The Public Health Research Branch-Research Direction, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico (Ms Perichart-Perera, Ms Balas-Nakash, Ms Rodriguez-Cano)
The Endocrinology Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico (Dr Parra-Covarrubias, Dr Ramirez-Torres, Dr Ortega-González)
Diabetes Educ. 2009 Nov-Dec;35(6):1004-13. doi: 10.1177/0145721709343125. Epub 2009 Aug 20.
Diabetes in pregnancy is a major public health problem in Mexico. Nutrition therapy is an important component of treatment. Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes. Its effect on different types of diabetes mellitus has not been studied.
The authors assessed the effect of a medical nutrition therapy (MNT) program on perinatal complications in Mexico City.
Quasi-experimental design with a historical control. Women were assigned to a MNT program (n = 88) and were followed up with every 2 weeks until delivery (2004-2007). The control group (n = 86) was selected from medical charts (2001-2003) and the same inclusion criteria were used. In each group, 55% of women had type 2 diabetes mellitus and 45% had gestational diabetes. The MNT program included a moderate intake of carbohydrate (40%-45% of total energy) and reduction in energy intake, capillary glucose self-monitoring, and education. The control group received usual hospital routine care. Statistical analysis included descriptive statistics, chi-square, and multivariate logistic regression (OR, 95% CI) as indicated.
Women in the MNT program had a lower risk of preeclampsia, fewer maternal hospitalization, and neonatal deaths in both types of diabetes. Low birth weight was less frequent only in women with gestational diabetes receiving MNT, while neonatal intensive care unit admissions were lower only in women with type 2 diabetes.
An intensive MNT program, including counseling, education, and capillary glucose self-monitoring, has a positive effect over preeclampsia, maternal hospitalization, and neonatal death in women with diabetes in pregnancy. MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy.
妊娠糖尿病是墨西哥一个主要的公共卫生问题。营养治疗是治疗的一个重要组成部分。但墨西哥的妊娠糖尿病妇女并未接受强化营养干预，其对不同类型糖尿病的影响也尚未得到研究。
作者评估了医学营养疗法（MNT）方案对墨西哥城围产期并发症的影响。
采用历史对照的准实验设计。将患者分配到 MNT 方案组（n = 88），并每 2 周随访一次直至分娩（2004-2007 年）。对照组（n = 86）从病历中选择（2001-2003 年），并使用相同的纳入标准。每组中，55%的女性患有 2 型糖尿病，45%患有妊娠期糖尿病。MNT 方案包括摄入适量碳水化合物（总能量的 40%-45%）和减少能量摄入、毛细血管血糖自我监测以及教育。对照组接受常规医院常规护理。统计分析包括描述性统计、卡方检验和多元逻辑回归（OR，95%CI）。
MNT 方案组的子痫前期、孕产妇住院和两种类型糖尿病的新生儿死亡风险较低。仅接受 MNT 的妊娠期糖尿病女性的低出生体重发生率较低，而仅接受 MNT 的 2 型糖尿病女性的新生儿重症监护病房入住率较低。
包括咨询、教育和毛细血管血糖自我监测在内的强化 MNT 方案对妊娠糖尿病女性的子痫前期、孕产妇住院和新生儿死亡有积极影响。MNT 指南应在治疗妊娠糖尿病的墨西哥医疗机构中实施。
