臺灣博碩士論文加值系統

一、探討本國籍與外籍母親之嬰幼兒哺餵母乳時間長短與神經行為發展的影響
背景：世界衛生組織提倡每位母親應持續哺餵母乳至嬰幼兒兩歲大，母乳不僅可以提供適當的營養也可減少嬰幼兒腹瀉、中耳炎、泌尿道及呼吸道感染等疾病。文獻指出，哺餵母乳對嬰幼兒神經行為發展是有助益的表現。根據內政部統計資料指出，外籍配偶子女人數在95年度已達當年度人口出生數之11.6％，亦即台灣每8名新生兒中，就有1名新生兒的母親為外國籍。這些「新台灣之子」在早期的神經行為發展是我們關心的議題之ㄧ。

目標：評估本國籍母親及外籍母親之嬰幼兒六個月大及十八個月大哺餵母乳時間長短對嬰幼兒發展里程碑及神經行為發展影響。

方法：本研究是採出生世代的研究設計。研究族群是自2003年11月至2003年12月出生，選取2048對嬰兒與母親。於嬰幼兒6個月大及18個月大以結構性問卷進行家庭訪視。排除低出生體重、先天缺陷、多胞胎等因素後，控制嬰兒性別、懷孕週數、胎次、母親年齡、教育程度、婚姻狀況，及懷孕期間是否暴露二手菸等因素，利用複迴歸統計分析方法探討本國籍與外籍母親嬰幼兒哺餵母乳時間長短與嬰幼兒發展里程碑及神經行為發展狀況。

結果：分析結果發現嬰幼兒六個月大時，哺餵母乳時間超過四個月與從未哺餵母乳外籍母親嬰幼兒相較，本國籍母親的嬰幼兒粗動作、身邊處理及社會能力分數顯著較高。但至嬰幼兒十八個月大時，哺餵母乳超過四個月的嬰幼兒與從未哺餵母乳外籍母親嬰幼兒相較，外籍母親的嬰幼兒的精細動作與神經行為發展總分高出0.93分及2.44分並且達到顯著意義。

結論：哺餵母乳超過四個月對本國籍與外籍母親之嬰幼兒神經行為發展影響明顯，應加強宣導每位母親持續哺餵母乳的行為。

二、母親懷孕期就業狀況與懷孕期高血壓之相關性：台灣出生世代研究
背景：懷孕期間工作、工作壓力、長期站姿工作，及體能付出高的工作被視為引發懷孕期高血壓(pregnancy-induced hypertension)的危險因子，然而懷孕婦女的就業狀況特性與懷孕期高血壓的關係則不明確。

目標：本研究目的於評估婦女懷孕期間工作的就業狀況特性與懷孕期高血壓之間的關係。

方法：本研究利用多階段系統抽樣由出生登記檔選取2005年生產的母親。並於生產六個月後使用結構式問卷進行家庭訪視蒐集相關資料。並由出生登記檔獲得婦女妊娠型高血壓(gestational hypertension)及子癇前症(pre-eclampsia)診斷資料。扣除婦女年紀小於18歲及生產多胞胎後，共有261位婦女診斷有妊娠型高血壓及56位婦女診斷有子癇前症。統計分析控制母親生產時年齡、胎次、產前身體質量指數(BMI)、教育程度、種族、是否經流產、懷孕期間是否有抽菸及喝酒行為等，利用logistic regression分析婦女懷孕期就業狀況與懷孕期高血壓之間的危險性。

結果與結論：分析結果顯示，懷孕期間工作壓力大的婦女與未工作且家庭月收入小於五萬的婦女相較具有較高的危險性罹患懷孕期高血壓。此外，婦女懷孕期間工作超過40小時者，從事服務業、勞動業者，工作滿意度較低的婦女有較高的危險性引發懷孕期高血壓。然而，控制其潛在的危險因子後上述結果與懷孕期高血壓則無顯著相關。

關鍵字：婦女就業特性，懷孕期高血壓，妊娠型高血壓，子癇前症

1.The Impact of Duration of Breast Feeding on the Neurodevelopment of Those Children Born to Taiwanese and Immigrant Mothers

Background: Many studies have suggested a positive association between breast feeding and developmental milestones, motor skills, language, and cognitive but there were no studies to evaluate the neurobehavioral development in early childhood and breast feeding in different ethnic.

Objective: The purpose of this study was to explore the impact of duration of breast feeding on the neurodevelopment of children born to Taiwanese and immigrant mothers.

