本文選題：糖尿病 + 妊娠��； 參考：《青島大學(xué)》2013年碩士論文

【摘要】：目的：①分析妊娠糖尿病(GDM)孕婦的飲食習(xí)慣、飲食結(jié)構(gòu)特點,為妊娠糖尿病孕婦合理飲食提供參考。 ②探討個體化醫(yī)學(xué)營養(yǎng)治療對妊娠糖尿病孕婦的血糖控制及妊娠結(jié)局的影響,為GDM孕婦合理飲食提供參考。 方法：①選擇確診的妊娠糖尿病孕婦96例為病例組,另選正常孕婦96例為對照組,以問卷調(diào)查孕婦飲食習(xí)慣,采用食物頻率法和24小時膳食回顧法相結(jié)合調(diào)查妊娠糖尿病孕婦的飲食結(jié)構(gòu)、能量及三大營養(yǎng)素的攝入和其食物來源。 ②選擇我院確診的妊娠糖尿病(GDM)孕婦48例為治療組,給予個體化醫(yī)學(xué)營養(yǎng)治療,另選同期只接受口頭飲食指導(dǎo)不愿接受個體化醫(yī)學(xué)營養(yǎng)治療的GDM孕婦48例為對照組,治療組制訂個體化食譜并全程監(jiān)督指導(dǎo)直至分娩,觀察兩組前后血糖、胰島素值變化,孕期體重增長的情況,新生兒出生體重及早產(chǎn),剖宮產(chǎn)、巨大胎兒、等母嬰并發(fā)癥的發(fā)生率。 結(jié)果：①GDM孕婦的薯芋類、畜肉類、水果和堅果的攝入量高于正常孕婦(P0.05),粗雜糧、禽肉、深海魚類和豆?jié){的攝入低于正常孕婦(P0.05);GDM孕婦每日總能量、脂肪和蛋白質(zhì)的攝入高于對照組(P0.05),GDM孕婦膳食中脂肪占總能量比高于正常孕婦(P0.05);GDM孕婦碳水化合物占總能量比低于正常孕婦,(P 0.05).GDM孕婦的畜肉類來源的脂肪多于對照組(P0.05),魚類來源的脂肪少于對照組P0.05)；粗雜糧來源的碳水化合物低于對照組(P0.05)；薯類和水果來源的碳水化合物高于對照組(P0.05)。 ②GDM孕婦治療組血糖在治療1周后空腹血糖、三餐后1小時血糖和三餐后2小時血糖恢復(fù)正常的人數(shù)多于對照組,有統(tǒng)計學(xué)意義(P0.05),GDM孕婦治療組在治療6周、12周和分娩前,空腹血糖、餐后1小時血糖、餐后2小時血糖均小于對照組(P0.05),GDM孕婦治療組經(jīng)過治療后,空腹胰島素、餐后1小時胰島素、餐后2小時胰島素、餐后3小時胰島素均低于對照組(P0.05),經(jīng)過治療GDM孕婦治療組的胰島素抵抗系數(shù)和分泌系數(shù)較對照組比較有明顯改善,治療組孕婦體重增長為11.53±2.89kg(對照組14.92±3.4kg),兩組有明顯差異(P0.05),治療組新生兒出生體重控制在正常范圍(3000～4000g),對照組平均出生偏大,達到3735.25±355.58g,兩組比較有明顯差異(P0.05)；治療組巨大兒的發(fā)生率較對照組低(P0.05),胎兒宮內(nèi)情況正常,在積極監(jiān)護下43例孕婦在38周左右自然順產(chǎn)。早產(chǎn)、剖官產(chǎn)、巨大兒發(fā)生率明顯低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：①GDM孕婦飲食習(xí)慣、飲食結(jié)構(gòu)及能量和三大營養(yǎng)素攝入不合理。孕婦在懷孕期間應(yīng)調(diào)整不合理的飲食結(jié)構(gòu),預(yù)防妊娠糖尿病的發(fā)生。 ②對GDM孕婦實施個體化醫(yī)學(xué)營養(yǎng)治療有助于控制其血糖,使其在保證充足營養(yǎng)供給的情況下,控制血糖,減小血糖波動,改善胰島素抵抗,孕期體重增長控制在理想范圍,新生兒出生體重理想,有利于獲得良好的妊娠結(jié)局。
[Abstract]:Objective to analyze the dietary habits and dietary structure of pregnant women with gestational diabetes mellitus (GDM). To provide reference for rational diet of pregnant women with gestational diabetes mellitus. 2 to explore the effect of individualized medical nutrition therapy on blood glucose control and pregnancy outcome of pregnant women with gestational diabetes mellitus, and to provide reference for rational diet of pregnant women with GDM. Methods: a total of 96 pregnant women with gestational diabetes mellitus were selected as case group and 96 normal pregnant women as control group. The dietary structure of pregnant women with gestational diabetes mellitus was investigated by the method of food frequency and 24 hours diet review. Energy intake and intake of three major nutrients and their food sources. (2) 48 pregnant women with gestational diabetes mellitus (GDM) diagnosed in our hospital were selected as treatment group and were given individualized medical nutrition therapy. In addition, 48 GDM pregnant women who received oral dietary guidance and were not willing to receive individualized medical nutrition were selected as control group. The treatment group made individualized diet and supervised the whole course until delivery, and observed the changes of blood glucose and insulin before and after delivery. Pregnancy weight gain, neonatal birth weight and premature delivery, cesarean section, macrosomia, and maternal and infant complications. Results the intake of tuber taro, animal meat, fruit and nut in 1 