臺灣博碩士論文加值系統

本研究是探討第三孕期婦女睡眠品質、憂鬱症狀以及身體活動量對懷孕結果的影響。研究採前曕性、相關描述性設計，研究對象共220位第三孕期婦女，在產前門診或媽媽教室以結構式問卷進行面對面的訪談。研究工具內容包括：睡眠品質、憂鬱症狀及三日身體活動三種量表。資料分析採用描述性統計、t-檢定、單因子變異數分析、卡方、皮爾森積差相關及邏輯式迴歸分析。研究結果顯示：（一）研究對象其懷孕結果以正向居多，非計劃性剖腹生產及真空吸引陰道分娩分別僅佔8.7％及20.2％，早產及低出生體重也分別僅佔3.2％及4.1％，平均新生兒出生週數為39.03±1.30週，平均出生體重為3177±424公克。（二）將近八成（79.5％）的孕期婦女有睡眠品質不良的問題，造成睡眠品質差的主要面向為「睡眠困擾」，而在睡眠困擾中又以「必須起來如廁」及「胎動」較為孕婦所惱。（三）研究對象約三成（34.5％）是屬於高憂鬱症狀，其中又以「身體症狀」最為嚴重，如「我睡得不安穩」、「我做任何事都覺得費力」等。（四）研究對象平日、假日及三日的身體活動之能量消耗都差不多，分別是
38.54 kcal/kg/day、38.58kcal/kg/day、38.56 kcal/kg/ day，而孕婦所從事的中重度身體活動都以散步、逛街或爬樓梯居多；且孕婦不論平日、假日或三日的身體活動能量消耗都較一般族群稍低。（五）研究對象之睡眠品質與憂鬱症狀呈現顯著正相關，表示睡眠品質愈好者，其憂鬱症狀愈輕；而睡眠品質及憂鬱症狀則與平日、假日及三日之身體活動量均未達顯著相關，但與假日、三日中重度之身體活動量均達顯著負相關，表示孕婦在中重度身體活動之能量消耗要達到一定的程度，才能改善睡眠品質、減輕憂鬱症狀。（六）探討與非計劃性剖腹生產的相關因素，結果顯示以初產婦、睡眠品質差者、以及身體活動量低者較多，並進一步探討各別睡眠變項與非計劃性剖腹生產的關係，顯示有剖腹生產者其睡眠時數較少，且睡眠困擾較多，在三日中重度身體活動量也較為低。（七）睡眠品質（PSQI）、三日身體活動量為非計劃性剖腹生產的重要預測變項，表示孕婦整體性睡眠品質愈差及身體活動量愈低者，其發生剖腹生產的機率愈高。（八）真空吸引陰道分娩的有關的因素為憂鬱症狀，研究結果顯示使用真空吸引陰道分娩的產婦中約六成（58.8％）為高憂鬱症狀。（九）在早產的婦女中八成（85.7）為經產婦。（十）低出生體重則與個人背景資料、睡眠品質、憂鬱症狀及身體活動均未達顯著相關。
本研究發現睡眠品質較差及身體活動量較低者，其發生剖腹生產的機率較高，以及真空吸引陰道分娩的婦女中約有六成為高憂鬱症狀；且一般的身體活動對於睡眠品質及憂鬱症狀沒有影響，只有在中重度的身體活動量可以改善睡眠品質及憂鬱症狀。因此，建議醫護人員多鼓勵孕期婦女從事中重度的身體活動，如：散步、逛街、爬樓梯或做產前運動，盡量避免採取靜態的活動，以助長睡眠品質，降低憂鬱症狀，減少負面懷孕結果的發生。

The purposes of this research were to examine the effects of sleep quality, depressive symptoms, and physical activities on pregnancy outcomes among pregnant women in their third trimester.
With prospective and descriptive correlational design, the subjects of this research were 220 pregnant women in their third trimester. At antepartum outpatient clinics, a face-to-face interview with structured questionnaires was conducted toward the subjects. The study variables included socio-demographic characteristics, sleep quality, depressive symptoms, and physical activities. The data was analyzed by descriptive statistics, t-test, one way ANOVA, chi-square, pearson correlation and logistic regression.
