Abstract: 　Background　The incidence of anxiety，depression and other adverse emotions in women with gestational diabetes mellitus（GDM）is significantly higher than that of those without，which seriously affects the physical and mental health and disease progression.Problem-solving therapy（PST）is a six-step cognitive-behavioral intervention that increases positive cognitive，emotional，and behavioral changes，but its use in women with GDM has been less reported.Objective　To investigate the effect of PST on the self-management ability，pregnancy-related anxiety and depression in women with GDM.Methods　From August 2018 to May 2019，100 women with GDM undergoing regular prenatal examination in the Second Affiliated Hospital of Zhengzhou University were selected by convenient sampling，and were divided into control group and observation group（50 cases in each） by a table of random numbers，receiving routine prenatal guidance and management of GDM，and routine prenatal guidance and management of GDM in combination with PST，respectively.The intervention effect was evaluated by comparing post-8-week intervention BMI，fasting blood glucose（FBG），2-h postprandial blood glucose（2hPG），self-management ability assessed by Self-management Ability Questionnaire for Gestational Diabetes Mellitus Patients（SMQGDM），anxiety level assessed by the Pregnancy-specific Anxiety Questionnaire（PAQ），and depression level assessed by Self-rating Depression Scale（SDS） with the baseline status.Results　During the study，6 cases were excluded due to loss to follow-up（3 in each group），the other 94 who completed this study were finally included.After intervention，the observation group showed lower mean levels of FBG and 2 hPG，and lower mean scores of PAQ and SDS，and higher mean scores of related knowledge，beliefs and attitudes，social support，self-management methods and behaviors，and higher mean total score of SMQGDM compared with the control group（P<0.05）although these aspects were similar in both groups before the intervention（P>0.05）.Conclusion　PST may help to improve the self-management ability，and glycemic control，and reduce pregnancy-related anxiety and depression levels of GDM patients.

Key words: Gestational, Gestational diabetes, Problem-solving-therapy, Anxiety, Depression, Self-management ability

摘要： 背景　妊娠期糖尿病（GDM）孕妇焦虑、抑郁等不良情绪发病率明显高于非GDM孕妇，而孕期不良情绪严重影响患者的身心健康和疾病进展。问题解决疗法（PST）是一种六步骤的认知-行为干预疗法，可增加积极的认知、情绪和行为改变，但其在GDM孕妇中的应用报道较少。目的　探讨PST对GDM患者自我管理能力及妊娠相关焦虑、抑郁的影响。方法　2018年8月—2019年5月采用便利抽样法选取在郑州大学第二附属医院定期产检的GDM患者100例为研究对象，采用随机数字表法将其均分为对照组与观察组（各50例）。对照组实施GDM常规产前指导和管理；观察组在对照组基础上实施PST。于干预前及干预后8周监测GDM患者体质指数（BMI）、空腹血糖、餐后2 h血糖等生理指标，并采用妊娠糖尿病患者自我管理能力问卷（SMQGDM）、妊娠相关焦虑量表（PAQ）、抑郁自评量表（SDS）调查患者自我管理能力及妊娠相关焦虑、抑郁情况。结果　调查过程中对照组、观察组各失访3例，共94例患者完成本研究。干预前，两组间空腹血糖、餐后2 h血糖、相关知识得分、信念与态度得分、社会支持得分、自我管理方法与行为得分、SMQGDM总分、PAQ及SDS得分比较，差异均无统计学意义（P>0.05）。干预后观察组空腹血糖、餐后2 h血糖、PAQ及SDS得分低于对照组（P<0.05），相关知识得分、信念与态度得分、社会支持得分、自我管理方法与行为得分、SMQGDM总分高于对照组（P<0.05）。结论　PST有助于提高GDM患者自我管理能力，控制妊娠期血糖，改善GDM患者妊娠相关焦虑、抑郁水平。

关键词: 糖尿病, 妊娠期糖尿病, 问题解决疗法, 焦虑, 抑郁, 自我管理能力