目的 构建基于自我效能理论的孕晚期妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇运动治疗方案,并探讨其对产妇产后42 d盆底功能恢复的影响.方法 2018年6月至2019年3月便利抽样选取某妇产科专科医院建卡产检并诊断为GDM的初产妇80例为研究对象,按照入组时间分为对照组(41例)和观察组(39例),对照组采取常规护理,观察组在此基础上实施基于自我效能理论的运动治疗方案,对两组人群的一般情况、自我效能、分娩情况和盆底功能障碍等指标进行比较.结果 干预前两组人群一般情况、自我效能和盆底功能情况以及分娩方式均无显著差异(均P>0.05).干预后,观察组孕妇的自我效能水平明显提高[(26.10±5.80)分vs.(27.08±5.68)分],对照组患者干预前后无显著差异[(27.76±5.77)分vs.(27.22±5.15)分],自评PFD症状得分明显低于对照组[(13.00±5.32)分vs.(16.27±6.68)分],差异均有统计学意义(均P<0.05).结论 基于自我效能理论的孕晚期运动方案能有效提高GDM患者的自我效能,有利于产后盆底功能恢复.

目的 探讨健康教育路径对分娩结局的影响.方法 随机选取2015年8月-2016年1月在该院建卡分娩的单胎初产妇1 492例为路径组,选择相同条件同期建卡分娩的孕妇1 480例为非路径组.路径组实施健康教育路径,非路径组实施常规健康教育,比较路径组与非路径组初产妇的妊娠结局及对新生儿的影响.结果 路径组产妇阴道分娩率(64.3％)明显高于非路径组的阴道分娩率(57.4％),两组差异有统计学意义(P＜0.05).路径组孕期体质量平均增加(14.83±6.56) kg,非路径组平均体质量增加(15.95±7.15) kg,两组差异有统计学意义(P＜0.05).路径组早产儿发生率为4.4％,明显低于非路径组的7.4％,两组差异有统计学意义(P＜0.05).结论 健康教育路径对控制孕期体质量增加、促进自然分娩、降低孕产期并发症有重要意义,值得临床推广应用.

目的 探讨健康教育对孕妇分娩方式认知及选择的影响.方法 采用“孕妇分娩知识调查表”,抽取2016-12至2017-08医院建卡的孕妇457名,随机分为两组,干预组237名,对照组220名,两组均接受基本孕期知识指导,干预组另进行分娩方式相关知识的系统宣教,比较两组孕妇对分娩方式的认知、态度和分娩方式的选择.结果 干预组对分娩相关知识的知晓度高于对照组,干预组孕妇对分娩镇痛的知晓率为94.5％,对照组的孕妇的知晓率为81.0％,明显低于干预组,差异具有统计学意义(均P＜0.05);干预组产前选择自然分娩率(97.9％)高于对照组(91.0％),差异均具有统计学意义(P＜0.05).结论 向孕妇进行分娩方式健康教育能明显降低剖宫产率,减少非医学指征的剖宫产现象.

Objective To investigate the effect of diet counseling intervention during overweight pregnancy on gestational outcomes and neonate.Methods 231 overweight (BMI≥24 kg/m+2) pregnant women were selected randomly as the intervention group, 1 261 overweight pregnant women were selected as the control group during the same period.Two groups were subject to regular antenatal examination and health education during pregnancy.The intervention group was provided 3 time diet consultation about diet and physical activity recommendation.Statistical analysis was used to evaluate the effect of diet consultation.Results Compared with the control group (12.22±4.58) kg, the mean of maternal gestational weight gain of the intervention group (10.34±5.26) kg were declined ,and GDM in intervention group were reduced.No significant difference of variables were observed between-groups in the prevalence of macrosomia, gestational hypertension, cesarean rate and birth weight.Conclusion Strengthening intervention on risk factors and diet of the overweight pregnant women, should be strengthed and weight growth during pregnancy should also be controlled, all these measures can reduce pregnancy complications, and have important significance to the healthy growth of the children in the future.