The results showed: （1）Most of women in the research had positive pregnancy outcomes. Non-plan cesarean section and vacuum vaginal delivery only took 8.7% and 20.2% respectively. The rate of preterm birth and low birth weight were 3.2% and 4.1% respectively. Average gestational age of newborn was 39.03±1.30 weeks. Average birth weight was 3177 ± 424 grams.（2）79.5% pregnant women had poor sleep quality problems. The main problem was sleep disturbance.（3）34.5% of research subjects had serious depressive symptoms. The most severe of all was somatic complaints.（4）The research subjects had nearly the same energy expenditure on record of ordinary days, holidays, and 3 days. They were 38.54 kcal/kg/day、38.58 kcal/kg/day、38.56 kcal/kg/ day respectively. The main moderate-to-vigorous physical activities of pregnant women were strolling, shopping, and climbing stairs.（5）The sleep quality and depressive symptoms of the research subjects were positively correlated, which indicated that the better the sleep quality, the less the depressive symptoms. No significant correlations are found between sleep quality and depressive symptoms, and the amount of physical activities on ordinary days, holidays, and the 3 days. However, negative correlations were evident in moderate-to-vigorous physical activities on holidays and the 3 days. That indicated pregnant women need a certain amount of energy expenditure in moderate-to-vigorous physical activities to improve sleep quality and reduce depressive symptoms.（6）Examined factors related to non-plan cesarean section, the results revealed that primipara, poor sleep quality, and low physical activities took more risk of non-plan cesarean section. Further examined the correlation between individual sleep variables and non-plan cesarean section, it showed that women who suffered from non-plan cesarean section have had fewer sleep hours, more sleep disturbance, and fewer moderate-to-vigorous physical activities. （7）Sleep quality (PSQI) and physical activities are important predictive factors of non-plan cesarean section. It indicated that pregnant women who had poor sleep quality and low physical activities had higher risk of non-plan cesarean section. （8）Depressive symptoms was a related factor of vacuum vaginal delivery. 58.8% of pregnant women who suffered from vacuum vaginal delivery have severe depressive symptoms.
From this research it was found that a higher risk of non-plan cesarean section was found in pregnant women who experienced poorer sleep quality and less amount of physical activities. 60% of pregnant women who adopted for vacuum vaginal delivery suffered from serious depressive symptoms. Only moderate-to-vigorous physical activities could improve sleep quality and depressive symptoms. Thus, it is recommended that health practitioners should encourage pregnant women to do some moderate-to-vigorous activities, such as stroll, and antepartum exercise. Pregnant women should avoid static activities to improve sleep quality, decrease depressive symptoms, and decrease negative pregnancy outcomes.

第一章 緒論
第一節 研究動機及重要性…………………………………………………….1
第二節 研究目的………………………………………………………….……5
第三節 研究問題………………………………………………………….……5
第四節 名詞界定………………………………………………………….……6
第二章 文獻查證
第一節 睡眠的概念…………………………………………………………….9
第二節 孕期睡眠與懷孕結果…………………………………………………11
第三節 孕期憂鬱與懷孕結果…………………………………………………16
第四節 身體活動與懷孕結果…………………………………………………20
第五節 個人背景資料與懷孕結果……………………………………………29
第六節 睡眠、憂鬱與身體活動之相關文獻探討……………………………30
第三章 研究方法
第一節 研究設計………………………………………………………………34
第二節 研究架構………………………………………………………………34
第三節 研究對象………………………………………………………………35
第四節 研究工具與信效度……………………………………………………35
第五節 研究步驟………………………………………………………………43
第六節 資料處理與統計分析…………………………………………………44
第四章 研究結果
第一節 孕期婦女個人背景資料之描述分析…………………………………..47
第二節 孕期婦女睡眠品質、憂鬱症狀、身體活動及懷孕結果之描述分析…50
第三節 個人背景資料與睡眠品質、憂鬱症狀及身體活動之關係……………59
第四節 睡眠品質、憂鬱症狀及身體活動之關係………………………………73
第五節 個人背景資料、睡眠品質、憂鬱症狀及身體活動對懷孕結果之影響75
第六節 影響懷孕結果之重要變項……………………………………………...91
第五章 討論
第一節 孕期婦女睡眠品質、憂鬱症狀與身體活動之現況描述……………...94
第二節 孕期婦女個人背景資料與睡眠品質、憂鬱症狀及身體活動之關係..101
第三節 孕期婦女個人背景資料與睡眠品質、憂鬱症狀及身體活動之影響..103
第四節 孕期婦女睡眠品質、憂鬱症狀及身體活動之關係…………………..106

第六章 研究結果、限制與建議
第一節 研究結論………………………………………………………………109
第二節 研究建議………………………………………………………………111
第三節 研究限制………………………………………………………………113

參考資料
中文部份………………………………………………………115
英文部份………………………………………………………118

附錄
附錄一 問卷效度之專家名單
附錄二 參加研究同意書
附錄三 問卷
附錄四 匹茲堡睡眠品質量表計分方法
附錄五 研究工具使用同意書

中文部份：
行政院國民健康局（2004，1月14日）．生育與健康．2006年7月1日
取自http://health99.doh.gov.tw/links/.
