臺灣博碩士論文加值系統

研究緣起：精神疾病孕婦是否比一般婦女容易發生生產併發症？文獻探討的結果沒有一致的結論，但大多數的研究顯示具有正相關。
研究目的：比較具有精神病史婦女的懷孕結果，研究假設精神疾病會影響孕婦的懷孕結果，使得生產併發症的風險提高。
研究方法：本研究利用全民健保資料庫選取在1996-2002年間曾經因精神疾病住院，之後又生產的婦女為病例組，對照組則從所有的生產婦女中隨機抽樣，並且排除曾因精神疾病住院者，比較兩組的生產結果，住院主診斷採用ICD-9-CM編碼，篩選結果得到病例組1707人，對照組5100人進行分析。
研究結果：精神疾病婦女有較高的比例出現分娩併發症，自然產比例比對照組下降了約10%。精神分裂異常的婦女比其他種類精神疾病有更常見的不良懷孕結果。病例組裡面有30.70%接受剖腹產，明顯高於對照組的28.96%。在校正生產年齡、醫院評鑑等級之後，「其他懷孕期伴隨流產結果」的危險性，精神分裂異常婦女比對照組高出2.15倍，「與妊娠相關併發症」高出1.51倍，「在分娩和生產期所發生的併發症」高出1.27倍，皆達到統計上的顯著差異。逐步複迴歸的結果顯示精神分裂異常婦女的分娩併發症較其他精神疾病高，其差異在統計顯著邊緣(p=0.05)。針對常見的生產結果分類，並沒有特定季節的住院孕婦是比較嚴重的。
結論：精神分裂異常的孕婦可能會增加不良懷孕的風險，研究建議曾罹患精神疾病的孕婦應按時接受產前檢查，尋求精神科醫師的協助，以減少原本可避免的不良結果。未來的研究可以將病患的社會因素與產前心理壓力納入考量，有助於釐清因果關係。

Background: The literature on obstetric complications in mental illness mothers found mixed results. Recent evidence suggests a positive relationship.
Aims: To investigate the pregnancy outcomes of mothers with a history of psychotic disorders. The researcher considers whether births to mothers with psychotic disorders have an increased risk of obstetric complications.
Method: A retrospective cohort study was carried out using National Health Insurance Database. Obstetric complications were studied in all women in Taiwan who gave birth during 1996-2002 and also had been admitted to a psychiatric department before pregnancy. Controls were recruited form a random sample of all deliveries in the general population without serious mental illness history. Major diagnosis were stored and retrieved by means of ICD-9-CM code and recorded to case-control status for 1707 cases and 5100 controls.
Results: Overall, Women who had presented to psychiatric services before pregnancy had a greater frequency of labour/delivery complications than controls. Among various diagnostic mental disorders in case group, schizophrenic women had the highest risks. 30.70% of case group had significant increases in Cesarean section compared with 28.96% in the control group. The risks of adverse pregnancy outcomes were even after adjusting for age and hospital degree in women with schizophrenia compared to women in the control group (e.g., abortive pregnancy; RR 2.15, 95%CI 1.09-4.27, pregnancy mainly complication; RR 1.51, 95%CI 1.22-1.87, labor and delivery complication; RR 1.27, 95%CI 1.05-1.54). The risks of labor and delivery complication were significantly elevated throughout the analyses in a multiple regression model. There were no seasonal differences in the frequency of specific complications.
Conclusions: Schizophrenia in the mother implies an increased risk for poor pregnancy outcome, not fully explained by maternal factors. Mental illness women should keep attending antenatal care visits and to offer the pregnancy schizophrenic women specific recommendations, in order to prevent potential harmful interventions that should be avoided. However, unknown pathological mechanisms and possible confounding by social factors and perinatal stress requests further explorations.

