臺灣博碩士論文加值系統

便秘是懷孕婦女常見的問題，便秘不僅引起生理不適外，還造成精神無法集中做事。本研究目的在了解婦女之於懷孕期便秘的症狀、影響因素及處置。本研究係以回溯性研究方法，以懷孕之婦女為研究對象，採立意取樣，於台中某區域醫院之產科門診為研究場所。採用結構性問卷，包括人口學、孕期因素、生活型態因素(飲食、身體活動、睡眠品質)、便秘症狀與處置。收案日期於105年7月至105年9月，第一孕期收案62名，第二孕期65名，第三孕期53名，共180名，所收集之資料以SPSS 19.0 for Windows統計軟體進行分析。結果顯示約七成的各期婦女自覺懷孕後的便秘症狀比懷孕前症狀更為嚴重(p< .01）；人口學、孕期因素、飲食型態及身體活動和便秘症狀統計上無顯著差異，睡眠品質和懷孕便秘症狀在統計上呈低度正相關（r= .24，p< .01），且它為孕後便秘的一預測因子；懷孕期間便秘的處置種類與便秘症狀呈正相關（r=.33，p< .01）。因此，本研究結論是睡眠為影響孕期便秘的因素，而飲食和身體活動則非為懷孕便秘的影響因素。

Constipation is a common problem among pregnant women. It not only causes physical discomfort but also makes their spirit not concentrated on doing something. The purpose of this study was to explore the influencing factors and management of constipation among women during pregnancy. The research was designed as a retrospective study. The subjects recruited were women diagnosed pregnancy. A purposive sampling was conducted. The research place was the obstetrics’ outpatient services of a regional hospital in Taichung. A structured questionnaire used included demographic data, pregnant factors, life habit factors (diet, physical activity and sleep quality), constipation patterns and the management of constipation. The subjects recruited from July 2016 to September 2016. Sixty two cases were received in the first trimester, 65 in the second trimester, and 53 in the third trimester. The number of total enrolled ones is 180. The data collected were analyzed with SPSS 19.0 for Windows statistical software. The results of this study were shown as follows：(1) About seventy percent of women in each stage of pregnancy perceived their constipations after pregnancy were more serious than pre-pregnant ones (p< .01). (2) There were no statistically significant differences in demographics, gestational factors, diet patterns, physical activities and constipation symptoms. There was a statistically significant low and positive correlation between sleep quality and pregnant constipation (r=.24, p< .01). Furthermore, it was a predictor of constipation after pregnancy. (3) During pregnancy the kinds of constipation management had a positive correlation with constipation (r=.33, p<.01). Therefore, this study concluded that sleep was a factor affecting constipation during pregnancy, while diet and physical activity were not factors affecting pregnancy constipation.

目錄
中文摘要……………………………………………………….........Ⅰ
英文摘要……………………………………………………….........Ⅱ
目錄…………………………………………………………….........Ⅳ
圖目錄………………………………………………………….........Ⅶ
表目錄……………………………………………………….............Ⅷ
第一章 前言
第一節 研究動機與重要性………………………………………………..1
第二節 研究目的…………………………………………………………..1
第三節 研究問題…………………………………………………………..2
第四節 研究假設…………………………………………………………..2
第五節 名詞解釋…………………………………………………………..3
第二章 文獻查證
第一節 與孕婦便秘有關之研究…………………………………………..7
第二節 懷孕期間便秘的處置……………………………………………16
第三節 便秘相關的研究工具……………………………………………19
第三章 研究方法
第一節 研究設計…………………………………………………………23
第二節 研究架構…………………………………………………………23
第三節 研究樣本數………………………………………………………25
第四節 研究對象及場所…………………………………………………26
第五節 研究工具之信效度………………………………………………27
第六節 研究步驟及資料收集過程………………………………………33
第七節 資料處理…………………………………………………………35
第八節 研究對象人權之倫理考量…………………………………….....39
第九節 資料分析………………………………………………………….39
