Effect Of Nutritional Intervention And Metabolic Risk Factors During Pregnancy On Gestational Outcome

Objective: To investigate the effect of nutritional intervention and metabolic riskfactors during pregnancy on gestational outcome. Methods: Subjects were pregnantwomen who were accepted routine prenatal examination and delivery in the InternationalPeace Maternity and Children’s Health Hospital of China Welfare Institute in Shanghaifrom May2010to April2012. We conducted a retrospective cohort study to evaluate theeffect of nutritional intervention on gestational diabetes mellitus (GDM) and used theInternational Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in2010to diagnose GDM. Stepwise multiple logistic regressions analysis was used toevaluate the effect of risk factors during pregnancy on macrosomia. Results:①Statisticalanalyses were performed among10421subjects who met the inclusion criteria. The meanof gestational week at the first prenatal visit was20.8(19.4~22.4) week. The mean offasting plasma glucose (FPG), triglyceride (TG) and total cholesterol(CHOL) was (4.34±0.38)mmol/L,(1.34±0.56)mmol/L and (4.7±0.8) mmol/L, respectively. The mean ofSBP and DBP was (111.3±11.5) and (67.9±13.3) mmHg. The prevalence of GDM was15.8%. The mean of birth weight was (3355.4±426.0) g and the prevalence ofmacrosomia was6.2%.②There were812pregnant women who were diagnosed to haveGDM,570pregnant women were accepted nutritional intervention and242pregnantwomen as control group. No significant between-group differences were observed forvariable in the baseline testing, including age, education, weight in20thgestational weekand biochemical testing at first prenatal visit. Compared with the control group the meanof birth weight and the prevalence of macrosomia and GDM in intervention group werelower, it was (3347.4±19.6g vs.3450.3±35.6g, P=0.007),(6.7%vs.15.6%, P=0.001) and(26.27%vs.47.86%, P<0.001), respectively. With the increase of times in nutritionintervention, the mean of gestational weight gain in middle and late pregnancy and birthweight were declining(r=-0.126, p=0.003; r=-0.112, p=0.002), and the prevalence ofmacrosomia was also decreased.③Stepwise multiple logistic regressions showed weightin20thgestational week(OR=1.08,95%CI:1.07~1.09), gestational weight gain in middle and late pregnancy(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 macrosomia. Conclusion: Nutritional interventionduring pregnancy can reduce the weight gain in middle and late pregnancy, birth weightand the prevalence of macrosomia and GDM, and it were decreased with the increase oftimes in nutrition intervention. Weight in20thgestational week, gestational weight gain inmiddle and late pregnancy and GDM were the risk factors for macrosomia. The findingscall for the urgent need for early and throughout management of risks and nutritionalintervention among pregnant women during pregnancy in order to control the adversegestation outcomes.