王國恭（1996）．早產．當代醫學，23（6），470-475。
王淑芳（1999）．影響婦女孕期運動行為之相關因素研究．未發表碩士論文，台北：國立臺灣師範大學衛生教育研究所
包怡芬（2002）．懷孕婦女與有氧舞蹈．大專體育，62，146-151。
呂宏淵（2003）．運動對懷孕的影響．國民體育季刊，32（1），26-30。
呂昌明、林旭龍、黃奕清、李明憲、王淑芳（2001）．身體活動自我報告量表之效度及信度的研究－以Polar Vantage NV心搏率監測器為效標．衛生教育學報，15，99-114。
呂昌明、李明憲、陳錫琦（2000）．都市國小學童身體活動及其影響因素之研究．衛生教育學報，14，95-111。
朱嘉華（1998）．國小教師身體活動與睡眠品質之相關研究．未發表之碩士論文，台北：國立台灣師範大學體育研究所。
李淑霞、吳淑瓊（1998）．家庭照護者負荷與憂鬱之影響因素．護理研究，6（1），57-67。
李裕菽、黃奕清、高毓秀（2005）．台北巿立醫院臨床護理人員身體活動及其相關因素之探討．護理研究，13（4），281-292。
李燕鳴、傅振宗（2001）．產婦年齡與不良懷孕結果的探討-花蓮縣三年生產記錄分析．慈濟醫學，13（2），95-103。
李麗晶（2001）．運動與懷孕．大專體育，52，144-150。
林秀娟（2004）．縱貫性研究：孕產婦憂鬱之影響因素探討．未發表碩士論文，桃
園：長庚大學護理學研究所。
林宇軒、沈易利（2003）．婦女身體活動與產程進展速度之相關研究．未發表碩士
論文，台北：國立台灣體育學院休閒運動管理研究所。
林嘉玲、蘇東平、張媚（2003）．機構老人之睡眠品質及其相關因素．台灣醫學，
7（2），174-183。
姚建安、呂碧鴻（1996）．睡眠與內科疾病．基層醫學，11（12），231-232。
柯慧貞、黃耿妍、李毅達、莊麗珍（1996）．「貝氏憂鬱量表」應用於國人周產期
憂鬱症篩選之適用性．中華醫誌，15（3），208-219。
高毓秀（2002）．職埸員工運動行為改變計畫之實驗研究－跨理論模式之應用．未
發表之博士論文．台北：國立台灣師範大學衛生教育所。
徐禎美（2003）．第三孕期婦女的壓力、社會支持與憂鬱．未發表碩士論文，高
雄：高雄醫學大學護理學研究所。
許秀桃（1994）．身體活動對懷孕婦女體重變化量、血壓、安靜心跳率及血液生化
值的影響．體育學報，18，267－270。
陳美妃、王秀紅（1995）．老年婦女睡眠品質及其相關因素．護理研究，3（4），323-333。
張艾如（1995）．自覺的親子關係與親密關係、性格特質及懷孕感受對產前憂鬱症之影響．未發表碩士論文，桃園：中原大學心理學研究所。
曾英芬、陳彰惠、王惠珍、蔡秋月 (1994)．比較在家中與坐月子中心婦女的產後
適應．高雄醫學雜誌，10，458-468。
張宏亮（2000）．運動能提升睡眠品質原因．健康世界，95-98。
張淑紅、蕭芝殷、吳思儀、張嫚純、林婉如（2005）．「運動與憂鬱症狀相關之研究」-以大台學生為例．醫護科技學刊，7（3），258-265。
黃俊元、陳維昭、楊銘欽（1996）．剖腹產對產婦健康之影響從影響剖腹產利用之產婦因素談起．台北：國立台灣大學醫學院公共衛生研究所。
雷啟文、林旭龍（2003）．中年婦女身體活動與睡眠品質之相關研究．衛生教育學報，20，151-169。
葉世彬(2004)．睡眠清醒週期紊亂的相關疾病．台灣醫界，46（2），17-19。
黎俊彥、吳家碧、賴正全、林威秀（2002）．女大學生身體活動與睡眠品質之相關
研究．體育學報，32，59-68。
蕭伃伶（2000）．促進健康妊娠．於陳彰惠總校閱，產科護理學（688-753頁）．台北：五南。
蕭伃伶（2005）．妊娠期間的護理．於余玉眉總校閱，產科護理學（第三版，166-193頁）．台北：新文京。
鍾聿琳（1998）．產科照護之再省思--由減少剖腹產談起．護理雜誌，45（5），61-65。
二、英文部份：
Abu-Heija, A. T., & Chalabi, H. E. (1997). Great grand multiparity: is it a risk?
