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中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (04) : 451 -458. doi: 10.3877/cma.j.issn.1673-5250.2020.04.012

所属专题： 文献；

论著

孕前超重/肥胖的妊娠期糖尿病孕妇血糖管理：基于静息能量消耗计算每日总能量消耗
赵秀伶1,†(), 高洁1, 马唯1, 田丹1, 姜珊2   
  1. 1. 首都医科大学附属北京潞河医院产科　101100
    2. 首都医科大学附属北京潞河医院营养科　101100
  • 收稿日期:2020-01-08 修回日期:2020-07-01 出版日期:2020-08-01
  • 通信作者: 赵秀伶

Blood glucose management of overweight/obese pregnant women with gestational diabetes mellitus: calculation of total energy expenditure based on resting energy expenditure

Xiuling Zhao1,†(), Jie Gao1, Wei Ma1, Dan Tian1, Shan Jiang2   

  1. 1. Department of Obstetrics, Beijing Luhe Hospital Affiliated Capital Medical University, Beijing 101100, China
    2. Department of Nutrition, Beijing Luhe Hospital Affiliated Capital Medical University, Beijing 101100, China
  • Received:2020-01-08 Revised:2020-07-01 Published:2020-08-01
  • Corresponding author: Xiuling Zhao
  • About author:
    Corresponding author: Zhao Xiuling, Email:
  • Supported by:
    Science and Technology Project of Tongzhou District, Beijing(KJ2018CX009-07)
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引用本文：

赵秀伶, 高洁, 马唯, 田丹, 姜珊. 孕前超重/肥胖的妊娠期糖尿病孕妇血糖管理：基于静息能量消耗计算每日总能量消耗[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(04): 451-458.

Xiuling Zhao, Jie Gao, Wei Ma, Dan Tian, Shan Jiang. Blood glucose management of overweight/obese pregnant women with gestational diabetes mellitus: calculation of total energy expenditure based on resting energy expenditure[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(04): 451-458.

目的

探讨基于静息能量消耗(REE)计算每日总能量消耗(TEE)，对孕前超重/肥胖的妊娠期糖尿病(GDM)孕妇血糖管理意义。

方法

选择2018年6月至2019年6月，于首都医科大学附属北京潞河医院产科"糖尿病一日门诊"就诊时，被诊断为孕前超重/肥胖的67例GDM孕妇为研究对象。按照其首次就诊时间的奇、偶周，将其分为研究组(n＝34，首次就诊时间为奇数周者)和对照组(n＝33，首次就诊时间为偶数周者)。采用成组t检验对2组孕妇年龄、孕次、孕期体重增加值、新生儿出生体重、空腹血糖、餐后2 h血糖等进行统计学分析。采用Mann-Whitney U检验对2组孕妇分娩孕龄、产次等进行统计学分析。采用χ2检验、Fisher确切概率法、连续性校正χ2检验对2组孕妇尿酮体阳性率、巨大儿发生率等进行统计学分析。本研究经首都医科大学附属北京潞河医院医学伦理委员审核批准(审批文号：2018-LHKY-027-02)，并与所有受试者签署知情同意书。

结果

①2组GDM孕妇年龄、孕次、产次、分娩孕龄及孕前人体质量指数(BMI)构成比比较，差异均无统计学意义(P>0.05)。②研究组孕妇TEE为(1 532.6±301.9)kcal/d，显著低于对照组的(1 824.1±313.2) kcal/d，并且差异有统计学意义(t＝3.311、P＝0.002)；2组孕妇血糖达标情况构成比比较，差异亦有统计学意义(P＝0.040)。③研究组孕妇孕期体重增加值、糖化血红蛋白(HbA1c)水平和新生儿出生体重分别为(13.4±6.2)kg、(5.6±0.3)%和(3 287.5±577.1)g，明显低于对照组的(18.2±4.8)kg、(6.2±0.2)%和(3 632.8±490.6)g，并且差异均有统计学意义(t＝2.235、P＝0.031，t＝2.882、P＝0.047，t＝2.121、P＝0.039)。

结论

基于REE估算的TEE，较通用系数法估算的TEE，更接近于孕前超重/肥胖GDM孕妇的实际能量需求。因此，基于REE估算的TEE更有利于对孕前超重/肥胖的GDM进行孕期血糖管理。

关键词: 能量摄取, 能量消耗, 总能量消耗, 静息能量消耗, 超重/肥胖育龄女性，孕前, 糖尿病，妊娠, 血糖, 孕妇
Objective

To explore effect of calculating everyday total energy expenditure (TEE) based on resting energy expenditure (REE) on blood glucose management of pregnant women with gestational diabetes mellitus (GDM) who were overweight/obese before pregnancy.