目的 通过对超重孕妇实施低血糖生成指数(GI)膳食的干预,探讨胎盘组织和脐血中与体重增长有关基因的甲基化的改变.方法 采用随机化单盲对照干预试验设计,研究对象为初次产检孕周≤12周且体重超重的孕妇.以研究对象纳入的顺序号为随机序列号,采用简单随机化的方法随机分为干预组和对照组.干预组在中国孕妇保健规范的基础上结合国家对孕妇的膳食和体力活动规范实施低GI膳食指导干预,对照组仅按照国家规范给予指导,不给予低GI膳食的指导.两组分别在孕早期、中期和晚期干预3次.干预组和对照组各纳入25例.孕妇分娩时收集胎盘组织和脐血,提取DNA,采用Illumina甲基化芯片进行两步法全基因组甲基化测定.结果 孕妇孕期相关暴露因素在干预组与对照组差异无统计学意义;胎儿出生体重干预组高于对照组[(3.7 ±0.5) vs(3.5±0.4)kg],但差异无统计学意义(P =0.248).本研究结果结合生物信息数据库分析,筛选出19个基因位点,所属18个基因,其中5个基因位于1号染色体,2个基因位于7号染色体,其余基因分布分散.比较干预组与对照组甲基化的改变,发现脐血中2个差异的甲基化CpG位点,分别位于TEKT5和MIR378C基因上,胎盘组织中1个差异的甲基化CpG位点,所属PGBD5基因.结论 通过对超重孕妇采取低GI膳食干预,胎盘组织和脐血中基因的甲基化可以发生改变,为中国超重、肥胖孕妇疾病的预防提供新的方法,对子代的健康成长有重要的意义.

Objective To investigate the effect of diet consultation and metabolic risk factors during pregnancy on gestational outcomes. Methods Subjects were consecutive pregnant women who accepted routine prenatal examination and delivery in the International Peace Maternity and Children's Health Hospital of China Welfare Institute in Shanghai from May 2010 to April 2012. The retrospective cohort was analyzed to evaluate the effect of diet consultation intervention on gestational complications among women with gestational diabetes mellitus( GDM). Stepwise logistic regressions analysis was used to evaluate the effect of metabolic risk factors on birth weight and macrosomia,respectively. Results ① Analyses were performed among 10 421 subjects. The mean of gestational week at the first prenatal visit was 20. 8( 19. 4- 22. 4) weeks. The mean of fasting blood glucose( FBS),triglyceride( TG) and total cholesterol( CHOL) was( 4. 4 ± 0. 4),( 1. 4 ± 0. 6) and( 4. 7 ± 0. 8) mmol·L- 1, respectively. The mean of SBP and DBP was( 111. 3 ± 11. 5) and( 67. 9 ± 13. 3) mmHg. The prevalence of GDM was 15. 8 %. The mean of birth weight was( 3 355. 4 ± 426. 0) g and the prevalence of macrosomia was 6. 2 %. ② Among 812 pregnant women with diagnosed GDM,570 accepted diet consultation at least once and the rest of 242 women never went to the diet consultation. No significant between-group differences were observed in variables in the baseline characteristics, including age,education,weight in 20 th gestational week and biochemical tests at first prenatal visit. Compared with the control group the mean of birth weight,the prevalence of macrosomia and gestational hypertension in intervention group were reduced,( 3 347. 4 ± 19. 6 g vs 3 450. 3 ± 35. 6 g,P = 0. 007; 6. 7 % vs 15. 6 %,P = 0. 001; 26. 3 % vs 47. 9 %,P 0. 001),respectively. With the increase of times of visiting nutrition intervention,the mean of maternal gestational weight gain and birth weight declined( r =- 0. 126,P = 0. 003; r =- 0. 112,P = 0. 002),and the prevalence of macrosomia was also decreased. ③Stepwise multiple logistic regressions showed the body weight at 20 th gestational week( OR = 1. 08,95 % CI: 1. 07- 1. 09),gestational weight gain( OR = 1. 10,95 % CI: 1. 07- 1. 12) and GDM( OR = 1. 63,95 % CI: 1. 22- 2. 19) significantly increased the risk of the neonatal macrosomia. Conclusion The findings show that the elevated metabolic risk factors in pregnancy increase the risk of adverse gestional outcomes,diet consultation help improve the neonatal outcomes. The findings call for the urgent need for early and throughout management of metabolic risk factors and diet consultation among pregnant women during pregnancy to achieve better control the adverse gestation outcomes.