第四章 研究結果
第一節 描述性資料分析分析…………………………………………….42
第二節 人口學、孕期、生活型態因素及便秘處置與便秘症狀之關係…………52
第三節 各孕期婦女之孕前、孕後便秘症狀比較及在生活型態因素上之差異……………56
第四節 影響孕後便秘症狀之預測力………………………………….....62
第五章 討論
第一節 人口學、孕期、生活型態因素、便秘處置與便秘症狀之關係……….64
第二節 各孕期婦女孕前、孕後便秘症狀比較及在生活型態因素上之差異………………….69
第三節 睡眠為預測孕後便秘症狀之因子……………………………….70
第四節 孕期便秘症狀之處置…………………………………………….70
第六章 結論與建議
第一節 研究結論………………………………………………………….71
第二節 研究限制及建議………………………………………………….72
參考文獻
中文部分…………………………………………………………………….74
英文部分…………………………………………………………………….81
附錄
附錄一 孕期身體活動問卷中文版授權同意書……………….………….88
附錄二 匹茲堡睡眠品質量表中文版授權證明………………………….90
附錄三 人體試驗計畫同意書………………………………………….....91
附錄四 研究問卷效度檢定內容效度專家名單………………………….92
附錄五 專家效度內容………………………………………………….…93
附錄六 人體試驗委員會受試者同意書.......……………………………100
附錄七 婦女懷孕期間之便秘症狀、影響因素及處置之正式問卷…...103
附錄八 臺灣地區新職業聲望與社經地位量表………………………...111
附錄九 社經地位指數計算方式………………………………………...112

參考文獻
中文部分
王子方、方郁文（2014）‧妊娠期母體的生理變化‧於李從業總校閱，實用產科護理（七版，159-178頁）‧臺北市:華杏。[Wang, Z. F., & Fang, Y. W. (2012). Maternal physiological changes during pregnancy. In Z. N. Li (Ed.), Practical Obstetric and Gynecology Nursing, (7th ed., pp. 159-178), Taipei City, Taiwan, ROC: Farseeing.]
王瑤華、方郁文（2014）‧妊娠期間的護理‧於李從業總校閱，實用產科護理（七版，269-320頁）‧臺北市:華杏。[Wang, Y. H., & Fang, Y. W. (2014). In Z. N. Li (Ed.), Nursing care of pregnancy. Practical Obstetric and Gynecology Nursing, (7th ed., pp. 269-320), Taipei City, Taiwan, ROC: Farseeing.]
王立雯（2013）‧台灣地區孕婦身體活動度及睡眠品質與生心理健康之探討‧（未發表的碩士論文）．新竹：元培科技大學健康產業管理研究所。[Wang, L. W. (2013). The effect of physical activity and sleep quality on physical and psychological health among pregnant women in Taiwani, Hsinchu: Yuanpei University of Health Industry Management Institute, Taiwan, ROC.]
申一中（2007）‧便秘的中西醫療法‧中醫內科醫學雜誌，5（1），32-41。[Shen, Y.Z.(2007).Traditional Chinese and Western medicine treatment of constipation.Journal of Traditional Chinese Internal Medicine, 5(1), 32-41.]
李小璐（2005）‧婦女之睡眠品質、疲倦及憂鬱：產後二週及四週時間序列研究（碩士論文）‧取自https://ndltd.ncl.edu.tw/cgi-bin/ gs32/ gsweb. cgi/ ccd=RjCnJZ/search#result［Lee, H. L. (2005). Women's sleep quality, fatigue and depression during the 2nd and 4th postpartum weeks (Master’s thesis). Retrieved from https://ndltd.ncl. edu.tw/c gi-bin/gs32/gsweb. cgi/ccd =RjCnJZ/search#result］
李增烈（2001）‧孕婦便秘怎麼辦‧家庭醫學，12，7-7。[Li, Z. L. (2001). How to do pregnant women constipation. Family Medicine, 12, 7-7.]
李靜芳、林顯明、孫吉珍、谷幼雄（2009）‧婦女於不同孕期之症狀困擾研究‧亞東學報，29，207-215。［Lee, C. F., Lin, H. M., Jhen, H. J., Gu, Y. S. (2012). Study on women in different pregnancy symptoms. Journal of Oriental Institute of Technology, 29, 207-215.］
李靜芳、姜逸群、林淑珊、林顯明、徐菊容（2012）‧懷孕婦女於不同孕期之身體活動型態及其相關因素之研究‧臺灣醫學，16(2), 103-111。Doi: http://dx.doi.org/10.6320/FJM.2012.16(2).01 ［Lee, C. F., Chiang, I. C. Lin, S. S., Lin, H. M., Hsu, C. J. (2012). Physical Activity Pattern and Related Factors among Women durin g Pregnancy. Formosan Journal of Medicine, 16(2),103-111. Doi: http://dx.doi.org/10.6320/FJM. 2012.16(2). 01 ］
辛海威、朱麗明、方秀才、費貴軍、姚方、王莉瑛、…柯美雲（2012）‧功能性便秘患者情緒和睡眠狀況調查‧胃腸病學，2，87-90。[Sin, H., W., Jhu,L. M., Fei, G. J., Yao, F., Wang, L. Y.,… & Ke, M. Y. (2012). A Survey on Emotion and Sleep Status in Patients with Functional Constipation. Chinese Journal of Gastroenterology, 2, 87- 90.]
