目的 调查妊娠糖尿病(gestational diabetes mellitus, GDM)患者孕期膳食营养、认知观点和自我管理情况,探讨个性化饮食干预和运动指导对妊娠糖尿病患者的影响。方法 对41例明确诊断为GDM的孕妇进行问卷调查,通过logistic回归分析综合评价GDM患者遵循饮食控制的影响因素,制定个性化的饮食方案和运动方式,监测干预前后三餐血糖、糖化血红蛋白(HbAlc)、总胆固醇(TC)、三酰甘油(TG)的数值变化,将干预前后的指标进行比较。结果 (1)认知:接受过饮食教育者37例(92.5%);饮食态度上只有27.5%的患者认为仅饮食治疗就能有效控制血糖;食物对血糖的影响答题全部正确率为零,食物的描述答题全部正确率为2.5%。(2)logistic回归分析显示,年龄、文化程度、BMI、接受过饮食教育、定期自我监测血糖、定期到医院复查糖尿病是影响GDM患者遵循饮食控制的因素。(3)干预后的2hPG、HbA₁c、TC、TG 均较治疗前水平明显下降(P＜0.01)。结论 我国GDM患者饮食认知水平不高,年龄越大、文化程度越高、接受过饮食教育、定期复查及自我监测血糖者遵循饮食控制情况较好,个性化的饮食干预和运动指导对GDM患者有明显的治疗作用。

Objective To investigate the the status of gestational diabetes mellitus dietary nutrition,cognitive point of view, and self management in patients with gestational diabetes mellitus,and to discuss the effect of cognitive view, individualized dietary intervention and exercise guidance on gestational diabetes mellitus patients. Methods Forty-one GDM pregnant women received questionnaire survey. Logistic regression analysis was conducted to evaluate the influencing factors on GDM patients following the diet control. Individualized dietary regimen and exercise mode were the diet control, worked out. Monitor three meals ,blood glucose, glycated hemoglobin (HbA₁c), total cholesterol (TC), triacyl glycerol (TAG) anollheir value changes before and after the intervention were compared.　Results (1) Cognition: 37 patients received dietary education (92.5%); 27.5% of the patients believed that diet therapy alone can effectively control blood sugar; the answers of to guestion of the effect of food on blood sugar were all wrong,the right answers to question on description of the food constituted only 2.5%. (2) Logistic regression analysis showed that age, educational level, BMI, having achieved diet education,regular self monitoring of blood sugar,regular visit to the hospital for checking diabetes are the influencing factors on GDM patients following the diet control.(3)Compared with the formor level, 2 h HPG, HbA₁c, TC, TAG all significantly declined after the intervention with significant difference (P<0.01). Conclusions GDM patients’ diet cognitive level is not high in China. Patients of older age, higher educational level and having received diet education, regular checking and self-monitoring of blood glucose following the diet control show good condition.Individualized dietary and exercise therapy have obvious therapeutic effect on GDM patients.