《中文部分》
行政院衛生署：中華民國台灣地區2002全民健保主要疾病就診率統計2004。
余金燕、潘德樑：疾病分類實務。合記圖書出版社2003。
李明濱等：精神醫學新知。台灣醫學會1999。
吳淑玲：精神分裂病患者擇偶行為與婚姻狀況，東海大學社會工作研究所2000。
沈楚文：新編精神醫學。永大書局1990。
胡海國：精神分裂症患者母親懷孕期之致病危險因素。當代醫學1996;23(2):160-166。
張盈寬、陳惟華、劉杭生：產前檢查的重要性。國防醫學1998;26(2):85-88。
許禎娟：憂鬱症婦女抉擇懷孕之經驗，國防大學醫學院護理研究所2002。
《英文部分》
Bagedahl-Strindlund M. Mentally ill mothers and their children. Acta psychiatrica Scandinavica 1986;74:32-40.
Bain M, Juszczak E, McInneny K, Kendell RE. Obstetric complications and affective psychoses: two case-control studies based on structured obstetric records. The British Journal of Psychiatry 2000;176:523-526.
Bennedsen BE, Mortensen PB, Olesen AV, Henriksen TB, Frydenberg M. Obstetric complications in women with schizophrenia. Schizophrenia Research 2001;47:167-175.
Byren M, Browne R, Mulryan N, Scully A, Morris M, Kinsella A, Takei N, McNeil T, Walsh D, O’Callaghan E. Labour and delivery complications and schizophrenia: case-control study using contemporaneous labour ward records. The British Journal of Psychiatry 2000;176:531-536.
Cannon M, Jones PB, Murray RM. Obstetric complications and schizophrenia: historical and meta-analytic review. The American Journal of Psychiatry 2002;159(7):1080-1092.
Cohler BJ, Gallant DH, Grunebaum HU, Weiss JL, Gamer E. Pregnancy and birth complications among mentally ill and mothers and their children. Social Biology 1975;22(3):269-278.
Compton MT. Consider schizophrenia from a prevention perspective. American Journal of Preventive Medicine 2004;61(2):178-185.
Howard LM, Goss C, Leese M, Thornicroft G. Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth. The British Journal of Psychiatry 2003;182:63-67.
Howard LM, Kumar C, Leese M. Thornicroft G. The general fertility rate in women with psychotic disorders. The American Journal of Psychiatry 2002;159(6):991-997.
Kinney DK, Yurgelun-Todd DA, Tohen M, Tramer S. Pre- and perinatal complications and risk for bipolar disorder: a retrospective study. Journal of Affective Disorders 1998;50:117-124.
Kunugi H, Nanko S, Murray RM. Obstetric complications and schizophrenia: prenatal underdevelopment and subsequent neurodevelopmental impairment. The British Journal of Psychiatry 2001;178 Suppl40:25-29.
Lea H, Riki VR, Devorah KF, Galia S, Leon E, Yoram S. Psychosocial and medical factors in pregnancy outcomes: a case study of Israely women. Social Science and Medcine 1995;40:567-571.
McDonald RL. The role of emotional factors in obstetric complications: a review. Psychosomatic Medicine 1968;30:222-237.
McNeil TF, Cantor-Graae E, Nordstrom LG, Rosenlund T. Are reduced head circumference at birth and increased obstetric complications associated only with schizophrenic psychosis? a comparison with schizo-affective and unspecified functional psychoses. Schizophrenia Research 1996;22:41-47.
McNeil TF, Kaij L. Obstetric complications and physical size of offspring of schizophrenic, schizophrenic-like, and control mothers. British Journal of psychiatry 1973;123:341-48.
Miller LJ, Finnerty M. Sexuality, pregnancy and childrearing among women with schizophrenia-spectrum disorders. Psychiatric Services 1996;47:502-506.
Miller LJ, Shah A. Major mental illness during pregnancy. Primary Care Update for OB/GYNS 1999;6:163-168.
Miller WH Jr, Bloom JD, Resnick MP. Chronic mental illness and perinatal outcome. General Hospital Psychiatry 1992;14:171-176.
Miller WH, Resnick MP, Williams MH, Bloom JD. The pregnant psychiatric inpatient: a missed opportunity. General Hospital Psychiatry 1990;12:373-378.
Mulder EJH, Robles de Medina PG, Huizink AC, Van den Bergh BRH, Buitelaar JK, Visser GHA. Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Human Development 2002;70:3-14.
Nimgaonkar VL, Ward SE, Agarde H, Weston N, Ganguli R. Fertility in schizophrenia: results from a contemporary US cohort. Acta Psychiatrica Scandinavia 1997;95:364-369.
Nilsson E, Lichtenstein P, Cnattingius S, Murray RM, Hultman CM. Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophrenia Research 2002;58:221-229.
Preti A, Cardascia L, ZenT, Pellizzari P, Marchetti M, Favaretto G, Miotto P. Obstetric complications in patients with depression- a population-based case-control study. Journal of Affective Disorders 2000;61:101-106.
Sacker A, Done DJ, Crow TJ. Obstetric complications in children born to patients with schizophrenia: a meta-analysis of case-control studies. Psychological Medicine 1996;26:279-287.
Sameroff AJ, Zax M. Perinatal characteristics of the offspring of schizophrenic women. The Journal of Nervous and Mental Disease 1973;157(3):191-199.
Sawa A, Snyder SH. Schizophrenia: diverse approaches to a complex disease. Science 2002;296(5568):692-695.
Sobel DE. Infant mortality and malformations in children of schizophrenic women. Psychiatric Quarterly 1961;35:60-64.
Sobell JL, Mikesell MJ, McMurray CT. Genetic and etiopathophysiology of schizophrenia. Mayo Clinic Preceedings 2002;77(10):1068-1082.
Thomas HV, Dalman C, David AS, Gentz J, Lewis G, Allebeck P. Obstetric complications and risk of schizophrenia: effect of gender, age at diagnosis and maternal history of psychosis. The British of Psychiatry 2001;179:409-414.
Wrede G, Mednick SA, Huttunen MO, Nilsson CG. Pregnancy and delivery complications in the births of an unselected series of Finnish children with schizophrenic mothers. Acta Psychiatric Scandinavica 1980;62:369-381.
Zou G. A modified poisson regression approach to perspective studies with binary data. American Journal of Epidemiology 2004;159:702-706.