Observation on the effect of group health care model during pregnancy in childbirth outcome of pregnant women with gestational diabetes

doi:10.3761/j.issn.0254-1769.2021.09.004

Abstract

Abstract:

Objective To explore the effect of group pregnancy health care model on the delivery outcome of pregnant women with gestational diabetes. Methods The convenience sampling method was adopted to select pregnant women who had established a card and had regular obstetric check-ups in a tertiary A-level maternity and child hospital in Taiyuan from May to December 2018 as the research subjects. The random number table method was used to divide them into an experimental group and a control group,with 92 cases in each group. The experimental group adopted the group pregnancy health care model,and the control group received the conventional pregnancy health care model to compare the differences in delivery outcomes and psychological status between 2 groups after intervention. Results After the intervention,the fasting and 2 h post-meal blood glucose levels of 2 groups were lower than those before the intervention（t=-4.286、P=0.021）,and the blood glucose level of the experimental group decreased significantly（t=-3.512、P=0.039）;the natural delivery rate of the experimental group（χ ²=7.276）,the perineum injury rate（χ ²=7.698） and the incidence of macrosomia（χ ²=5.821） were lower than those of the control group,and the difference was statistically significant（all P<0.05）. The anxiety scale score in the experimental group was（37.63±5.62） points,and（50.67±8.69） in the control group. The difference between 2 groups was statistically significant（t=5.374,P=0.039）;the depression scale score in the experimental group was（41.16±3.12）points and （54.13±4.22）in the control group,and the difference between 2 groups was statistically significant（t=7.125,P=0.044）. Conclusion Compared with the traditional model,the group pregnancy health care model can effectively increase the natural delivery rate of pregnant women with gestational diabetes,improve the delivery outcomes,and reduce the occurrence of negative emotions.

Key words: Group Health Care Model During Pregnancy, Gestational Diabetes Mellitus, Prenatal Care, Childbirth Outcome, Anxiety, Depression, Nursing Care

摘要：

目的探讨群组孕期保健模式对妊娠期糖尿病孕妇分娩结局的影响。方法采用便利抽样法,选取2018年5月—12月在太原市某三级甲等妇幼专科医院建卡并规律产检的孕妇作为研究对象,采用随机数字表法分为试验组和对照组,每组各92例。试验组采用群组孕期保健模式,对照组采用常规孕期保健模式,比较两组干预后血糖水平、分娩结局、心理状态等方面的差异。结果干预后试验组空腹血糖（t=-4.286、P=0.021）及餐后2 h血糖（t=-3.512、P=0.039）均低于对照组,且试验组血糖下降水平更明显;试验组自然分娩率（ χ ²=7.276）、会阴损伤率（ χ ²=7.698）、巨大儿发生率（ χ ²=5.821）均低于对照组,差异具有统计学意义（均P<0.05）。干预后试验组焦虑自评量表得分为（37.63±5.62）分、对照组为（50.67±8.69）分,两组比较,差异具有统计学意义（t=5.374,P=0.039）;干预后试验组抑郁自评量表得分为（41.16±3.12）分、对照组为（54.13±4.22）分,两组比较,差异具有统计学意义（t=7.125,P=0.044）。结论群组孕期保健模式可有效提高妊娠期糖尿病孕妇的自然分娩率,改善分娩结局,减少负性情绪的发生。

关键词: 群组孕期保健模式, 妊娠期糖尿病, 产前保健, 分娩结局, 焦虑, 抑郁, 护理

YAN Meiqin, WANG Jiao, LIU Yina, ZHANG Huijun, REN Yonglian. Observation on the effect of group health care model during pregnancy in childbirth outcome of pregnant women with gestational diabetes[J]. Chinese Journal of Nursing, 2021, 56(9): 1305-1311.

燕美琴, 王娇, 刘亦娜, 张慧君, 任永莲. 群组孕期保健模式在妊娠期糖尿病孕妇分娩结局中的效果研究[J]. 中华护理杂志, 2021, 56(9): 1305-1311.

