Objective:To explore the effect of oral nutritional supplements (ONS) during labor on delivery outcomes in low-risk pregnant women and the risk factors of cesarean section.Methods:A retrospective analysis was conducted in a total of 206 full-term pregnant women with singleton and cephalic presentation at the delivery center in our hospital from March 15th to May 15th, 2022. Standard diet education was given to all those women by midwives. Pregnant women who received the enteral nutrient solution prepared by the Department of Clinical Nutrition during labor were in the ONS group ( n = 110), while those who did not were in the control group ( n = 96). The baseline characteristics and delivery outcomes were compared between the two groups, and the risk factors of cesarean section were also analyzed. Results:There were no significant differences in terms of maternal age, height, baseline weight, baseline body mass index (BMI), weight gain during pregnancy, prenatal BMI, gestational week, intraspinal labor analgesia, oxytocin, gastrointestinal intolerance, neonatal length, and weight between the two groups ( P > 0.05). However, the total oral energy intake during labor in the ONS group was significantly higher than that in the control group ([1 349.99± 569.51] kJ vs [249.59 ± 455.19] kJ, P < 0.01). The rate of vaginal delivery in the ONS group was significantly higher than that in the control group (93.6% vs 81.3%, P = 0.01), and the duration of the first stage of labor ([487.06 ± 232.94] min vs [416.17 ± 191.13] min, P = 0.03) was also significantly longer in the ONS group. There were no significant differences between the two groups in terms of the duration of the second and third stages of labor, perineal laceration, cervical laceration, vaginal laceration, amount of bleeding, hospital stay, and Apgar score after birth ( P > 0.05). Multivariate logistic regression analysis showed that maternal age was a risk factor for changing to cesarean section in women with low-risk pregnancies ( OR 1.20, 95% CI 1.03 to 1.40, P = 0.02), while ONS during labor ( OR 0.31, 95% CI 0.11 to 0.85, P = 0.02) and intraspinal labor analgesia ( OR 0.10, 95% CI 0.04 to 0.26, P < 0.01) were protective factors. Conclusions:ONS during labor can significantly increase the vaginal delivery rate, without increasing the incidence of gastrointestinal intolerance in low-risk pregnant women. Maternal age is a risk factor for cesarean section while ONS during labor and intraspinal labor analgesia are protective factors in women with low-risk pregnancies.

妊娠剧吐(HG)是妊娠期恶心呕吐(NVP)发展至最严重的状态,其发生率约为0.3％～3.0％.HG患者发生营养不良的风险极高,且母亲营养不良与低出生体重儿、胎儿宫内生长受限等不良妊娠结局高度相关.因此,重视HG患者的营养状态,予以规范的营养支持,提高母婴临床结局,成为当前的迫切需求.本文通过给予1例顽固性HG伴代谢紊乱患者规范的个体化营养支持,取得满意妊娠结局进行分享和讨论.

中华医学会肠外肠内营养学分会（Chinese society for parenteral and enteral nutrition，CSPEN）营养风险-不足-支持-结局-成本/效果多中心分享数据库协作组（nutritional risk- undernutrition-support-outcome-cost/effectiveness，NUSOC）第45次工作坊及CSPEN年会NUSOC协作组第46次工作坊分别于2020年10月24-25日、2020年12月17-20日在线上举行。全国25个中心共48名协作组代表参加了两次工作坊。协作组成员为临床医师、病房护士（师）、营养师、药师、统计学和卫生经济学工作者，是多学科诊疗团队。

Objective:Objective To explore the special role of nutrition specialists in the one-day-care clinic of gestational diabetes mellitus (GDM), and provide a basis for strengthening the standardized construction of one-day-care clinic.Methods:It was a retrospective observation study that the pregnant women who participated in the one-day-care clinic of GDM in our hospital without nutrition specialists in November and December 2017 were divided into control group (177 cases), and who participated in the one-day-care clinic of GDM in our hospital with nutrition specialists in January and February 2018 were divided into observation group (307 cases). The differences of pregnancy outcomes between the two groups were compared after the propensity score matching.Results:176 pairs of patients were successfully matched with a 1:1 propensity score. The incidence of macrosomia in pregnant women with GDM in the observation group (2.8%) was significantly lower than that in the control group (8.5%) ( P=0.036). There were no significant differences in the weight gain during pregnancy, the gestational week of delivery and the incidences of insulin use, hypertension during pregnancy, preeclampsia, cesarean section, premature infants, premature rupture of membranes, umbilical cord around the neck, and fetal distress between the two groups ( P>0.05). Conclusion:Nutrition specialists are indispensable in the multidisciplinary cooperation of one-day-care clinic of GDM, and they play a key role in considerably lowering the prevalence of macrosomia in GDM pregnant women.

Global leading scholars in the field of parenteral and enteral nutrition have been seeking for the criteria of diagnosis of malnutrition. In determining the diagnostic criteria for malnutrition, it is also necessary to take into account the normal values and clinically obtained cut-off points of different countries and races. The Global Leadership (nutrition field) Initiative on Malnutrition, GLIM) diagnostic criteria published online on Sep. 2 & Sep.3 2018. In January & February 2019, the [American Society for Parenteral and Enteral Nutrition, ASPEN] and the [European Society for Clinical Nutrition and Metabolism, ESPEN] published in print. The GLIM criteria has also been recorded in [National terminology of parenteral and enteral nutrition of China-2019]. In 2016 "Disease Classification and Code (Chinese expanding version of ICD-10)" having "nutritional risk" and "malnutrition" items officially listed. In 2019 " Notice on National Tertiary Public Hospitals" and in the "National Medical Insurance Administration-coding standard" also include the items of "nutritional risks " and "malnutrition" as diseases name.Although promoting individualized medical therapy in China now, but the actual situation of each clinical department is different. As far as parenteral and enteral nutrition is concerned, it was far from "precision medicine" or "targeted therapy " in clinical practice nowadays. The current aim is to identify which patients need nutrition support therapy for reasonable application - benefit to patient. China's DRG being developed by "big data survey system" . Therefore, it is necessary for "this system" can find nutritional risk and malnutrition as diseases name with the codes from Chinese expanding version of ICD-10. So, nutritional risk and malnutrition need to be filled in the cover page of discharged medical record.

目的 了解重庆市女性产褥期的膳食营养状况,提出合理建议,改善母婴健康.方法 对1 048例重庆市产褥期女性进行24h膳食回顾调查,询问其各类食物的摄人量,计算总能量、三大产能营养素、各餐次能量的摄人情况,计算矿物质和维生素的每日平均摄入量.用体成分分析仪测量体质量、体脂百分比、腰臀比等.结果 重庆市产褥期女性总能量、碳水化合物摄入量不足,蛋白质、脂肪摄人量超标.能量、蛋白质、脂肪、碳水化合物平均值分别为1 939.35 kcal/d、87.53 g/d、98.14 g/d、181.01 g/d.早餐和加餐摄入能量较低,但晚餐能量明显超标.肉类和蛋类摄入较多,而蔬菜、水果、鱼虾类、奶类、大豆类食物严重不足.维生素和矿物质有不同程度的缺乏,其中维生素C、叶酸、钙、膳食纤维的摄入量远远低于RNI.产后42d产妇的平均体质量为58.06 kg,体质量正常者仅占59.16％,体脂百分比和腰臀比达标者不到一半.结论 重庆市产褥期女性存在膳食结构不合理、体质量和体脂百分比偏高的现象,应开展个性化的营养宣教和指导,以改善营养状况.