International Journal of Gynaecology and Obstetrics, 59(3), 213-216.
Alderman, B. W., Zhao, H., Holt, V. L., Watts, D. H., & Beresford, S. A. (1998). Maternal
physical activity in pregnancy and infant size for gestational age. Annals of Epidemi-
ology, 8(8), 513-519.
Allgoewer, A., Wardle, J., Steptoe, A. (2001). Depressive symptoms, social support, and personal health behaviors in young men and women. Health Psychology, 20(3), 223-227.
American College of Obsterricians and Gynecologist. (1994). Exercise during pregnancy and the prenatal period. Washing, DC: ACOG.
American College of Sports Medicine. (2000). ACSM's guidelines for exercise testing and
prescription (6th ed). Philadelphia : Lippincott Williarms & Wilkins.
Armstrong, K., Edwards, H. (2004). The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women . International Journal of Nursing Practice , 10(4), 177-94.
Babkoff, H., Capy, T., & Mikulinecer, M. (1991). Subjective sleepiness rating: The effects
of sleep deprivation, circadian rhythmicity and cognitive performance. Sleep, 14(6), 534-539.
Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50 (5), 275-285.
Beckmann, C. R. B., & Beckmann, C. A. (1990). Effects of a structured antepartum
exercise program on pregnancy and labor outcome in primiparas. Journal of Reproductive Medicine, 35(7), 704-709.
Bolton, H. L., Hughes, P. M., Turton, P., & Sedgwick, P. (1998). Incidence and demographic correlates of depressive symptoms during pregnancy in an inner London population. Journal of Psychosomatic Obstetrics and Gynecology, 19(4), 202-209.
Bouchard, C., Shephard, R. J., & Stephens, T. (1993). Physical activity, fitness, and health: Concensus statement. Champaign, IL: Human Kinetics.
Bungum, T. J., Peaslee, D. L., Jackson, A. W., & Perez, M. A. (2000). Exercise during
pregnancy and type of delivery in nulliparae. Journal of Obstetric , Gynecology,
and Neonatal Nursing, 29(3), 258-264.
Buysse, D. J., Renolds III, C. F., Monk, T. H., Berman, S. U., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28 (2), 193-213.
Branchey, M., Branchey, L., & Nadler , R. D. (1971). Effects of estrogen and progesterone
on sleep patterns of female rates. Physiology & Behavior, 6(6), 743-746.
Brenner, I. K. M., Wolfe, L. A., Monga, M., McGrath, M. J. ( 1999). Physical conditioning
effects on fetal heart rate responses to graded maternal exercise. Medicine and Science
in Sports and Exercise, 31(6), 792-799.
Casperson, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2) , 126-131.
Choo, V. (2002). WHO reassesses appropriate body-mass index for Asian populations. Lancet, 360(9328), 235.
Chou, F. H., Lin, L. L., Cooney, A. T., Walker, L. O., & Riggs, M. W. (2003).
Psychosocial factors related to nausea, vomiting, and fatigue in early
pregnancy. Journal of Nursing Scholarship, 35(2), 119-125.
Chrousos, G. P., Torpy, D. J., & Gold, P. W. ( 1998). Interactions between the hypothalamicptuitary-adrenal axis and the female reproductive system: Clinical implications. Annals of Internal Medicine, 129, 229-240.
Chung, T. K., Lau, T. K., Yip, A. S., Chiu, H. F., & Lee, D. T. (2001). Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine, 63(5), 830-834.
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression
development of the 10-item Edinburgh Postnatal Depression Scale. British
Journal of Psychiatry, 150, 782-786.
Clapp, J. F. (1991). Exercise and fetal health. Journal of Developmental Physiology.
15(1), 9-14.
Clapp, J. F., Kim, H., Burciu, B., & Lopez, B. (2000). Beginning regular exercise in early
pregnancy: Effect on fetoplacetal growth. American Journal of Obstetrics and
Gynecology, 183(6), 1484-1488.
Clapp, J. F., Kim, H., Burciu, B., Schmidt, S., Petry, K., Lopez, B. (2002). Continuing regular exercise during pregnancy : Effect of exercise volume on fetoplacental growth. American Journal of Obstetrics and Gynecology, 186(1),142-147.
