10.9%.The incidence of amniotic fluid fecal staining was 6.0%.Pre-eclampsia had the lowest incidence of 5.9%;The incidence of premature births was 8.5%;The incidence of macrosomia was 5.9%;The incidence of low birth weight infants was 6.2%.2.The PSM was used to match the confusion bias caused by the difference in baseline data between the balanced GCBT group and the simple IMNT group.The area under the OGTT curve and test-tube babies were taken as co-variables,and GCBT participation was taken as dependent variables to construct the model.The caliper value was set at 0.02,and 1:2PSM matching was performed.Control group:256 cases.3.After PSM,No rate of cesarean section(46.3%vs 49.6%),oligohydramnios(16.4%vs 17.2%),premature rupture of membranes(19.4%vs 25.8%),fetal distress(11.9%vs 10.5%),fecal amniotic fluid contamination(7.5%vs 6.3%),pre-eclampsia(2.2%vs 5.1%),there was a statistical difference between the observation group and the control group(P value was high than 0.05).4.After PSM,there was a statistically significant difference between the two groups in the proportion of gestational weeks at delivery(P>0.05),the results of pairwise comparison showed that the incidence of preterm birth in observation group(3.7%)was lower than that in control group(10.5%),and the incidence of full term/late term term in observation group(63.4%)was higher than that in control group(52.3%).The proportion of weight gain during pregnancy between the two groups was statistically significant(P<0.05),the incidence of excess weight gain during pregnancy in the observation group(50.7%)was higher than that in the control group(41.1%).The percentages of preterm infants(3.7%),macrobiotic infants(1.5%)and low birth weight infants(2.2%)in observation group were lower than those in control group(10.5%,5.9%,9.0%)(P<0.05).5.Multivariable logistic regression showed that age≥35years old(OR=3.854,95%CI=1.793-8.283)was an independent risk factor for premature delivery.GCBT(OR=0.298,95%CI:0.110-0.806)was an independent protective factor against preterm birth.Excessive weight gain during pregnancy was a risk factor for macrosomia(OR=16.992,95%CI:2.137～135.081).Age≥35 years(OR=2.529,95%CI:1.009-6.339)was an independent risk factor for preterm birth.GCBT(OR=0.222,95%CI:0.064-0.762)was an independent protective factor for low birth weight infants.Conclusions:1.It is suggested that overweight and obese women before pregnancy should carry out body quality management in preparation for pregnancy to control body quality within the ideal range before pregnancy.2.Women of childbearing age should reasonably plan the duration of pregnancy to reduce adverse pregnancy outcomes.3.Women of childbearing age should plan the pregnancy time reasonably to reduce the incidence of adverse pregnancy outcomes.4.GCBT can make pregnant women with GDM gain weight during pregnancy within the normal range,extend the gestational weeks,and reduce the incidence of premature infants,macrosomia,and low birth weight infants,providing reference for the establishment of a multidisciplinary management model of GDM.However,the long-term effects on pregnant women with GDM need to be further explored. |
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