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

doi:10.3877/cma.j.issn.1673-5250.2020.04.012

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(%)]
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)]	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(%)]
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)]	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)
组别	例数	TEE(kcal/d，±s)	不达标	部分达标	达标	空腹血糖(mmol/L，±s)	餐后2 h血糖(mmol/L，±s)
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)
组别	例数	TEE(kcal/d，±s)	不达标	部分达标	达标	空腹血糖(mmol/L，±s)	餐后2 h血糖(mmol/L，±s)
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

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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