Coren, S. (1996). Sleep thieves. New York: The free press.
Da Costa, D., Larouche, J., Dritsa, M., & Brender, W. (2000). Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders, 59(1), 31-40.
Da Costa, D., Rippen, N., Dritsa, M., Ring, A. (2003). Self-reported leisure-time physical activity during pregnancy and relationship to psychological well-being. Journal of Psychosomatic Obstetrics and Gynecology. 24(2), 111-119.
Darling, M. R., & Hawkins, D. F. ( 1981). Sex hormones in pregnancy. Clinics in
Obstetrics and Gynaecology, 8(2), 405-419.
Davis, D. C. (1996). The discomforts of pregnancy. Journal of Obstetric, Gynecologic,
and Neonatal Nursing, 25(1), 73-81.
Dayan, J., Creveuil, C., Herlicoviez, M., Herbel, C., Baranger, E., Savoye, C., &
Thouin, A. (2002). Role of anxiety and depression in the onset of spontaneous
preterm labor. American Journal of Epidemiology, 155(4), 293-301.
Dinges, D. F., Pack, F., Williams, K., Gillen, K. A., Powell, J. W., Ott, G. E., Aptowicz, C.,
& Pack, A. I. (1997). Cumulative sleepiness, mood disturbance, and psychomotor
vigilance performance decrements during a week of sleep restricted to 4-5hours per
night. Sleep, 20(4), 267-267.
Doi, Y., Mionwa, M., Uchiyama, M., Okawa, M., Kin, K., Shibui, K.,＆Kamei,Y.（2000）.
Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index(PSQI-J) in psychiatric disordered and control subjects. Psychiatry Research, 97(2-3), 165-172.
Dzaja., A., Arber, S., Hislop, J., Kerkhofs, M., Kopp,C., Pollmacher, T., Polo-Kantola, P.,
Skene, D. J., Stenuit, P., Tobler, I., & Porkka-Heiskanen. (2004). Women’s sleep in
health and disease. Journal of Psychiatric Research, 39(1), 55-76.
Ecker, J. L. (2004). Once a pregnancy, always a cesarean? Rationale and feasibility of a randomized controlled trial. American Journal of Obstetrics and Gynecology, 190(2), 314-318.
Eliyahu, S., Weiner, E., Nachum, Z, & Shalev, E. (2002). Epidemiologic risk factors for
preterm delivery. Israel Medical Association Journal: Imaj, 4(12), 1115-1117.
Evans, J., Heron, J., Francomb, H,. Oke, S., & Golding, J. (2001). Cohort study of
depressed mood during pregnancy and after childbirth. British Medical Journal,
323(7307), 257-260.
Fang, J., & Fishbein, W. (1996). Sex differences in paradoxical sleep: Influences of estrus cycle and ovariectomy. Brain Reserch, 734(1-2), 275-285.
Friede, A., Baldwin W., & Rhodes P. H. (1987) . Young matermal age and infant mortality:The role of low birth weight. Public Health Rep,102,192-19
Friedman, E. A. (1978). Labor: clinical evaluation and management. ( 2nd ed.). New York: Appleton-Century-Crofts.
Grantham-McGregor, S. M., Lira, P. I., Ashworth, A., Morris, S. S., & Assuncao, A.
M .(1998). The development of low birth weight term infants and the effects of the
environment in northeast Brazil. The Journal of Pediatrics, 1328(4),661-666.
Hatch, M., Levin , B., Shu, X-O., Susser, M. (1998). Maternal leisure-time
exercise and timely Delivery. American Journal of Public Health, 88(10),
1528-1533.
Hedmann, C., Pohjasvaara, T., Tolonen, U., Suhonen-Malm, A. S., & Myllyla, V. V.
(2002). Effects of pregnancy on mothers' sleep. Sleep Medicine, 3(1), 37-42.
Hertz, G., Fast, A., Feinsilver, S. H., Albertario, C. L., Schulman, H., & Fein, A.
M. (1992). Sleep in normal late pregnancy. Sleep, 15(3), 246-251.
Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psycholog, 63(3), 445-453.
Hood, B. D., & Kennely, G. (2004). Determinants of sleep quality in the healthy
aged:The role of physical, psychological, circadian and naturalistic light variables.
Age and Ageing, 33 (2), 159-165.
Horns, P. N., Ratcliffe, L. P., Leggett, J. C., & Swanson, M. S. (1996). Pregnancy outcomes among active and sedentary primiparous. American Journal of Obstetrics and Gynecology, 25(1), 49-54.
