| Objective:To construct a systematic and comprehensive weight management program for Gestational diabetes(GDM)patients.The GDM weight management program was applied to GDM patients to test the impact of the program on the patient’s weight,blood glucose and adverse pregnancy outcomes.Methods:1.Construction of weight management scheme for patients with gestational diabetes:firstly,systematic search was carried out on the research of GDM weight management at home and abroad,and the quality of the literature was evaluated.According to the results of literature review and discussion by the research team,the first draft of evidence-based weight management scheme for gestational women was formed;The Delphi method was used to conduct two rounds of expert correspondence on the initially constructed scheme for modification and improvement.SPSS 25.0 was used to calculate the enthusiasm coefficient,authority coefficient and concentration degree of experts’ opinions,analyze the reliability of the inquiry results,and modify the weight management of GDM patients in combination with experts’ opinions to form the final intervention plan.2.Application of weight management scheme for pregnant women with diabetes:126 pregnant women with GDM who were hospitalized in Wuxi Maternal and Child Health Hospital from November 2021 to January 2022,filed in our hospital and planned to give birth in our hospital were selected as the research objects.Randomized controlled trial was used to divide them into an intervention group and a control group with 63 cases each.The control group was given routine care,and the intervention group implemented the "weight management of pregnant diabetes patients" program based on the control group.The qualification rate of the total weight gain range and the rate of weight gain in the second and third trimesters of pregnancy,the score of the weight management knowledge,attitude and behavior questionnaire of pregnant women,the level of fasting blood glucose(FBG),the level of glycosylated hemoglobin(HbA1c),the survey score of diabetes self-management activity questionnaire(SDSCA),and the adverse pregnancy outcomes of the two groups of patients were compared.results:1.Construction of weight management scheme for diabetes patients during pregnancy:21 articles were finally included after literature screening and evaluation,and the first draft of GDM weight management was formulated based on the literature results and team discussion.Then the scheme is constructed by Delphi expert consultation method.The recovery rates of the two rounds of expert correspondence questionnaires were 100%respectively,and the authority coefficients of the experts were 0.897 respectively.The experts’ judgment was mainly based on theoretical analysis and clinical experience.The average values of the two rounds of experts assigned to the importance of the inquiry items are more than 3.5,and the coefficient of variation is less than 0.25,indicating that the experts are highly concentrated.The W values of the two rounds of expert coordination are 0.39 and 0.45 respectively,indicating that the experts have a high degree of consistency and acceptability.Finally,the weight management plan for GDM patients was determined based on two rounds of expert opinions.2.Application of weight management program for pregnant women with diabetes:There was no significant difference between the two groups in terms of baseline data and the distribution of patients with different BMI before pregnancy(P>0.05).(1)Weight control level:Based on the recommended weight gain value and growth rate during pregnancy by IOM in 2009,after intervention,the qualified rate of total weight gain in the intervention group was higher than that in the control group,and the qualified rate of weight gain rate in the middle and late stages was also significantly higher than that in the control group,with significant statistical significance(P<0.05).(2)Influencing factors of weight control:Two groups of patients were divided into qualified and unqualified groups based on the recommended weight gain value for pregnancy according to IOM 2009.The results of univariate analysis showed that the education level,occupation,family monthly income,residence,delivery experience The family history of diabetes and whether the weight management construction scheme was adopted or not were statistically significant(P<0.05).The multifactor results showed that education level(OR=1.380,95%CI:1.117-1.706),delivery experience(OR=1.440,95%CI:1.103-1.880)and weight management construction scheme(OR=2.349,95%CI:1.2271.934)were independent factors affecting the weight management outcome of GDM patients.(3)Self management level of weight:There was no significant difference in weight management knowledge,weight management attitude and weight management behavior between the two groups before intervention(P>0.05);The scores of weight management knowledge,weight management attitude and weight management behavior between the two groups at the 4th and 8th week of intervention and after delivery were significantly different(P<0.05).Repeated measurement analysis of variance was used before,at the 4th,8th and after delivery.The scores of weight management knowledge were compared between groups(F=5943.332,P<0.001)and time effect analysis(F=132.158,P<0.001);Comparison of weight management attitude scores between groups(F=30876.578,P<0.001),time effect analysis(F=86.281,P<0.001);Comparison of weight management behavior scores between groups(F=24909.472,P<0.001),time effect analysis(F=251.069,P<0.001).Therefore,there were significant differences in weight management knowledge score,attitude score and behavior score between the two groups(P;Simple effect analysis showed that there were significant differences in weight management knowledge,attitude and behavior scores between the two groups at the 4th and 8th weeks and after delivery(P<0.05).(4)After intervention,the levels of FBG and HbA1c in the two groups were lower than those before intervention;The levels of FBG and HbA1c in the intervention group were also lower than those in the control group,and the differences were statistically significant(P<0.05).(5)Self management level of blood glucose:There was no difference in SDSCA scores between the two groups before intervention(P>0.05);There was statistically significant difference in SDSCA scores between the two groups at the 4th and 8th week of intervention and after delivery(P<0.05).For the analysis of repeated measures of variance before,at the 4th,8th and after delivery,the differences of factors and time factors between the two groups were statistically significant(P.Simple effect analysis,the comparison of SDSCA scores between the two groups showed that there was statistically significant difference in the 4th,8th week and after delivery(P<0.05).(6)After intervention,the total incidence of adverse pregnancy outcomes in the control group was 27.59%,and the total incidence of adverse pregnancy outcomes in the intervention group was 6.67%.The total incidence of adverse pregnancy outcomes in the intervention group was lower than that in the control group,with statistical significance(P<0.05).conclusion:1.In this study,the construction process of the comprehensive weight management program for GDM patients constructed by the Delphi method is scientific and reliable,and the program is highly practical and easy to promote.2.The GDM weight management program constructed in this study can effectively control the reasonable weight growth of GDM patients and maintain normal blood glucose level;At the same time,it can effectively improve the patient’s self-management of weight and blood glucose,thus effectively reducing the adverse pregnancy outcome of GDM patients. |
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