Results

From June 2018 to June 2019, 67 GDM pregnant women who were overweight/obese before pregnancy were selected into this study. According to the odd and even weeks of outpatient treatment, they were divided into study group (n=34, pregnant women who first outpatient treatment in odd weeks of a calendar) and control group (n =33, pregnant women who first outpatient treatment in even weeks of a calendar). Among age, gravidity, weight gain during pregnancy, neonatal birth weight, fasting blood glucose and postprandial 2 h blood glucose between two groups were statistically analyzed by independent-samples t test. Mann-Whitney U test was used to analyze gestational age and parity. Chi-square test, continuity correction of chi-square test or Fisher′s exact test were used to statistically analyze positive rate of urine ketone and incidence of macrosomia. The procedures followed in this study was in accordance with the ethical standards established by the Human Beings Test Committee of Beijing Luhe Hospital Affiliated Capital Medical University, and was approved by the committee (Approval No. 2018-LHKY-027-02). Informed consent was obtained from each participate.

Results

① There were no significant differences in age, gravidity, parity, gestational age of delivery and constituent ratio of BMI before pregnancy between two groups (P>0.05). ② TEE of pregnant women in study group [(1 532.6±301.9) kcal/d] was significantly lower than that in control group [(1 824.1±313.2) kcal/d], and the difference was statistically significant (t=3.311, P=0.002). There was also a significant difference between two groups in composition ratio of blood sugar reaching the standard (P=0.040). ③The weight gain during pregnancy, glycosylated hemoglobin, HbcAl level and neonatal birth weight in study group were (13.4±6.2) kg, (5.6±0.3)% and (3 287.5±577.1) g, which were significantly lower than those in control group (18.2±4.8) kg, (6.2±0.2)% and (3 632.8±490.6) g. There were significant differences between two groups (t=2.235, P=0.031; t=2.882, P=0.047; t=2.121, P=0.039).

Conclusions

TEE estimated based on REE is more closer to actual energy demand of GDM pregnant women who are overweight/obese before pregnancy than that of TEE estimated by general coefficient method. TEE estimated based on REE is much more beneficial to management of blood sugar of GDM pregnant women who are overweight/obese before pregnancy.

Key words: Energy intake, Energy metabolism, Total energy expenditure, Resting energy expenditure, Preconception overweight/obese reproductive woman, Diabetes, gestational, Blood glucose, Pregnant women
表1 GDM孕妇PAL系数评估方法
活动分级 PAL系数
活动/运动量非常低，但并非卧床休息 1.20
活动/运动量非常低(很少/没有运动、仅办公室伏案工作) 1.20
轻度活动/运动(每周进行1～3 d轻度活动/运动) 1.38
中度活动(每周进行3～5 d中度活动/运动) 1.55
重度活动(每周进行6～7 d重度活动/运动) 1.73
超重度活动(极重活动/运动) 1.90
表2 2组GDM孕妇的一般临床资料比较
组别 例数 年龄(岁，±s) 孕次(次，±s) 产次[次，M(P25～P75)] 分娩孕龄[周，M(P25～P75)] 孕前BMI[例数(%)]
25～29.9 kg/m2 ≥30 kg/m2
研究组 34 32.8±4.6 2.2±1.3 2.0(1.0～3.0) 38.6(38.1～39.6) 22(64.7) 12(35.3)
对照组 33 34.5±4.9 2.7±1.3 3.0(2.0～3.0) 39.0(38.6～40.3) 25(75.8) 8(24.2)
检验值 ? t＝1.347 t＝1.284 Z＝1.417 Z＝1.621 χ2＝0.977
P值 ? 0.184 0.205 0.159 0.107 0.425
表3 2组GDM孕妇"糖尿病一日门诊"的相关检查结果比较
组别 例数 TEE(kcal/d，±s) 血糖情况[例数(%)] 空腹血糖(mmol/L，±s) 餐后2 h血糖(mmol/L，±s)
不达标 部分达标 达标
研究组 34 1 532.6±301.9 0(0) 3(8.8) 31(91.2) 4.5±0.5 5.8±0.9
对照组 33 1 824.1±313.2 1(3.0) 9(27.3) 23(69.7) 4.7±0.4 6.3±1.0
检验值 ? t＝3.311 — t＝1.229 t＝1.701
P值 ? 0.002 0.040 0.225 0.095
表4 2组GDM孕妇的妊娠结局比较
组别 例数 孕期体重增加值(kg，±s) 尿酮体结果呈阳性[例数(%)] HbAlc(%，±s) 新生儿出生体重(g，±s) 巨大儿[例数(%)]
研究组 34 13.4±6.2 3(8.8) 5.6±0.3 3 287.5±577.1 3(8.8)
对照组 33 18.2±4.8 2(6.1) 6.2±0.2 3 632.8±490.6 7(21.2)
检验值 ? t＝2.235 — t＝2.882 t＝2.121 χ2＝1.166 a
P值 ? 0.031 1.000 0.047 0.039 0.280
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