Huang, Y. C., & Malina, R. M. (1996). Physical activity and correlates of estimated energy expenditure in Taiwanese adolescents 12-14 years of age. American Journal of Human Biology, 8, 225-236.
Hung, C. M., Carter, P. A., & Guo, J. L. (2004). Sleep and daytime sleepiness in
depressed and non-depressed mothers during early postpartum. The Journal of
Nursing Research, 12(4), 287-296.
Ibáñez, L., Ferrer, A., Marcos, M. V., Hierro, F. R., & de Zegher, F. (2000). Early
puberty: Rapid progression and reduced final height in girls with low birth
weight. American Academy of Pediatrics, 106(5), e72.
John, U., Meyer, C., Rumpf, H. J., & Hapke, U. (2005). Relationships of psychiatric
disorders with sleep duration inan adult general population sample. Psychiatry
Research, 39(6), 577-583.
Josefsson, A., Berg, G., Nordin, C., & Sydsjo, G. (2001). Prevalence of depressive
symptoms in late pregnancy and postpartum. Acta Obstetricia et Gynecologica
Scandinavica, 80(3), 251-255.
Kardel, K. R., & Kase, T. (1998). Traning in pregnancy women: Effects on fetal
development and birth. American Journal of Obstetrics and Gynecology, 178(2),
280-286.
Kelly, R. H., Russo, J., & Katon, W. (2001). Somatic complaints among pregnant
women cared for in obstetrics: Normal pregnancy or depressive and anxiety
symptom amplification revisited? General Hospital Psychiatry, 23(3), 107-113.
King, J.C. (2000). Physical of pregnancy and nutrient metabolism. American Journal of
Climical Nutrition, 71(5), 1218-1225.
Kitamura, T., Shima, S., Sugawara, M., & Toda, M. A. (1993). Psychological and social
correlates of the onset of affective disorders among pregnant women.
Psychological Medicine, 23(4), 967-975.
Kohout, F. J., Berkman, L. F. , Evans, D. A., & Cornoni-Huntley, J. (1993). Two Shorter Forms of the CES-D Depression Symptoms Index. Center for Health Services Research, 5(2), 179-193.
Koltyn, K. F., & Schultes, S. S.(1997). Psychological effects of an aerobic exercise session and a rest session following pregnancy. Journal of Sports Medicine and Physical Fitness, 37(4), 287-291.
Kurki, T., Hiilesmaa, V., Raitasalo, R., Mattila, H., & Ylikorkala, O. (2000). Depression
and anxiety in early pregnancy and risk for preeclampsia. American Journal of
Obstetrics and Gynecology, 95(4), 487-490.
Lee, I. M., Rexrode, K. M., Cook, N. R., Mason, J. E., & Buring, J .E. (2001). Physical activity and coronary heart disease in women, is〝no pains no gain〞Passe？The Journal of the American Medical Association, 288(11), 1447-1454.
Lee, K. A., & Gay, C. L. (2004). Sleep in late pregnancy predicts length of labor and type of delivery. American Journal of Obstertrics and Gynecology,191(6), 2041-2046.
Leung, P. L., Hui, D. S., Leung, T. N., Yuen, P. M., & Lau, T. K. (2005). Sleep
disturbances in Chinese pregnancy women. British Journal o f Obstetric and
Gynaecology, 112, 1568-1571.
Lindgren, K. (2001). Relationships among maternal-fetal attachment, prenatal
depression,and health practices in pregnancy. Research in Nursing and Health, 24
(3), 203-217.
Lopes, E. A., Carvalho, L. B., Seguro, P. B., Mattar, R., Silva, A, B., Prado, L, B., & Prado, G. F. (2004). Sleep disorders in pregnancy. Arquivos de Neuro-Psiquiatria, 62(2a), 217-221.
Lundy, B., Jones, N. A., Field, T., Nearing, G., Davalos, M., Pietro, P. A., Schanberg, S.,
& Kuhn, C. (1999). Prenatal depression effects on neonates. Infant Behavior and
Development, 22(1), 119-129.
Lutter & Jaffee. (1996). Lutter, J. M., & Jaffee, L. (1996). The bodywise women. Champaign, IL: Human Kinetics.
Marcus, S. M., Flynn, H. A., F., & Blow, F. C. (2003). Depressive symptoms among pregnancy women screened in obstetrics settings. Journal of Women's Health, 12(4), 373-379.
Meleis, A. I., & Trangenstein, P. A . (1994) .Facilitating transitions: Redefinition of the nursing mission. Nursing Outlook, 42(6), 255-259.
