自我管理對妊娠糖尿病孕婦血糖控制及新生兒體重改善之成效：統合分析

The Effect of Self-Management Programs on the Improvement of Glycemic Control and Birth Weight Among Pregnant Women with Gestational Diabetes: A Meta-Analysis

祝婕芸(Jie-Yun Chu)

指導教授 ： 黃惠娟

臺北醫學大學/護理學院/護理學系碩士暨碩士在職專班/碩士(2017年)

摘要

隨著時代變遷、飲食、生活型態改變，妊娠婦女於懷孕期間罹患妊娠糖尿病比例逐漸增加，由於罹患妊娠糖尿病孕婦在分娩後成為糖尿病機率顯著較無妊娠糖尿病病史孕婦高，此外，新生兒出生體重也受孕婦血糖過高而增加，因此，如何控制妊娠糖尿病孕婦血糖及新生兒出生體重為孕期照護之重要議題。目前，妊娠糖尿病控制血糖主要以藥物及非藥物治療，但針對妊娠糖尿病接受藥物治療仍有爭議，因此本研究以非藥物治療方式，探討妊娠糖尿病自我管理介入（包含，飲食、運動及自我監測血糖），探討對妊娠糖尿病孕婦血糖及新生兒出生體重之控制成效。
本研究採統合分析，共納入52篇文獻以探討妊娠糖尿病孕婦血糖控制及新生兒出生體重之成效；研究結果顯示，自我管理對於控制空腹血糖（Mean Difference, MD = -1.02，95% CI = -1.24, -0.79）及糖化血色素（MD = -0.94，95% CI = -1.55, -0.32）皆有顯著成效，對於降低新生兒出生體重無顯著成效（MD = -0.17, p = 0.126）；個別飲食、運動及綜合管理模式對血糖控制及新生兒出生體重亦無顯著差異。
　　本研究結果確立自我管理介入有助於妊娠糖尿病孕婦血糖控制成效；本研究結果有助於未來護理實務擬定合適照護策略以提供個人化介入，促使妊娠糖尿病孕婦能夠在日常生活中執行自我管理，進而達到控制血糖之成效。

關鍵字

妊娠糖尿病 ； 新生兒出生體重 ； 空腹血糖 ； 糖化血色素 ； 自我管理

並列摘要

With the change of diet and lifestyle, the proportion of pregnant women suf-fering from gestational diabetes mellitus (GDM)gradually increased. Most pregnant women with GDM have higher proability of developing diabetes mellitus in ten years after after childbirthcompared to those without t a history of gestational diabetes. In addition, the pregnant women with GDM could re-sult in an increasing birth weight of newborn. Therefore, controlling blood glucose for the pregnant women with GDM is critical in gestational care.
Current treatments for the pregnant women with GDM included pharma-cology therapy and non-pharmacology treatments comprising diet, exercise and self-monitoring blood glucose. Although the results of adopting pharma-cology therapy on the improvement of blood sugar were conflicting, the idtn-tification of appropriate non-pharmacology treatments is important issue.
Previous sutides have adopted various non-pharmacology treatments comprising diet, exercise and self-monitoring blood glucose on the improve-ment blood sugar for the preganat women with GDM; however, the conflicit-ing results made the effect of non-pharmacology treatments remain unclear. Therefore, the purposes of this study were to identify the effect of self-management programs on the improvement of blood glucose control of prgeant women with GDM and birth weight of infants using meta-analysis.
In total, 52 eligible articles were included and reviewed to investigate the effects of self management program on the improment of glycemic control and birth weight in pregnant women with diabetes mellitus. Results found that the overall effect of self-management program on the improvement of fasting blood glucose (Mean Difference, MD = -1.02, 95% CI= -1.24, -0.79) and Glycosylated hemoglobin (MD = -0.94, 95% CI= -1.55, -0.32) were signifi-cant, but the effect was no significant on reducing birth weight of infants (MD = -0.17, p = 0.126). The individual intervention comprising diet, exercise and composite forms showed significant effect on improving blood sugar control; but the effect between the three forms was not significant.
Our findings show that perfomring self-management programs would help pregnant women with GDM to decrease blood sugar and birth weight of infants. Healthprofessionals could further develop appropriate strategies to promote perform exercise and diet control by themselves in daily activities to decrease blood sugar and reduce the birth weight of newborns.

並列關鍵字

gestational diabetes mellitus ； neonatal birth weight ； blood glucose control ； self-management

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