Abstract:

Objective To systematically evaluate relevant guidelines on calories and 3 nutrients allocations during pregnancy in patients with gestational diabetes mellitus，and to compare the similarities and differences in recommendations between these guidelines. Methods Domestic and foreign guideline networks，websites of specialist associations related to diabetes，obstetrics and gynecology，as well as databases，were systematically searched from January 2010 to June 2022. There were 2 appraisers who used the Appraisal of Guidelines for Research & Evaluation II to evaluate the quality of guidelines and then used the content analysis method to synthesize the recommendations of each guideline and compare similarities and differences. Results This study included 18 guidelines with fair overall quality（10 with grade A，2 with grade B and 6 with grade C）. The guidelines provided recommendations in 5 aspects of meal allocation，calories，carbohydrates，proteins，and fats，totaling 57 recommendations. While the recommendations for meal allocation were consistent across guidelines，there were significant differences in the recommendations for calories and the 3 major nutrients. Conclusion The recommendations regarding the distribution of calories and the 3 major nutrients mostly rely on expert consensuses，with low-quality evidence but mostly strong recommendations. These guidelines exhibit significant variations from one to another. Consequently，future studies with higher quality on the distribution of calories and 3 nutrients should be conducted，and high-quality evidence-based nutrition guidelines for gestational diabetes should be developed in China.

Key words: Gestational Diabetes Mellitus, Energy, Three Nutrients, Guideline, Recommendation, Evidence-Based Nursing

摘要：

目的 系统评价妊娠期糖尿病患者孕期热量及三大营养素分配相关指南，比较各指南推荐意见的异同。 方法 系统检索国内外指南网、糖尿病和妇产科相关的专业协会网站及数据库，检索时限为2010年1月—2022年6月。由2名研究者采用临床指南研究与评价工具Ⅱ对指南进行质量评价，采用内容分析法汇总各指南推荐意见并比较异同。 结果 最终纳入18篇指南，整体质量尚可，10篇为A级，2篇为B级、6篇为C级；推荐意见包括餐次分配、热量、碳水化合物、蛋白质、脂肪5个方面，共归纳整理为57条；不同指南对餐次分配的推荐意见较一致，但对热量和三大营养素的推荐意见存在明显差异。 结论 妊娠期糖尿病患者有关孕期热量和三大营养素分配的推荐意见大多来自专家共识，证据质量偏低，但多为强推荐，不同指南的推荐意见差异明显。建议未来开展更多有关热量和三大营养素分配的高质量研究，并制订国内高质量妊娠期糖尿病患者循证营养指南。

关键词: 妊娠期糖尿病, 热量, 三大营养素, 指南, 推荐意见, 循证护理学