Mindell, J. A., & Jacobson, B. J. (2000). Sleep disturbances during pregnancy. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 29(6), 590-597.
Motl, R. W., Birnbaum, A. S., Kubik, M. Y., & Dishman, R. K. (2004). Naturally
occurring changes in physical activity are inversely related to depressive
symptoms during early adolescence. Psychosomatic Medicine, 66(3), 336-342.
Nesbitt , T. S., Gilbert, W. M., & Herrchen, B. (1998) . Shoulder dystocia and associated risk factors with macrosomic infants born in California. American Journal of Obstetrics & Gynecolog, 179(2), 476-480.
Nordhagen, I. H., Sundgot-Borgen, J.(2002). Physical activity among pregnant women in relation to pregnancy-related complaints and symptoms of depression. Tidsskrift for Den Norske Laegeforening, 122(5), 470-474. from abstract.
O’Hara, M. W. (1986 ). Social support, life events, and depression during pregnancy
and the puerperium. Archives of General Psychiatry, 43 (6), 569-573.
O’Hara, M. W., & Kohout, F. J., & Wallace, R. B. (1985). Depression among the rural elderly. A study of prevalence and correlates. Journal of Nervous and Mental Disease, 173 (10), 9-17.
O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression : A
meta-analysis. International Review of Psychiatry, 8, 37-54.
Pajulo, M., Savonlahti, E., Sourander, A., Helenius, H., & Piha, J. (2001). Antenatal depression, substance dependency and social support. Journal of Affective Disorders, 65(1), 9-17.
Pate, R., Pratt, M., Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., et
al.(1995). Physical activity and public health ,a recommendation from the Centers
for Disease Control and Prevention and the American College of Sports Medicine
The Journal of American Medical Association, 1273(5), 402-407.
Penninx, B. W., Rejeski, W. J., Pandya, J., Miller, M. E,. Di Bari, M., Applegate, W. B., Pahor, M. (2002). Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 57(2), 124-32.
Pfost, K. S., Stevens, M. J., & Lum, C. U. (1990). The relationship of demographic
variables, antepartum depression, and stress to postpartum depression. Journal of
Clinical American Journal of Obstetrics and Gynecology, 191(6), 2041-2046.
Pilcher, J. J., Ginter, D. R., & Sadowsky, B. (1997). Sleep quality versus sleep quality:
Relationships between sleep and measures of health, well-being and sleepiness in
college students. Journal of Psychosomatic Research, 42(6), 583-596.
Pilcher, J. J., Schoeling, S. E., & Prosansky, C. M. (2000). Self-report sleep habits as
predictors of subjective sleepiness. Behavioral Medicine,25(4), 161-168.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in
the general population. Applied Psychological Measurement, 1(3), 385-401.
Rahman, A., Iqbal., Z., Bunn, J., Lovel, H., & Harrington R. (2004). Impact of maternal
depression on infant nutritional status and illness :a cohort study. Archives of
General Psychiatry, 61(9), 946-952.
Recreation & Dance. (1998). Physical activity and depression among older adults.
Journal of physical Education , 69(9), 16-18.
Ritter, C., Hobfoll, S. E., Lavin, J., Cameron, R. P., & Hulsizer, M. R. (2000). Stress,
psychosocial resources, and depressive symptomatology during pregnancy in
low-income, inner-city women. Health Psychology, 19(6), 576-585.
Rofe, Y., Blittner, M., & Lewin, I. (1993). Emotional experiences during the three
trimesters of pregnancy. Journal of Clinical Psychology, 49(1), 3-12.
Sachar, E. J., Roffwarg, H. P., Gruen, P. H., Altman, N., & Sassin, J. (1976).
Neuroendocrine studies of depressive illness. Pharmakopsychiatr
Neuropsychopharmakol, 9(1), 11-17.
Santiago, J. R., Nolledo, M. S., Kinzler, W., & Santiago, T. V. ( 2001). Sleep and sleep
disorders in pregnancy. Annals of Internal Medicine, 134(5), 396-408.
Satin, A. J., Leveno, K. J., Sherman, M. L., Reedy, N. J., Lowe, T. W., & Mclntire, D. D (1994). Maternal youth and pregnancy outcomes: Middle school versus high school age groups compared with women beyond the teen years. American Journal Obstet Gynecol, 171(1), 184-187.
Schramm, W. F., Stockbauer, J. W., & Hoffman, H. J. (1996). Exercise, Employmen, Other Daily Activities, and Adverse Pregnancy outcomes. American Journal of Epidemiology, 143(3), 211-219.