Figures/Tables 5

Table 1 Group pregnancy health care program

Table 2 General data comparison of the two groups

Table 3 Comparison of changes in blood glucose levels between the two groups before and after intervention（mmol/L,$\bar{x}$±s）

Table 4 Comparison of two-component delivery outcomes[case（percentage,%）]

Table 5 Comparison of mental status between the two groups before and after intervention （score,$\bar{x}$±s）

References 25

[1]	杨慧霞, 徐先明, 王子莲, 等. 妊娠合并糖尿病诊治指南(2014)[J]. 糖尿病天地(临床), 2014,8(11):489-498.
	Yang HX, Xu XM, Wang ZL, et al. Guidelines for diagnosis and treatment of diabetes in pregnancy(2014 edition)[J]. Clin J Diabetes World, 2014,8(11):489-498.
[2]	Vounzoulaki E, Khunti K, Abner SC, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes:systematic review and meta-analysis[J]. BMJ, 2020,369:1361.
[3]	Franzago M, Fraticelli F, Stuppia L, et al. Nutrigenetics,epigenetics and gestational diabetes:consequences in mother and child[J]. Epigenetics, 2019,14(3):215-235.
[4]	吕美丹, 吴燕, 李华林. 知-信-行理论模式配合孕期营养保健对妊娠期糖尿病孕妇营养状态、自我保健能力及妊娠结局的影响[J]. 中国妇幼保健, 2019,34(21):4856-4859.
	LÜ MD, Wu Y, Li HL. Effects of knowledge-attitude-practice theory model combined with nutrition and health care during pregnancy on nutritional status,self-care ability and pregnancy outcomes of pregnant women with gestational diabetes mellitus[J]. Matern Child Heal Care Chin, 2019,34(21):4856-4859.
[5]	潘旋, 张晶, 张邢炜. 国外集中群组孕期保健模式的应用研究进展[J]. 中华护理杂志, 2016,51(8):988-991.
	Pan X, Zhang J, Zhang XW. Review of application and research on centering pregnancy model in foreign countries[J]. Chin J Nurs, 2016,51(8):988-991.
[6]	周临, 张晶, 陈丹丹, 等. 以家庭为中心的群组式孕期保健模式的应用及效果研究[J]. 中华护理杂志, 2019,54(3):401-405.
	Zhou L, Zhang J, Chen DD, et al. The application and effects of family-centered group prenatal care model[J]. Chin J Nurs, 2019,54(3):401-405.
[7]	许国敏, 余慧. 群组孕期保健干预对初产妇心理状态及分娩方式的影响[J]. 中国健康心理学杂志, 2020,28(7):1000-1003.
	Xu GM, Yu H. Effect of group health-care intervention on the psychological state and the delivery mode of the primiparas[J]. China J Heal Psychol, 2020,28(7):1000-1003.
[8]	Ickovics JR, Earnshaw V, Lewis JB, et al. Cluster randomized controlled trial of group prenatal care:perinatal outcomes among adolescents in New York City health centers[J]. Am J Public Health, 2016,106(2):359-365.
[9]	中华医学会妇产科学分会产科学组. 孕前和孕期保健指南(2018)[J]. 中华围产医学杂志, 2018,21(3):145-152.
	Obstetrics and Gynecology Branch of Chinese Medical Association. Preconception care and prenatal care guidelines(2018)[J]. Chin J Perinat Med, 2018,21(3):145-152.
[10]	Zung WWK. A self-rating depression scale[J]. Arch Gener Psych, 1965,12:63-70.
[11]	田银娣, 王怡恺, 李静, 等. 焦虑和抑郁量表在肝硬化患者临床应用中的信效度评价[J]. 实用肝脏病杂志, 2019,22(1):105-108.
	Tian YD, Wang YK, Li J, et al. Evaluation of reliability and validity of self-rating anxiety scale(SAS) and self-rating depression scale(SDS) in patients with liver cirrhosis[J]. J Practi Live Dis, 2019,22(1):105-108.