邱曉彥、邱艷芬（2010）‧睡眠品質之概念分析‧護理雜誌，57(4)，106-111。
doi:10.6224/JN.57.4.106［Chiu, H. Y., Chao, Y. F. (2010). Concept Analysis: Sleep Quality, The Journal of Nursing, 57(4), 106-111. doi:10.6224/JN. 57.4.106］
林姿伶（2001）‧台灣地區18-64 歲國人飲食型態研究（碩士論文）‧取自http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/ccd=UCHKYf/record?r1=1&h1=1 ［Lee, T. L. (2001). A Study on the Diet Patterns of 18-64 Years old People in Taiwan (Master’s thesis). Retrieved from http://ndltd.ncl. edu.tw/ cgi-bin/gs32/gsweb.cgi/ccd=UCHKYf/record?r1=1&h1=1fromdoi:10.6224/JN.57.4.106］
林生傳（1993）‧教育社會學‧高雄市：復文。［Lin, S. Z. (1993). sociology of education. Kaohsiung City, Taiwan, ROC: Fuwen］
汪健橋、胡桂風（2015）‧乳果糖與小麥纖維素治療妊娠期便秘的療效觀察‧齊齊哈爾醫學院學報，24，3663 – 3665。[Wang, J. Q., & Hu, G. F. (2015). Efficacy of pregnancy constipation lactulose and wheat cellulose treatment. Journal of Qiqihar University of Medicine, 24, 3663-3665.]
林麗味、葉淑惠、潭蓉瑩、傅元聰、黃國城（2013）‧便秘中醫護理指導對於改善大學生便秘症狀及生活品質之成效‧護理暨健康照護研究，9（4），320-330。 doi:10.6225/JNHR.09.4.320 [Lin, L. W., Yeh, S. H., Tan, J. Y., Fu, Y. T., & Huang, K. C. (2013). The Effectiveness of Chinese Medicine Nursing Instructions on Constipation for Managing Constipation Symptoms and Quality of Life among College Students. Journal of Nursing and Healthcare Research, 9 (4), 320-330. doi:10.6225/JNHR.09.4.320]
吳嘉煖（2008）‧女性便秘特點的調查分析（碩士論文）．取自華藝線上圖書館。［Wu, C. H. (2008). Investigation and Characterization of Female Chronic Constipation (Master’s thesis). Available from Airiti Library.］
郭蕊（2013）‧功能性便秘患者情緒和睡眠狀況的分析‧中國當代醫藥，26，29-30。［Guo, R. (2013). Analysis of mood and sleep in patients with functional constipation. China Modern Medicine, 26, 29-30.］
康立東、楊繼瑞（2010）‧小麥纖維素治療孕婦便秘36例療效觀察‧醫學理論與實踐，7，823-824。[Kang, L. D., Yang, J. R. (2001). Observation of 36 cases of pregnant women constipation treatment with wheat cellulose. The Journal of Medical Theory and Practic, 7, 823-824. ]
陳葵蓉（2011）･懷孕婦女三期營養攝取及飲食喜好之相關研究（碩士論文）･取自http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/ccd=n2qjs0/record? r1=18&h1=0［Chen, K. J. (2011). An association study of nutrient intakes and dietary preferences of the three trimesters during pregnancy (Master’s thesis).Retrieved from https://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/ccd= EAgJFN/record? r1=1&h1=2]
陳嘉慧(2013)‧第三孕期身體活動、懷孕前身體質量指數和孕期體重增加量對生產結果之影響（碩士論文）．取自華藝線上圖書館。［Chen, C. H. (2013). Physical activity during the third trimester, maternal pre-pregnancy body mass index, gestational weight gain, and pregnancy outcomes (Master’s thesis). Available from Airiti Library.］
陳雅莉、林文絹(2016)‧以整合照護指引與文獻回顧為基礎的老年人慢性便秘非藥物照護建議‧台灣公共衛生雜誌，35（3），248 – 259。 doi： 10.6288/TJPH201635104088 ［Chen,Y. L., & LinW. C. (2016). Non- pharmacologic care for chronic constipation in the elderly based on intergraded guidelines and literature review. Taiwan Journal of Public Health, 35 (3), 248 – 259。 doi：10.6288/TJPH201635104088］