Material and Methods: This study was based on the pilot databases of the Taiwan Birth Cohort Study. Questionnaire interviews were used to collect the information on the duration of breastfeeding, milestone, and neurobehavioral development scale including gross motor, fine motor, language, and self-help and social competence, and its covariates at the 6 (n = 1580) and 18 months (n = 1423). Mother’s ethnicity was grouped into two groups: Taiwanese and immigrant and the duration of breastfeeding into three groups: never breastfed, less than four months, and four months and more. The reference group was never breastfed children born to Taiwanese mothers. Multiple linear regression model and Cox proportional hazard model were used to estimate the effects and controlled for potential confounders including maternal age, education, marital status, smoking during pregnancy, and infant sex, gestational age and birth order.

Results and Conclusions: We found that neurobehavioral development scores at the age of 18 months increased consistently with increasing duration of breastfeeding either in child born to Taiwanese or immigrant mothers.

Although immigrant mothers were in lower education level, lower family income, and more living in rural area than Taiwanese mothers; longer breastfeeding duration could still benefit to their children’s neurobehavioral development.


2.Characteristics of Maternal Employment during Pregnancy and Pregnancy-induced Hypertension: Results from the Taiwan National Birth Cohort Study

Background: Maternal employment during pregnancy and occupational stress has been considered risk factors for pregnancy-induced hypertension (PIH) but it is unclear what aspects of characteristics of employment might be important.

Objective: The objective of this study is to evaluate the associations between characteristics of employment during pregnancy and PIH in a large birth cohort study.

Material and Methods: In this study, we used the multistage stratified systematic sampling to recruit 21,248 postpartum women from the Taiwan National Birth Registration database in 2005. Interviewers had a home interview at the sixth month after their deliveries by using a structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of PIH including gestational hypertension and pre-eclampsia was obtained from the birth registration. After excluding mothers with multiple gestations and women less than 18 years old of age, 261 of 20,147 women had been diagnosed with gestational hypertension and 56 women were pre-eclampsia. We used logistic regression models to explore the effect of characteristics if maternal employment on PIH.

Results: Compared to women who employed during pregnancy, women with higher occupational stress had a slight higher risk to develop PIH. In addition, women with more than 8 working hours per week, working in service industry, and unsatisfied with her job may increase the risk of PIH. However, these findings were not significant after controlling potential confounders.

Discussion and Conclusions: There was no convincing evidence that maternal employment had a higher risk of PIH. However, further research is warranted to confirm these negative findings.

一、探討本國籍與外籍母親之嬰幼兒哺餵母乳時間長短與神經行為發展的影響 2
中文摘要 3
Abstract 4
Introduction 6
Material and Methods 7
Results 11
Discussion 13
Conclusions 16
References 18
二、母親懷孕期就業狀況與懷孕期高血壓之相關性：台灣出生世代研究 27
中文摘要 28
Abstract 29
Introduction 31
Material and Methods 32
Results 35
Discussion 37
References 40

List of Tables and Figures
一、探討本國籍與外籍母親之嬰幼兒哺餵母乳時間長短與神經行為發展的影響
Figure 1 Random Sampling of 29 Towns Out of 369 in Taiwan 21
Table 1 Characteristics of Study Participates 22
Table 2.1 Neurobehavioral Development Score at 6 and 18 Months of Age by ANOVA 23
Table 2.2 Milestone at 6 and 18 Months of Age by ANOVA 24
Table 3 Cox Proportional Hazard Model of Breastfeeding Duration and the Milestone at 6 and 18 Months 25

Table 4 Multiple Linear Regression Model of Breastfrrding Duration and the Neurobehavioral Development Scores at 6 and 18 Months 26

二、母親懷孕期就業狀況與懷孕期高血壓之相關性：台灣出生世代研究

Figure 1 Randomly Selected 85 Primary Sampling Units in Taiwan 44
Table 1 Characteristics of study subjects by maternal employment status during pregnancy 45
Table 2 Working Characteristics of Women with Hypertension and Normotensive Women 47
Table 3 Odds Ratios for Gestational Hypertension, Pre-eclampsia, and Pregnancy-induced Hypertension According to Working Characteristics 49

1.The Impact of Duration of Breast Feeding on the Neurodevelopment of Those Children Born to Taiwanese and Immigrant Mothers
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2.Characteristics of Maternal Employment during Pregnancy and Pregnancy-induced Hypertension: Results from the Taiwan National Birth Cohort Study

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