臺灣博碩士論文加值系統

本研究的目的在評估孕前身體質量指數(BMI)和孕期體重增加(GWG)對妊娠的預後、孕婦的生活品質，以及醫療費用的影響。研究採用回溯性世代研究方式(Retrospective cohort study)，調查的對象為在北部某醫學中心生產的2210名單胞胎產婦。收集的數據包含（1）產婦的人口統計特徵，以及孕期體重的增加和生產相關的資料；（2）胎兒的各項特徵和生產時的健康狀況；（3）懷孕期間尿失禁的資料、SF-12健康調查量表，以及性生活問卷；（4）住院期間的醫療總費用。根據孕前BMI將產婦分為4組：體重不足（BMI <18.5），體重正常（BMI 18.5-25），體重超重（BMI 25-30）和肥胖（BMI >30）。依照2009年美國醫學研究所（IOM）發佈的建議，將產婦在懷孕期間增加的體重分為3組：(1)體重增加低於IOM指南，(2)體重增加符合IOM指南，(3)體重增加高於IOM指南。本研究所有BMI和GWG各組資料差異的分析皆使用SAS 9.4版的軟體統計。
研究結果顯示，與BMI正常的產婦相比，孕前超重和肥胖的產婦更容易發生GWG高於IOM指南，以及出現子癇前症、妊娠糖尿病、早產，胎兒頭圍較大和巨大胎兒。超重和肥胖的產婦在懷孕期間比孕前BMI正常和不足的產婦更容易出現尿失禁。四個BMI組的SF-12健康調查量表的評分並無顯著的差異，但是超過90％的產婦性活動在妊娠期間出現減少，甚至完全沒有。
只有41.9%產婦的GWG符合IOM指南的建議。與GWG符合指南的產婦相比，GWG高於IOM指南的產婦風險增加的變項有孕前BMI超重和肥胖、剖腹產、子癇前症、嚴重會陰裂傷、胎兒頭圍較大和巨大胎兒，而GWG低於IOM指南的產婦則會增加孕前BMI體重不足以及早產的風險。與符合IOM的孕婦相比，GWG高於IOM的孕婦容易發生妊娠尿失禁。SF-12健康調查量表的評分在三組GWG的產婦之間並無顯著的差異。雖然對性滿意度的調查項目呈現有意義的差異，不過在妊娠期間仍有性行為的產婦只有17%。超重和肥胖的孕婦（BMI ≥ 25）比體重正常的產婦有較高的醫療費用；與符合IOM指南的產婦相比，孕期GWG高於IOM指南的產婦會增加醫療費用。
本研究發現，孕前BMI超重和肥胖，以及GWG不符合IOM指南與子癇前症、妊娠糖尿病、巨大胎兒，妊娠尿失禁和醫療費用增加有相關。負責產檢和生產的醫護人員應該告知婦女，以正常BMI懷孕會減少妊娠引發的合併症，另外GWG需要符合IOM建議的範圍才能擁有比較好的妊娠預後。

The study was conducted to evaluate the effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on pregnancy outcomes, quality of life and medical cost. The observational cohort included 2210 pregnant women who were divided into 4 groups according to their prepregnancy BMI: underweight (< 18.5), normal weight (18.5-24.9), overweight (25-29.9), and obese (≥ 30). Furthermore, women were categorized into 3 groups based on GWG in relation to the 2009 Institute of Medicine (IOM) recommendations: (1) weight gain below the IOM guidelines, (2) weight gain within the IOM guidelines, and (3) weight gain above the IOM guidelines. Data were analyzed for pregnancy outcomes, prevalence of urinary incontinence during pregnancy, scores of the Short Form 12 health survey (SF-12), changes in sexual function and medical cost for hospitalization during delivery.
Women with overweight and obesity were more likely to have adverse maternal outcomes (GWG above the IOM guidelines, preeclampsia and gestational diabetes) and fetal outcomes (large fetal head circumference and macrosomia) compared to normal weight women. Overweight and obese women (BMI ≥ 25) were more likely to have urinary incontinence than normal weight and underweight women. There were no significant differences in SF-12 scores among the four BMI groups, but more than 90% of pregnant women reported no or reduced sexual activities regardless of pregnancy BMI.
Regarding GWG, only 41.9% of women met the IOM guidelines. Compared to women with normal GWG, women with excessive GWG had adverse pregnancy outcomes including nulliparity, large fetal head circumference and macrosomia; women with below GWG were more likely to have preterm delivery and low birth weight fetus. Excessive GWG women were at higher risks of urinary incontinence than those of normal GWG women. There were no significant differences in SF-12 scores among GWG groups. A comparison of sexual activities in three GWG groups found a significant difference in sexual satisfaction, even thought there was only 17% of women responding to have sexual activity during pregnancy. Overweight and obese pregnant women (prepregnancy BMI ≥ 25) and excessive GWG spent higher medical costs, compared with women with BMI< 25 and normal GWG.
Our results show that excessive GWG and maternal overweight and obesity are associated with greater risks of preeclampsia, gestational diabetes, macrosomia, urinary incontinence and more medical expenses. Health care providers are advised to counsel women to control their prepregnancy BMI in the normal weight range and maintain their GWG following IOM recommendation throughout the pregnancy.