[12]	Parikh LI, Jelin AC, Iqbal SN, et al. Glycemic control,compliance,and satisfaction for diabetic gravidas in centering group care[J]. J Matern Fetal Neonatal Med, 2017,30(10):1221-1226.
[13]	段雪亚. 妊娠糖尿病孕妇群组管理健康教育应用效果[J]. 健康教育与健康促进, 2018,13(4):358-359,368.
	Duan XY. Effect of group health education on pregnant women with gestational diabetes[J]. Heal Educ Heal Promot, 2018,13(4):358-359,368.
[14]	Magriples U, Boynton MH, Kershaw TS, et al. The impact of group prenatal care on pregnancy and postpartum weight trajectories[J]. Am J Obstet Gynecol, 2015,213(5):688.
[15]	McNeil DA, Vekved M, Dolan SM, et al. Getting more than they realized they needed:a qualitative study of women’s experience of group prenatal care[J]. BMC Pregnancy Childbirth, 2012,12:17.
[16]	Byerley BM, Haas DM. A systematic overview of the literature regarding group prenatal care for high-risk pregnant women[J]. BMC Pregnancy Childbirth, 2017,17(1):329.
[17]	曾丽华, 张爱霞, 朱珠, 等. 会阴按摩对产时会阴损伤影响的Meta分析[J]. 护理学报, 2018,25(13):46-51.
	Zeng LH, Zhang AX, Zhu Z, et al. Effect of perineal massage on preventing perineal trauma in childbirth:a meta-analysis[J]. J Nurs Chin, 2018,25(13):46-51.
[18]	胡胜男. 导乐分娩球配合自由体位对初产妇产程进展、分娩结局及产痛的影响[J]. 中国妇幼保健, 2020,35(19):3571-3574.
	Hu SN. The effect of doula delivery ball combined with free body position on the progress of labor,delivery outcome and labor pain of primipara[J]. Matern Child Heal Care Chin, 2020,35(19):3571-3574.
[19]	蔡红侠, 吴晓钰, 许翠月, 等. 妊娠期糖尿病孕妇赋能教育的实践[J]. 护理学杂志, 2019,34(16):30-32.
	Cai HX, Wu XY, Xu CY, et al. Practice of empowerment education in women with gestational diabetes mellitus[J]. J Nurs Sci, 2019,34(16):30-32.
[20]	Felder JN, Epel E, Lewis JB, et al. Depressive symptoms and gestational length among pregnant adolescents:cluster randomized control trial of centering pregnancy plus group prenatal care[J]. J Consult Clin Psychol, 2017,85(6):574-584.
[21]	王竞, 燕美琴, 王丽敏. 剖宫产后再妊娠孕妇分娩知识知晓状况调查[J]. 中国实用护理杂志, 2016,32(21):1636-1639.
	Wang J, Yan MQ, Wang LM. Investigation on the repeat pregnant women’s knowledge of delivery mode after cesarean section[J]. Chin J Pract Nurs, 2016,32(21):1636-1639.
[22]	王义会, 王惠琳, 李颖. 集中群组孕期保健模式的临床效果评价[J]. 中国妇幼保健, 2020,35(9):1603-1606.
	Wang YH, Wang HL, Li Y. Evaluation of clinical effect of concentrated group pregnancy health care model[J]. Matern Child Heal Care Chin, 2020,35(9):1603-1606.
[23]	Chae SY, Chae MH, Kandula S, et al. Promoting improved social support and quality of life with the centering pregnancy group model of prenatal care[J]. Arch Womens Ment Health, 2017,20(1):209-220.
[24]	袁春蕾, 刘燕群, 刘光华, 等. 集中群组孕期健康教育对孕妇分娩恐惧的干预效果[J]. 护理学杂志, 2017,32(18):27-29.
	Yuan CL, Liu YQ, Liu GH, et al. The effect of health education based on centering pregnancy model on fear of childbirth[J]. J Nurs Sci, 2017,32(18):27-29.
[25]	Zulfiqar T, Lithander FE, Banwell C, et al. Barriers to a healthy lifestyle post gestational-diabetes:an Australian qualitative study[J]. Women Birth, 2017,30(4):319-324.