Abstract:

Objective To investigate the effect of diet consultation and metabolic risk factors during pregnancy on gestational outcomes. Methods Subjects were consecutive pregnant women who accepted routine prenatal examination and delivery in the International Peace Maternity and Children's Health Hospital of China Welfare Institute in Shanghai from May 2010 to April 2012. The retrospective cohort was analyzed to evaluate the effect of diet consultation intervention on gestational complications among women with gestational diabetes mellitus (GDM). Stepwise logistic regressions analysis was used to evaluate the effect of metabolic risk factors on birth weight and macrosomia, respectively. Results ①Analyses were performed among 10 421 subjects. The mean of gestational week at the first prenatal visit was 20.8 (19.4-22.4) weeks. The mean of fasting blood glucose (FBS), triglyceride (TG) and total cholesterol(CHOL) was (4.4±0.4), (1.4±0.6) and (4.7±0.8) mmol·L-1, respectively. The mean of SBP and DBP was (111.3±11.5) and (67.9±13.3) mmHg. The prevalence of GDM was 15.8%. The mean of birth weight was (3 355.4±426.0) g and the prevalence of macrosomia was 6.2%. ②Among 812 pregnant women with diagnosed GDM, 570 accepted diet consultation at least once and the rest of 242 women never went to the diet consultation. No significant between-group differences were observed in variables in the baseline characteristics, including age, education, weight in 20th gestational week and biochemical tests at first prenatal visit. Compared with the control group the mean of birth weight, the prevalence of macrosomia and gestational hypertension in intervention group were reduced, (3 347.4±19.6 g vs 3 450.3±35.6 g, P=0.007; 6.7% vs 15.6%, P=0.001; 26.3% vs 47.9%, P<0.001), respectively. With the increase of times of visiting nutrition intervention, the mean of maternal gestational weight gain and birth weight declined (r=-0.126, P=0.003; r=-0.112, P=0.002), and the prevalence of macrosomia was also decreased. ③Stepwise multiple logistic regressions showed the body weight at 20th gestational week(OR=1.08, 95%CI: 1.07-1.09), gestational weight gain (OR=1.10, 95%CI: 1.07-1.12) and GDM(OR=1.63, 95%CI: 1.22-2.19) significantly increased the risk of the neonatal macrosomia. Conclusion The findings show that the elevated metabolic risk factors in pregnancy increase the risk of adverse gestional outcomes, diet consultation help improve the neonatal outcomes. The findings call for the urgent need for early and throughout management of metabolic risk factors and diet consultation among pregnant women during pregnancy to achieve better control the adverse gestation outcomes.

Key words: Birth weight, gestational diabetes mellitus, gestational weight gain, Macrosomia, nutritional intervention