妊娠期糖尿病生活方式干预研究进展

发布时间：2025-09-25 09:24

孕期控制糖分摄入，预防妊娠糖尿病。 #生活知识# #饮食技巧# #孕妇饮食#

摘要: 妊娠期糖尿病（GDM）是妊娠期首次发生或发现的血糖异常，是妊娠期常见并发症之一。GDM不但会对围产期母儿产生影响，而且会对母儿产生长期影响。各指南建议，GDM治疗策略应首选饮食和生活方式干预。本文综述了当前针对GDM开展的各种生活方式干预的研究进展，认为对GDM女性实施生活方式干预，尤其是联合生活方式干预，将带来一定的健康收益；但证据受到当前的试验研究数量少、样本量小和方法学质量变异较大的限制，将来需要更多的随机对照试验评价生活方式干预对GDM女性及其子代的影响，尤其是长期影响。

Abstract: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset of or first recognition during pregnancy. It is one of the common complications during pregnancy. GDM has adverse effects on women and their offspring, including not only short-term impacts, but also long-term effects. Guidelines recommend that dietary and lifestyle interventions should be the preferred GDM treatment strategies. We reviewed current research progress on various lifestyle interventions for GDM, and suggested that the implementation of lifestyle interventions for GDM women, especially the joint lifestyle interventions, would bring certain health benefits. However, the evidences were limited by insufficient number of current randomized controlled trials, small sample size and large variation of methodological quality. More randomized controlled trials with high quality in the future will be needed to evaluate the effects of lifestyle interventions on GDM women and their offspring, especially the long-term effects.

表 1 2017年Han S等对19项饮食干预试验1 398名GDM女性的研究结果汇总

饮食干预策略风险比率RR95 % CI试验项数研究对象 1.低中度血糖指数（GI）食物vs中高度GI食物（4项试验）　　大于胎龄儿（LGA） 0.71 0.22～2.34 2项 89名婴儿　　严重高血压或先兆子痫 1.02 0.07～15.86 1项 95名女性　　子痫 0.34 0.01～8.14 1项 83名女性　　剖宫产 0.66 0.29～1.47 1项 63名女性 2.低GI饮食vs高纤维中度GI饮食（1项试验）　　大于胎龄儿 2.87 0.61～13.50 1项 92名婴儿　　剖宫产 1.91 0.91～4.03 1项 92名女性　　产后3个月2型糖尿病 0.76 0.11～5.01 1项 58名女性 3.能量限制饮食vs无能量限制饮食（3项试验）　　大于胎龄儿（LGA） 1.17 0.65～2.12 1项 123名婴儿　　围产期死亡率无事件 2项 423名婴儿　　先兆子痫 1.00 0.51～1.97 1项 117名女性　　剖宫产 1.12 0.80～1.56 2项 420名女性 4.DASH（dietary approaches to stop hypertension）vs常规饮食组（3项试验）　　先兆子痫 1.00 0.31～3.26 3项 136名女性　　剖宫产 0.53 0.37～0.76 2项 86名女性 5.低碳水化合物饮食（碳水化合物与总能量摄入比 ≤ 45 %）vs高碳水化合物饮食（每日碳水化合物与总能量摄入比 ≥ 50 %）（2项试验）　　大于胎龄儿 0.51 0.13～1.95 1项 149名婴儿　　围产期死亡率 3.00 0.12～72.49 1项 150名婴儿　　母亲高血压 0.40 0.13～1.22 1项 150名女性　　剖宫产 1.29 0.84～1.99 2项 179名女性 6.高不饱和脂肪酸饮食（单不饱和脂肪与总能量摄入比 ≥ 20 %）vs高碳水化合物饮食（碳水化合物与总能量摄入比 ≥ 50 %）（2项试验）　　大于胎龄儿 0.54 0.21～1.37 1项 27名婴儿　　先兆子痫无一例 1项 27名女性　　妊娠期高血压 0.54 0.06～5.26 1项 27名女性　　剖宫产 1.08 0.07～15.50 1项 27名女性　　产后1～2周糖尿病 2.00 0.45～8.94 1项 24名女性　　产后4～13月糖尿病 1.00 0.10～9.61 1项 6名女性续表1饮食干预策略风险比率RR95 % CI试验项数研究对象 7.饮食建议 + 饮食相关行为建议vs仅饮食建议（1项试验）　　大于胎龄儿 0.73 0.25～2.14 1项 99名婴儿　　剖宫产 0.78 0.38～1.62 1项 99名女性 8.大豆蛋白富集vs非大豆蛋白饮食（1项试验）　　先兆子痫 2.00 0.19～21.03 1项 68名女性　　剖宫产 1.00 0.57～1.77 1项 68名女性 9.种族特异性饮食vs标准健康饮食（1项试验）　　大于胎龄儿 0.14 0.01～2.45 1项 20名婴儿　　新生儿复合不良结局无事件 1项 20名婴儿　　妊娠期高血压 0.33 0.02～7.32 1项 20名女性　　剖宫产 1.20 0.54～2.67 1项 20名女性 10. 富含纤维的饮食（每天80 g膳食纤维）vs标准纤维饮食（美国糖ADA饮食推荐的每天20 g膳食纤维）（1项试验）　　未报告主要结果

