营养干预对妊娠期糖尿病患者妊娠结局影响的系统评价

    Effect of Nutrition Interventions on Pregnancy Outcomes of Gestational Diabetes Mellitus Patients: A Systematic Review

    • 摘要: 目的 系统评价营养干预对妊娠期糖尿病患者妊娠结局的影响。 方法 计算机检索PubMed、EMBASE、Web of Science、Cochrane图书馆(2015年1期)、中国知网、中国生物医学文献数据库、维普和万方数据库,收集关于营养干预对妊娠期糖尿病患者妊娠结局影响的随机对照试验,检索时限均从建库至2015年5月。由2名研究者按照纳入与排除标准独立筛选文献,提取资料并交叉核对,使用Cochrane系统评价员手册5.1.0文献质量评价标准评价纳入研究的质量,采用漏斗图评估发表偏倚、RevMan 5.1软件进行Meta分析。 结果 最终纳入12个研究,共1 561例患者。Meta分析结果显示: ①孕产妇围产期结局方面,剖宫产(相对危险度=0.51,95%可信区间 0.30~0.86,P=0.01)、胎膜早破(相对危险度=0.42,95%可信区间0.19~0.93,P=0.03)和妊娠期高血压综合征(相对危险度=0.32,95%可信区间0.18~0.59,P=0.000 2)等8个结局指标的发生率均低于对照组;②围生儿结局方面,胎儿窘迫(相对危险度=0.35,95%可信区间0.24~0.52,P<0.000 01)、呼吸窘迫综合征(相对危险度=0.13,95%可信区间0.04~0.47,P=0.002)和巨大儿(相对危险度=0.27,95%可信区间0.19~0.39,P=0.000 01)等9个结局指标的发生率均低于对照组。 结论 通过对妊娠期糖尿病患者实施科学合理的营养干预,能有效控制血糖在正常范围内,降低妊娠期母婴并发症的发生率,改善妊娠结局,提高孕产妇及新生儿生存质量。由于受纳入研究数量和质量所限,上述结论尚需进一步开展大样本、高质量的随机对照试验加以验证。

       

      Abstract: Objective To systematically review the effect of nutrition intervention on pregnancy outcomes of gestational diabetes mellitus (GDM) patients. Methods Databases including PubMed, EMBASE, Web of Science, the Cochrane library (Issue 1, 2015), CNKI, CBM, VIP, Wanfang database were searched from inception to May 2015 to collect randomized controlled trials (RCTs) studies on the effect of nutrition interventions on pregnancy outcomes of gestational diabetes mellitus patients. Two researchers independently screened the studies according to inclusion and exclusion criteria, extracted data and cross-check. The Cochrane reviewers manual 5.1.0 quality assessment criteria to evaluate the quality of included studies. Publication bias was evaluated by funnel plot. Then, meta-analysis was performed using RevMan 5.1 software. Results Finally, 12 RCTs involving 1 561 patients were included. The results of meta-analysis showed that: ①For maternal perinatal outcome, the incidence of eight outcome indicators including caesarean section (RR=0.51, 95%CI 0.30~0.86, P=0.01), premature rupture of membranes (RR=0.42, 95%CI 0.19~0.93, P=0.03) and pregnancy-induced hypertension syndrome (PIH) (RR=0.32, 95%CI 0.18~0.59, P=0.000 2) were lower than the control group; ②For perinatal outcome, the incidence of nine outcome indicators including fetal distress (RR=0.35, 95%CI 0.24~0.52, P<0.000 01), respiratory distress syndrome (RDS) (RR=0.13, 95%CI 0.04~0.47, P=0.002) and fetal macrosomia (RR=0.27,95%CI 0.19~0.39,P=0.000 01)were lower than the control group. Conclusion Through scientific and reasonable nutrition intervention on GDM patients, which blood glucose with effectively controlling in the normal range, reducing the incidence of maternal and infant complications during pregnancy and improving the pregnancy outcome, enhancing the quality of maternal and newborn survival. Due to the limited quantity and quality of the included studies, more larger sample and high quality RCTs are needed to verify the above conclusion.

       

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