Kgosidialwa Oratile, Egan Aoife M, Carmody Louise, Kirwan Breda, Gunning Patricia, Dunne Fidelma P
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
J Clin Endocrinol Metab. 2015 Dec;100(12):4629-36. doi: 10.1210/jc.2015-3259. Epub 2015 Oct 23.
Prevalence of gestational diabetes mellitus (GDM) and obesity continue to increase.
This study aimed to ascertain whether diet and exercise is a successful intervention for women with GDM and whether a subset of these women have comparable outcomes to those with normal glucose tolerance (NGT).
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study of five antenatal centers along the Irish Atlantic seaboard of 567 women diagnosed with GDM and 2499 women with NGT during pregnancy.
Diet and exercise therapy on diagnosis of GDM were prescribed and multiple maternal and neonatal outcomes were examined.
Infants of women with GDM were more likely to be hypoglycemic (adjusted odds ratio [aOR], 7.25; 95% confidence interval [CI], 2.94-17.9) at birth. They were more likely to be admitted to the neonatal intensive care unit (aOR, 2.16; 95% CI, 1.60-2.91). Macrosomia and large-for-gestational-age rates were lower in the GDM group (aOR, 0.48; 95% CI, 0.37-0.64 and aOR, 0.61; 95% CI, 0.46-0.82, respectively). There was no increase in small for gestational age among offspring of women with GDM (aOR, 0.81; 95% CI, 0.49-1.34). Women with diet-treated GDM and body mass index (BMI) < 25 kg/m(2) had similar outcomes to those with NGT of the same BMI group. Obesity increased risk for poor pregnancy outcomes regardless of diabetes status.
Medical nutritional therapy and exercise for women with GDM may be successful in lowering rates of large for gestational age and macrosomia without increasing small-for-gestational-age rates. Women with GDM and a BMI less than 25 kg/m(2) had outcomes similar to those with NGT suggesting that these women could potentially be treated in a less resource intensive setting.
妊娠期糖尿病（GDM）和肥胖症的患病率持续上升。
本研究旨在确定饮食和运动对患有GDM的女性是否是一种成功的干预措施，以及这些女性中的一部分人与糖耐量正常（NGT）的女性是否有相似的结局。
设计、地点和参与者：这是一项对爱尔兰大西洋沿岸五个产前中心的回顾性队列研究，研究对象为567名在孕期被诊断为GDM的女性和2499名NGT女性。
对诊断为GDM的患者进行饮食和运动治疗，并检查多种孕产妇和新生儿结局。
GDM女性的婴儿出生时更易发生低血糖（校正比值比[aOR]，7.25；95%置信区间[CI]，2.94 - 17.9）。他们更有可能入住新生儿重症监护病房（aOR，2.16；95% CI，1.60 - 2.91）。GDM组巨大儿和大于胎龄儿的发生率较低（aOR分别为0.48；95% CI，0.37 - 0.64和aOR，0.61；95% CI，0.46 - 0.82）。GDM女性的后代中小于胎龄儿的发生率没有增加（aOR，0.81；95% CI，0.49 - 1.34）。接受饮食治疗且体重指数（BMI）< 25 kg/m²的GDM女性与相同BMI组的NGT女性有相似的结局。无论糖尿病状态如何，肥胖都会增加不良妊娠结局的风险。
对GDM女性进行医学营养治疗和运动可能成功降低大于胎龄儿和巨大儿的发生率，而不会增加小于胎龄儿的发生率。BMI小于25 kg/m²的GDM女性与NGT女性有相似的结局，这表明这些女性可能可以在资源需求较少的环境中接受治疗。