表 2 2017年Brown等对GDM女性联合生活方式干预效果的随机对照试验结果汇总

项目风险比RR95 % CI试验项数研究对象质量等级联合生活方式干预对母亲的影响　　妊娠期高血压疾病（先兆子痫） 0.70 0.40～0.22 4项 2 796名女性低质量证据　　剖宫产 0.90 0.78～1.05 10项 3 545名女性低质量证据　　产后（最多10年）2型糖尿病 0.98 0.54～1.76 2项 486名女性低质量证据　　会阴创伤/撕裂 1.04 0.93～1.18 1项 1 000名女性中等质量证据　　引产 1.20 0.99～1.46 4项 2 699名女性高质量证据　　产后1年体重达标 1.75 1.05～2.90 1项 156名女性低质量证据　　产后抑郁 0.49 0.31～0.78 1项 573名女性低质量证据续表2项目风险比RR95 % CI试验项数研究对象质量等级联合生活方式干预对子代的影响　　大于胎龄（LGA） 0.60 0.50～0.71 6项 2 994名婴儿中等质量证据　　儿童期超重（BMI ≥ P85） 0.91 0.75～1.11 3项 767名儿童中等质量证据　　围产儿死亡 0.09 0.01～1.70 2项 1 988名婴儿低质量证据　　严重的婴儿结局 0.57 0.21～1.55 2项 1 930名婴儿非常低质量证据　　新生儿低血糖 0.99 0.65～1.52 6项 3 000名婴儿中等质量证据儿童晚期神经感觉残疾、成年期糖尿病和肥胖　　无研究报告此结果 [1]

Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop – Conference on Gestational Diabetes Mellitus. The Organizing Committee[J]. Diabetes Care, 1998, 21(Suppl 2): B161 – 167.

[2]

National Collaborating Centre for Women′s and Children′s Health (UK). Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period[M]. London: National Institute for Health and Clinical Excellence (NICE), 2015.

[3]

Metzger BE, Gabbe SG, Persson B, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care, 2010, 33(3): 676 – 682. DOI: 10.2337/dc09-1848

[4]

Zhu WW, Yang HX, Wang C, et al. High prevalence of gestational diabetes mellitus in Beijing: effect of maternal birth weight and other risk factors[J]. Chin Med J (Engl), 2017, 130(9): 1019 – 1025. DOI: 10.4103/0366-6999.204930

[5]

Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes[J]. N Engl J Med, 2008, 358(19): 1991 – 2002. DOI: 10.1056/NEJMoa0707943

[6]

Anderberg E, Kallen K, Berntorp K. The impact of gestational diabetes mellitus on pregnancy outcome comparing different cut-off criteria for abnormal glucose tolerance[J]. Acta Obstet Gynecol Scand, 2010, 89(12): 1532 – 1537. DOI: 10.3109/00016349.2010.526186

[7]

Jastrow N, Roberge S, Gauthier RJ, et al. Effect of birth weight on adverse obstetric outcomes in vaginal birth after cesarean delivery[J]. Obstet Gynecol, 2010, 115(2 Pt 1): 338 – 343.