GDM pregnant women was higher than that in normal pregnant women (P 0.05), and the intake of crude cereals, poultry, deep-sea fish and soybean milk was lower than that of normal pregnant women. The intake of fat and protein was higher than that of the control group (P0.05 / GDM). The ratio of fat to total energy in the diet of pregnant women with GDM was higher than that of normal pregnant women (P 0.05 / GDM). The ratio of carbohydrate to total energy of pregnant women with GDM was lower than that of normal pregnant women (P 0.05). GDM pregnant women had more fat than the control group. The fat of fish was less than that of control group (P 0.05). Carbohydrates from crude grains were lower than those from control group (P 0.05), carbohydrates from potato and fruit were higher than those from control group (P 0.05). 2 fasting blood glucose of pregnant women treated with GDM was 1 week after treatment. The number of patients who returned to normal at 1 hour after three meals and 2 hours after three meals was significantly higher than that in the control group. There were significant differences in fasting blood glucose and 1 hour postprandial blood glucose between 6 weeks and 12 weeks and before delivery in the pregnant women treatment group with P0.05 and GDM. 2 hours postprandial blood glucose was lower than that of control group (P 0.05). After treatment, fasting insulin, 1 hour postprandial insulin and 2 hour postprandial insulin were observed in the treatment group. Insulin at 3 hours after meal was lower than that in control group (P 0.05). The insulin resistance coefficient and secretion coefficient of treated GDM pregnant women were significantly improved compared with those of control group. The weight gain of pregnant women in the treatment group was 11.53 鹵2.89 kg (control group 14.92 鹵3.4 kg / kg), there was significant difference between the two groups (P 0.05). In the treatment group, the birth weight of newborns was controlled in the normal range of 3 000 ~ 4 000 g / g, and the average birth weight in the control group was 3735.25 鹵355.58 g, there was significant difference between the two groups (P0.05). The incidence of macrosomia in the treatment group was lower than that in the control group (P 0.05), and the fetal intrauterine condition was normal. The incidence of premature delivery, anatomic delivery and macrosomia was significantly lower than that of the control group (P 0.05). Conclusion the dietary habits, dietary structure, energy and the intake of three nutrients are not reasonable for the pregnant women with 1: 1 GDM. Pregnant women should adjust their unreasonable diet during pregnancy to prevent gestational diabetes. 2 individualized medical nutrition therapy for pregnant women with GDM can help to control their blood sugar and ensure adequate nutrition supply. Control of blood sugar, decrease of blood sugar fluctuation, improvement of insulin resistance, control of weight gain during pregnancy in ideal range, ideal birth weight of newborns, good outcome of pregnancy.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R153.1;R714.256

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