指導教授推薦書
口試委員會審定書
誌謝 iii
中文摘要 iv
英文摘要 vi
目錄 viii
表目錄 xii
圖目錄 xiii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 4
第三節 研究目的 5
第四節 名詞界定與操作型定義 6
第二章 文獻探討 10
第一節 孕前身體質量指數分類和孕期體重增加的準則 10
第二節 孕前身體質量指數和孕期體重與妊娠預後的相關研究 13
第三節 孕前身體質量指數和孕期體重與尿失禁的相關研究 15
第四節 孕前身體質量指數和孕期體重對生活品質的影響 16
第五節 孕前身體質量指數和孕期體重對性生活的影響 17
第六節 孕前身體質量指數和孕期體重與生產醫療費用的影響 18
第三章 研究方法 19
第一節 研究架構與假說 19
第二節 研究設計與資料來源 21
第三節 研究工具 22
第四節 研究步驟 24
第五節 資料分析 25
第四章 研究結果 27
第一節 產婦的人口學與生理特性的分析 27
第二節 孕前BMI與妊娠預後的單變項分析 31
第三節 孕前BMI與妊娠預後的多元邏輯回歸分析 31
第四節 孕期體重增加與妊娠預後因素的單變項分析 34
第五節 孕期體重增加與妊娠預後因素的多元邏輯回歸分析 36
第六節 妊娠尿失禁的危險因素 38
第七節 SF-12與孕前BMI和孕期體重增加的關係 40
第八節 性活動與孕前 BMI和孕期體重增加的關係 42
第九節 孕前 BMI和孕期體重增加和醫療費用的相關分析 45
第五章 討論 47
第一節 孕前 BMI相關的妊娠預後 47
第二節 孕期GWG相關的妊娠預後 50
第三節 妊娠尿失禁的危險因素 52
第四節 生活品質與孕前 BMI和孕期GWG的關係 55
第五節 性活動評分與孕前 BMI和孕期GWG的關 55
第六節 孕前 BMI與孕期GWG和醫療費用的相關因素 56
第七節 研究限制 57
第六章 結論與建議 61
第一節 結論 61
第二節 管理意涵與實務 63
第三節 研究建議 66
參考文獻 69
附錄 79







表目次
表4-1 孕前BMI相關的產婦人口學與生理特性分析 28
表4-2 孕期體重增加相關的產婦人口學分析 30
表4-3 孕前BMI與妊娠預後相關因素的單變項分析 32
表4-4 孕前BMI與妊娠預後相關因素的多元邏輯斯回歸分析 33
表4-5 孕期體重增加與妊娠預後相關因素的單變項分析 35
表4-6 孕期體重增加與妊娠預後相關因素的多元邏輯斯回歸分析 37
表4-7 妊娠尿失禁的危險因素 39
表4-8 SF-12各個範疇的平均分數與孕前BMI的關係 40
表4-9 SF-12各個範疇的平均得分與孕期體重增加的關係 41
表4-10 性活動的分數與孕前BMI的關係 43
表4-11 性活動的分數與孕期體重增加的關係 44
表4-12 醫療費用在臨床特性與周產期預後的比較 46


圖目次
圖2-1 WHO的 BMI定義 11
圖2-2 WHO針對亞洲人的 BMI定義 11
圖2-3 台灣肥胖標準的定義 12
圖2-4 妊娠期體重增加（GWG）建議 13
圖3-1 本研究的架構圖 20
圖4-1 孕前BMI分佈圖 27
圖4-2 BMI分組比率圖 27
圖4-3 孕期增加體重分佈圖 29
圖4-4 IOM孕期重量增加的分組比率圖 29
圖4-5 妊娠尿失禁比率圖 38
圖4-6 性活動的頻率分佈圖 42

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