基于移动健康技术的孕期体重生活方式干预对超重肥胖孕妇代谢性指标的影响

The effect of mobile health-based gestational weight lifestyle interventions on metabolic indicators in overweight and obese pregnant women

摘要

目的 本研究旨在探讨基于移动健康技术的孕期体重生活方式干预对超重肥胖孕妇妊娠中期空腹血糖(FBG)、血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、空腹胰岛素(FINS)、糖化血红蛋白(HbA₁c)等代谢性指标的影响。方法 采用随机对照试验设计,在山东省潍坊市妇幼保健院和北京市通州区妇幼保健院各选取100名超重肥胖孕妇,按孕前体质指数(BMI)、年龄、产次分层,随机分为干预组和对照组。干预组通过微信公众号干预平台进行管理,以改善饮食行为、增加身体活动水平为目标,从健康教育、饮食行为目标设定、饮食行为监测、运动监测、体重监测、和评估反馈六个方面进行干预。干预从妊娠10~14周开始,每2周开展一次面对面随访或电话随访;收集孕妇孕前体重、妊娠8~14周和28周左右血常规、血生化检测的FBG、TC、TG、HDL-C、LDL-C结果。通过留取两个时点的血常规、血生化剩余血样,测量FINS和HbA₁c指标;妊娠24~28周进行口服葡萄糖耐量试验常规产检时收集孕妇空腹体重。对照组按各妇幼保健机构常规产检模式进行管理。采用广义线性混合模型分析干预对妊娠中期体重和代谢指标的影响,采用R语言Mediation包分析中介作用。结果 在纳入分析的178名孕妇中,与对照组相比,妊娠24~28周中期随访时,干预组孕期增重明显低于对照组,调整后平均组间差异为-1.63kg(95%CI:-2.80~-0.46,t=-2.736,P=0.007);干预可有效降低FBG变化值,调整后平均组间差异为-0.34(95%CI:-0.53~-0.14,t=-3.409,P<0.001),中介作用分析结果显示,孕24~28周前增重介导了31.0%(P=0.036)的FBG变化。结论 基于移动健康技术以控制妊娠期增重为目的的生活方式干预可有效降低超重肥胖孕妇的妊娠中期空腹血糖水平,且孕期增重(GWG)发挥了中介作用。

Abstract

Objective This study aimed to investigate the effects of a mobile health-based lifestyle intervention for gestational weight management on metabolic indicators, including fasting blood glucose (FBG), blood lipids [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], fasting insulin (FINS), and glycated hemoglobin (HbA₁c), in overweight and obese pregnant women during the second trimester of pregnancy. Methods A randomized controlled trial (RCT) was conducted at Weifang Maternal and Child Health Hospital (Shandong Province) and Tongzhou District Maternal and Child Health Hospital (Beijing), each enrolling 100 overweight or obese pregnant women. Participants were stratified by pre-pregnancy body mass index (BMI), age, and parity, and then randomly assigned to an intervention group or a control group. The intervention group received management through a WeChat-based platform aimed at improving dietary behaviors and increasing physical activity, focusing on six components: health education, dietary goal setting, dietary behavior monitoring, exercise monitoring, weight tracking, and evaluation feedback. The intervention began at 10-14 gestational weeks, with face-to-face or telephone follow-ups every two weeks. Data were collected on pre-pregnancy weight, FBG, TC, TG, HDL-C, and LDL-C at 8-14 and around 28 gestational weeks. Residual serum samples from these two time points were used to measure FINS and HbA₁c. Maternal fasting weight was recorded during the routine oral glucose tolerance test (OGTT) at 24-28 weeks. The control group received routine prenatal care according to standard institutional procedures. A generalized linear mixed model (GLMM) was applied to assess the effects of the intervention on gestational weight gain (GWG) and metabolic indicators. Mediation analysis was conducted using the “Mediation” package in R. Results Among the 178 pregnant women included in the analysis, compared with the control group, the intervention group had significantly lower gestational weight gain at 24-28 weeks, with an adjusted mean difference of -1.63 kg (95% CI: -2.80 to -0.46, t = -2.736, P = 0.007). The intervention effectively reduced FBG change, with an adjusted mean group difference of -0.34 mmol/L (95% CI: -0.53 to -0.14, t = -3.409, P < 0.001). Mediating results showed that weight gain in the second trimester mediated 31.0% (P = 0.036) of the changes in FBG before and after the intervention. Conclusion The lifestyle intervention based on mobile health technology to control weight gain during pregnancy can effectively reduce the level of FBG in overweight and obese pregnant women in the second trimester, and gestational weight gain (GWG) exerted partial mediating roles in reducing FBG.

关键词

移动健康 / 孕前 / 超重肥胖 / 孕期 / 体重管理 / 生活方式干预 / 代谢结局

Key words

mobile health / weight management / lifestyle intervention / overweight and obesity / metabolic outcome

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基金资助

国家自然科学基金面上项目(82473640)

北京大学医学部-潍坊市妇幼健康联合研究中心基金项目(PKUWF-Y09)