School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia.
Department of Nutrition & Dietetics, The Royal Women's Hospital, Parkville, VIC, Australia.
J Hum Nutr Diet. 2019 Dec;32(6):728-736. doi: 10.1111/jhn.12682. Epub 2019 Jul 19.
In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes.
The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM-care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes.
Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22-0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23-4.41; P < 0.001) and had a greater number of dietetic consultations (β-coefficient = 0.28, 95% CI = 0.17-0.39; P < 0.001) compared to women managed through diet.
Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further.
2010 年，妊娠糖尿病（GDM）的诊断阈值被修订，这导致 GDM 的诊断增加，同时也给 GDM 管理服务带来了压力，特别是对饮食治疗的工作量产生了影响。本研究检查了 GDM 妇女的饮食干预与母婴健康结果之间的关系。
本研究涉及 2015 年 7 月至 2017 年 5 月在澳大利亚墨尔本皇家妇女医院（RWH）分娩的 1233 名成年 GDM 妇女。从患者病历中检索了评估 GDM 护理（治疗类型、诊断时间和护理模式、母婴健康结果和门诊饮食咨询）的回顾性数据。使用未调整和调整后的线性和逻辑回归来评估 GDM 护理饮食干预以及 GDM 护理和饮食干预与母婴健康结果的关联。
与未接受饮食干预的女性相比，接受饮食干预的女性婴儿入住新生儿重症监护病房或特别护理婴儿室的可能性较低[调整后的优势比（OR）=0.41，95%置信区间（CI）=0.22-0.75；P=0.004）。需要药物治疗的女性更有可能出现母体并发症（调整后的 OR=3.13，95%CI=2.23-4.41；P<0.001），并且饮食咨询次数更多（β系数=0.28，95%CI=0.17-0.39；P<0.001）与通过饮食治疗的女性相比。
饮食干预在优化 GDM 妇女的母婴健康结果方面发挥着关键作用。进一步探讨 GDM 诊断女性饮食干预的影响对于了解这些女性的最佳护理提供方式至关重要。应进一步调查饮食干预中包含的咨询类型和数量。
