Artal Raul, Catanzaro Rosemary B, Gavard Jeffrey A, Mostello Dorothea J, Friganza Joann C
Saint Louis University School of Medicine, Department of Obstetrics, Gynecology, and Women's Health, St. Louis, MO 63117, USA.
Appl Physiol Nutr Metab. 2007 Jun;32(3):596-601. doi: 10.1139/H07-024.
This study assessed whether a weight-gain restriction regimen, with or without exercise, would impact glycemic control, pregnancy outcome, and total pregnancy weight gain in obese subjects with gestational diabetes mellitus (GDM). A total of 96 subjects with GDM met the inclusion criteria and were sequentially recruited, with 39 subjects self-enrolled in the exercise and diet (ED) group, and the remaining 57 subjects self-enrolled in the diet (D) group owing to contraindications or a lack of personal preference to exercise. All patients were provided a eucaloric or hypocaloric consistent carbohydrate meal plan and instructed in the self-monitoring of blood glucose. In addition, all ED subjects were prescribed an exercise routine equivalent to a 60% symptom-limited VO2 max. Subjects were followed at weekly or biweekly office visits. Results showed maternal weight and body mass index (35.2+/-7.2 (ED) vs. 33.5+/-9.2 (D)) at study entry as well as number of weeks into the study (7.7+/-5.7 (ED) vs. 9.4+/-4.7 (D)) were similar in both the ED and D groups. Weight gain per week was significantly lower in the ED group than in the D group (0.1+/-0.4 kg vs. 0.3+/-0.4 kg; p<0.05). Subjects (either ED or D) who gained weight had a higher percentage of macrosomic infants than those subjects who lost weight or had no weight change during pregnancy. Other pregnancy and fetal outcomes such as complications, gestational age at delivery, and rate of cesarean delivery were similar in both groups. Conclusions of this study were that caloric restriction and exercise result in limited weight gain in obese subjects with GDM, less macrosomic neonates, and no adverse pregnancy outcomes. Pregnancy is an ideal time for behaviour modification, and this intervention may also help promote long-term healthy lifestyle changes.
本研究评估了体重增加限制方案（无论有无运动）是否会影响患有妊娠期糖尿病（GDM）的肥胖受试者的血糖控制、妊娠结局和孕期总体重增加。共有96名患有GDM的受试者符合纳入标准并被依次招募，其中39名受试者自行报名参加运动与饮食（ED）组，其余57名受试者因禁忌症或缺乏运动个人偏好而自行报名参加饮食（D）组。所有患者均获得等热量或低热量的碳水化合物一致饮食计划，并接受血糖自我监测指导。此外，所有ED组受试者都被规定了相当于60%症状限制最大摄氧量的运动常规。受试者每周或每两周到诊所随访一次。结果显示，ED组和D组在研究开始时的孕妇体重和体重指数（分别为35.2±7.2（ED）和33.5±9.2（D））以及进入研究的周数（分别为7.7±5.7（ED）和9.4±4.7（D））相似。ED组每周的体重增加显著低于D组（0.1±0.4千克对0.3±0.4千克；p<0.05）。孕期体重增加的受试者（无论是ED组还是D组）所产巨大儿的比例高于孕期体重减轻或无体重变化的受试者。两组的其他妊娠和胎儿结局，如并发症、分娩时的孕周和剖宫产率相似。本研究的结论是，热量限制和运动导致患有GDM的肥胖受试者体重增加受限、巨大儿减少且无不良妊娠结局。孕期是行为改变的理想时机，这种干预也可能有助于促进长期健康的生活方式改变。
