The impact of the internet plus flipped classroom continuous reinforcement lifestyle intervention model on reducing the incidence of gestational diabetes and improving pregnancy outcomes in high-risk pregnant women
互联网+翻转课堂连续性强化生活干预模式对高危孕妇降低妊娠期糖尿病的发生率及妊娠结局的影响

摘要

目的 探讨互联网+翻转课堂从孕早期开始连续性强化生活干预模式在降低高危孕妇妊娠期糖尿病（Gestational diabetes mellitus, GDM）的发生率及妊娠不良结局的作用。方法 选取2023年5月至2023年12月在产科门诊建卡，孕周6-12周的GDM高危孕妇200人，将其随机分为常规组（100例，孕早期一次普通营养门诊集体宣教），干预组（100例孕产妇不良结局，参加翻转课堂后加入互联网微信平台进一步连续性每天线上微信平台打卡评估的强化生活方式管理）。两组孕妇在孕24-28周进行75 g口服葡萄糖耐量试验（Oral glucose tolerance test, OGTT）。统计两组孕妇GDM发生率、孕期体重增长、妊娠不良结局及新生儿出生体重。结果 干预组和对照组孕妇相比较，干预组GDM发生率明显下降：[13%（13/100）vs38%（38/100），χ2=44.22，P<0.001]，差异有统计学意义；干预组孕期体重增长明显减少：[12.57±1.25vs14.23±1.32，t=9.13，P<0.001]，差异有统计学意义；不良妊娠结局发生率：（1）干预组发生率明显减少：妊娠期高血压疾病，产后出血，剖宫产总和[17%（17/100）vs36%（36/100），χ2=9.27，P<0.001]，差异有统计学意义；（2）新生儿不良结局发生率减少：包括早产，巨大儿，胎儿生长受限（Fetal growth restriction，FGR），锁骨骨折，窒息总和[2%（2/100）vs8%（8/100），χ2=2.63，P>0.05]，但差异无统计学意义。干预组新生儿出生体重明显较低：[3.39±0.05vs3.55±0.07，t=18.59，P<0.001]，差异有统计学意义。结论 通过互联网+翻转课堂从孕早期开始连续性强化生活方式管理GDM高危孕妇可以降低GDM发生率、减少孕妇孕期体重增长及妊娠不良结局，新生儿出生体重也明显较低。

Abstract

Objective To explore the effect of the continuous lifestyle intervention model based on the Internet + flipped classroom starting from the early pregnancy on reducing the incidence of gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in high-risk pregnant women.
Methods A total of 200 high-risk pregnant women who established cards in the obstetric outpatient department from May 2023 to December 2023 and were at 6-12 weeks of gestation were randomly divided into a conventional group (100 cases, with a single general nutrition outpatient group education in the early pregnancy) and an intervention group (100 cases, participating in the flipped classroom and further continuous lifestyle management through the Internet WeChat platform). Both groups underwent a 75g oral glucose tolerance test (OGTT) for GDM screening at 24-28 weeks of gestation. The incidence of GDM, weight gain during pregnancy, adverse pregnancy outcomes, and neonatal birth weight were statistically analyzed.
Results Compared with the control group, the incidence of GDM in the intervention group was significantly lower [13%（13/100）vs 38%（38/100）, χ2=44.22, P<0.001], with a statistically significant difference; the weight gain during pregnancy in the intervention group was significantly less [12.57±1.25 vs 14.23±1.32, t=9.13, P<0.001], reached statistical significance; the incidence of adverse pregnancy outcomes: (1) The incidence of adverse outcomes in the intervention group was significantly lower: gestational hypertension, postpartum hemorrhage, and cesarean section combined [17%（17/100）vs 36%（36/100）, χ2=9.27, P<0.001], showed statistically significant divergence; (2) The incidence of adverse neonatal outcomes decreased: including preterm birth, macrosomia, FGR, clavicle fracture, and asphyxia combined [2%（2/100）vs 8%（8/100）, χ2=2.63, P>0.05], but the difference was not statistically significant. The birth weight of neonates in the intervention group yielded statistically significant lower [3.39±0.05 vs 3.55±0.07, t=18.59, P<0.001].
Conclusion   Continuous lifestyle management for high-risk pregnant women with GDM through the Internet + flipped classroom starting from the early pregnancy can reduce the incidence of GDM, decrease weight gain during pregnancy, and adverse pregnancy outcomes, and the neonatal birth weight is also significantly lower.