Cao Hongxia, Wu Yingchun
Department of Obstetrics, Nantong University Affiliated Maternal and Child Health Hospital, Nantong, Jiangsu, China.
Medicine (Baltimore). 2025 Sep 5;104(36):e44293. doi: 10.1097/MD.0000000000044293.
This study aimed to evaluate the association between a dietary education approach grounded in the transtheoretical model and cognitive load theory and glycemic control and pregnancy-related outcomes in patients diagnosed with gestational diabetes mellitus (GDM). A retrospective analysis was performed using clinical data from 126 pregnant women with GDM who received care at our hospital between September 2021 and September 2023. Participants were grouped based on the type of nursing intervention received: a control group that underwent standard care and an observation group that received an additional cognitive load-informed dietary education program based on transtheoretical model. Baseline characteristics, including age, education, delivery method, GDM history, gestational age, body mass index, residential area, family history of diabetes, and monthly household income, were collected. Propensity score matching was applied to balance the baseline data and reduce selection bias, resulting in 42 matched cases per group. Glycemic indicators, urinary ketones, self-care ability, self-efficacy, and the occurrence of negative pregnancy outcomes were assessed and compared post-intervention. No significant differences were noted between the 2 groups before the intervention in fasting plasma glucose, 2-hour postprandial glucose, urinary ketones, self-care capabilities, or self-efficacy (P > .05). After receiving the dietary education, the observation group was associated with significantly lower levels of fasting plasma glucose, 2-hour postprandial glucose, and urinary ketones, alongside higher scores in self-management and self-efficacy compared to the control group (P < .05). Moreover, the rate of adverse pregnancy outcomes was markedly reduced in the observation group (11.90%) compared to the control group (30.95%) (P < .05). A dietary education strategy integrating cognitive load principles and the transtheoretical model was associated with improved health literacy, self-management, glycemic control, and maternal and neonatal outcomes among women with GDM.
本研究旨在评估基于跨理论模型和认知负荷理论的饮食教育方法与妊娠期糖尿病（GDM）患者血糖控制及妊娠相关结局之间的关联。采用回顾性分析方法，使用了2021年9月至2023年9月期间在我院接受治疗的126例GDM孕妇的临床数据。根据接受的护理干预类型对参与者进行分组：接受标准护理的对照组和接受基于跨理论模型的额外认知负荷知情饮食教育计划的观察组。收集了基线特征，包括年龄、教育程度、分娩方式、GDM病史、孕周、体重指数、居住地区、糖尿病家族史和家庭月收入。应用倾向得分匹配来平衡基线数据并减少选择偏倚，每组产生42例匹配病例。干预后评估并比较血糖指标、尿酮、自我护理能力、自我效能以及不良妊娠结局的发生情况。干预前，两组在空腹血糖、餐后2小时血糖、尿酮、自我护理能力或自我效能方面无显著差异（P>0.05）。接受饮食教育后，与对照组相比，观察组的空腹血糖、餐后2小时血糖和尿酮水平显著降低，自我管理和自我效能得分更高（P<0.05）。此外，观察组的不良妊娠结局发生率（11.90%）明显低于对照组（30.95%）（P<0.05）。将认知负荷原则与跨理论模型相结合的饮食教育策略与GDM女性的健康素养、自我管理、血糖控制以及母婴结局改善相关。