Schorr, S. J., Chawla,A ., Devidas, M., Sullivan, C. A., & Morrison , J. C. (1998). Sleep
Patterns in pregnancy: a longitudinal study of polysomnography recordings during
pregnancy. Journal of Perinatology, 18(6), 427-430.
Schumacher, K. L., & Meleis, A .I . (1994). Transitions: a central concept in nursing., - The Journal of Nursing Scholarship: Image, 26(2), 119-127.
Sharma, V., Smith, A., & Khan., M. (2004). The relationship between duration of labour, time of delivery, and puerperal psychosis. Journal of Affective Disorders, 83, 215-220.
Sternfeld, B., Quesenberry, C. P., Eskenazi, B., & Newman, L. A. (1995). Exercise during pregnancy and pregnancy outcome. Medicine and Science in Sports and Exercise, 27(5), 634-640.
Strange, L. B. (2004). Sleep patterns of woman at risk for the development of preterm
labor. Unpublished doctoral dissertation, Emory University, Atlanta.
St John, E. B. S., Nelson, K. G., Cliver, S. P., Bishnoi, R. R., & Goldenberg, R. L.(2000). Cost of neontal care according to gestational age at birth and survival status. Americian Journal of Obstetrics and Gyneology, 182(1), 170-175.
Suzuki, K., Ohida ,T., Sone, T., Takemura, S., Yokoyama, E., Miyake, T., Harano, S.,
Nozaki, N., Motojima, S., Suga, M., & Ibuka, E. (2003). An epidemiological study
of sleep problems among the Japanese pegnant women. Nippon Koshu Eisei
Zasshi-Janpanses Journal of Public perinatology, 50(6), 526-539.From abstract.
Towner, D., Castro, M. A., Eby-Wilkens, E., Gilbert, W. M. (1999) . Effect of mode of delivery in nulliparous women on neonatal intracranial injury. The New England Journal of Medicine. 341(23), 1709-1714.
U.S Department of Health & Human Services. (1998). Depression,Clininian’s
Handbook of Preventive Services (pp.240-245). Washington DC: U.S. Government
Printing Office.
Van Dinter, M. (1991). Ptyalism in pregnancy women. Journal of Obstetric, Gynecologic,
and Neonatal Nursing, 20(3), 206-211.
Wallace, A. M., Boyer, D. B., Dan, A. (1986). Aerobic exercise, maternal self-esteem
and physical discomforts. Journal of nurse-midwifery,31(6), 255-262.
Welk, G. J., Differding, J. A., Thormpson, R. W., Rlair, S. N., Dziura, J., & Hart,
P. (2000). The utility of the digi-walker step counter to assess daily physical
activity patterns. Medicine and Science in Sports and Exercise,32(suppl.9), s481-
s488.
Wilkerson, D. S., Volpe, A . G., Dean, R. S., & Titus, J. B. (2002). Perinatal complications as predictors of infantile autism. International Journal of Neuroscience, 112(9), 1085-1089.
Wilkie, G., & Shapiro, C. M. (1992). Sleep deprivation and the postnatal blues. Journal of Psychosomatic Research, 36(4), 309-316.
Worth, J., Onyeije, C. I., Ferber, A., Pondo, J. S., & Divon, M. Y. (2002). The association between fetal and maternal sleep patterns in third-trimester pregnancies. American Journal of Obstertrics Gynecology, 186(5), 924-925.
Yonkers, K. A., Ramin, S. M., Rush, A. J., Navarrete, C. A., Carmody, T., March, D.,
Heartwell, S. F., & Leveno, K. J. (2001). Onset and persistence of postpartum
depression in an inner-city Maternal health clinic system. American Journal of
Psychiatry, 158(11), 1856-1863.
Zeanah, M., & Schlosser, S. P. (1993). Adherence to ACOG guidelines on exercise during pregnancy: effect on pregnancy outcome. Journal of Obstetrics , Gynecology,
and Neonatal Nursing, 22(4), 329-335.
Zhang, J., & Savitz, D. A. (1996). Exercise during pregnancy among US women.
Annals of Epidemilogy , 6(1), 53-59.
Zimmer-Gembeck, M. J., & Helfand, M. (1996). Low birth weight in a public prenatal
care program: Behavioral and psychosocial risk factors and psychosocial
intervention. Social Science & Medicine, 43(2), 187-197.
Zuckerman, B., Amaro, H., Bauchner, H., & Cabral, H. (1990). Depressive symptoms
during pregnancy: Relationship to poor health behaviors. American Journal of
Obstetrics and Gynecology, 160(5), 1107-1111.