[8]

Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes: the need for a common ground[J]. Lancet, 2009, 373(9677): 1789 – 1797. DOI: 10.1016/S0140-6736(09)60515-8

[9]

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review[J]. Diabetes Care, 2002, 25(10): 1862 – 1868. DOI: 10.2337/diacare.25.10.1862

[10]

Vaarasmaki M, Pouta A, Elliot P, et al. Adolescent manifestations of metabolic syndrome among children born to women with gestational diabetes in a general-population birth cohort[J]. Am J Epidemiol, 2009, 169(10): 1209 – 1215. DOI: 10.1093/aje/kwp020

[11] 宋耕, 孔令英, 王晶, 等. 妊娠期糖尿病患者子代3~4岁的随访研究[J]. 中华围产医学杂志, 2013, 16(6): 331 – 336. DOI: 10.3760/cma.j.issn.1007-9408.2013.06.004 [12]

Xiang AH, Wang X, Martinez MP, et al. Association of maternal diabetes with autism in offspring[J]. JAMA, 2015, 313(14): 1425 – 1434. DOI: 10.1001/jama.2015.2707

[13]

American Diabetes Association. Management of diabetes in pregnancy[J]. Diabetes Care, 2015, 38(Suppl): S77 – 79.

[14]

Reader DM. Medical nutrition therapy and lifestyle interventions[J]. Diabetes Care, 2007, 30(Suppl 2): S188 – 193.

[15]

Jenkins DJ, Wolever TM, Taylor RH, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange[J]. Am J Clin Nutr, 1981, 34(3): 362 – 366. DOI: 10.1093/ajcn/34.3.362

[16]

Thomas DE, Elliott EJ. The use of low-glycaemic index diets in diabetes control[J]. Br J Nutr, 2010, 104(6): 797 – 802. DOI: 10.1017/S0007114510001534

[17]

Moses RG, Barker M, Winter M, et al. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial[J]. Diabetes Care, 2009, 32(6): 996 – 1000. DOI: 10.2337/dc09-0007

[18]

Ilic S, Jovanovic L, Pettitt DJ. Comparison of the effect of saturated and monounsaturated fat on postprandial plasma glucose and insulin concentration in women with gestational diabetes mellitus[J]. Am J Perinatol, 1999, 16(9): 489 – 495. DOI: 10.1055/s-1999-6801

[19]

Barrett HL, Dekker Nitert M, McIntyre HD, et al. Normalizing metabolism in diabetic pregnancy: is it time to target lipids?[J]. Diabetes Care, 2014, 37(5): 1484 – 1493. DOI: 10.2337/dc13-1934

[20]

Kim C. Gestational diabetes: risks, management, and treatment options[J]. Int J Womens Health, 2010, 2: 339 – 351.

[21]

Cheung NW. The management of gestational diabetes[J]. Vasc Health Risk Manag, 2009, 5(1): 153 – 164.

[22]

Han S, Crowther CA, Middleton P, et al. Different types of dietary advice for women with gestational diabetes mellitus[J]. Cochrane Database Syst Rev, 2013(3): CD009275.

[23]

Han S, Middleton P, Shepherd E, et al. Different types of dietary advice for women with gestational diabetes mellitus[J]. Cochrane Database Syst Rev, 2017, 2: CD009275.

[24]

Ceysens G, Rouiller D, Boulvain M. Exercise for diabetic pregnant women[J]. Cochrane Database Syst Rev, 2006, 3: CD004225.

[25]

ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy[J]. Obstet Gynecol, 2005, 106(3): 671 – 675. DOI: 10.1097/00006250-200509000-00054

[26]

Muktabhant B, Lawrie TA, Lumbiganon P, et al. Diet or exercise, or both, for preventing excessive weight gain in pregnancy[J]. Cochrane Database Syst Rev, 2015, 6: CD007145.

[27]

Rasmussen KM, Yaktine AL. Weight gain during pregnancy[M]//Reexamining the Guidelines. Washington DC: National Academies Press (US), 2009.

[28]

Brown J, Alwan NA, West J, et al. Lifestyle interventions for the treatment of women with gestational diabetes[J]. Cochrane Database Syst Rev, 2017, 5: CD011970.

网址：妊娠期糖尿病生活方式干预研究进展 https://www.yuejiaxmz.com/news/view/1333377

⬅️上一篇：适合 1 型糖尿病患者的生酮饮食

➡️下一篇：糖尿病治疗的前世今生

妊娠期糖尿病生活方式干预研究进展

相关内容

随便看看

最新动态分享

热点动态分享

专题

推荐动态分享