曾玉惠(1996)‧膳食纖維與健康‧高雄區農業專訊，16，10-11。［Zeng.Y., H. (1996). Dietary Fiber and Health. Kaohsiung District Agricultural newsletter , 16, 10-11.］
張超, 王景傑, 楊琦, 盧王, 黃博, 黃裕新, ...劉煜（2008）‧睡眠障礙伴便秘患者胃肌電活動的臨床觀察‧胃腸病學和肝病學雜誌，17(10)，833-835。［Zhang. C., Wang. J. J., Yang. Q., Lu. W., Huang. B., Huang. Y. X.,... Liu. Y. (2008). The Clinical Observation on Gastric Myoelecerical Activity of the Patients with Sleep Disorder and Constipation. Chinese Journal of Gastroenterology and Hepatology, 17(10), 833 – 835.］
黃建勳、蘇奕彰、洪壽宏、邱泰源、曾慶孝（2009）‧老年人便秘的評估與處置‧台灣老年醫學暨老年學雜誌，4（1），15 - 26［Huang, C. H.,Su, Y. C. , Hung, S. H., Chiu, T. Y., Tseng, C.H. (2009). Evaluation and Treatment of Constipation in the Elderly. Taiwan Association of Gerontology and Geriatrics, 4(1), 15-26.］
黃毅志（2003）‧「臺灣地區新職業聲望與社經地位量表」之建構與評估社會科學與教育社會學研究本土化‧教育研究集刊，49（4），1-31。
［Hwang, Y. J. (2003). The Construction and Assessment of the “New Occupational Prestige and Socioeconomic Scores for Taiwan”: The Indigenization of the Social Science and Sociology of Education Research. Bulletin of Educational Research, 49(4), 1-31.］
馮容莊、張宏江（2014）‧生殖系統的解剖與生理‧於李從業總校閱，實用產科護理（七版，70-112）‧臺北市:華杏。[Fong, R.Z., & Jhang, H. J. (2014).Anatomy and physiology of the reproductive system.In Z. N. Li (Ed.), Practical Obstetric and Gynecology Nursing, (7th ed., pp. 70-112), Taipei City, Taiwan, ROC: Farseeing.]
馮錦屏（2013）‧孕婦便秘的原因分析與護理對策‧中國農村衛生，z2，163-164。［Fong, J. P. (2013).The cause and nursing Strategy of constipation in pregnant women.China rural health, z2, 163-164.］
湯振青、王建楠、林鏡川、蘇世斌、林佳淑、李明昕‧（2014）‧國內職場孕婦睡眠品質的相關研究-以中文版匹茲堡睡眠品質量表作評估‧中華職業醫學雜誌，21(4)，181-192。
蔡名秀、黃久美、郭維茗、吳慧美、李美鶯（2010）‧孕婦身體活動、睡眠品質與非計畫性剖腹產‧護理暨健康照護研究，6(1)，13-23。doi：10.6225/JNHR.6.1.13［Tsai, M. S.,Huang, C. M., Kuo, W. M.,Wu, H. M.,Lee, M. Y. (2010). Physical Activity, Sleep Quality, and Unplanned Cesarean Section in Pregnant Women.Journal of Nurs ing and Healthcare Research. 6 (1), 13-23. doi：10.6225/JNH R .6.1.13］
衛生福利部國民健康署（2010）．台灣健康體能指引‧取自https://101.health.gov.tw/upload/20118117028_%E8%87%BA%E7%81%A3%E5%81%A5%E5%BA%B7%E9%AB%94%E8%83%BD%E6%8C%87%E5%BC%95.pdf ［Health Promotion Administration, Ministry of Health and Welfary, R.O.C. (Taiwan). (2010). Taiwan Physical Activity Guidelines. Retrieved from https://101.health.gov.tw/upload/ 20118117028 _%E8%87%BA%E7%81%A3%E5%81%A5%E5%BA%B7%E9%AB%94 % E8%83%BD%E6%8C%87%E5%BC%95.pdf］
衛生福利部國民健康署（2013.08.30）‧天天量體重‧取自http:// www. hpa. gov.tw/BHPNet/Web/HealthTopic/TopicArticle.aspx?id=201308300012&parentid=201109290001［Health Promotion Administration, Ministry of Health and Welfary, R.O.C. (Taiwan). (2013). Measuring weight everyday. Retrieved from http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/Topic Article.aspx?id=201308300012&parentid=201109290001］
衛生福利部國民健康署（2014）‧孕婦健康手冊‧取自http://health99.hpa. gov.tw/educZone/edu_detail.aspx?Catid=21766［Health Promotion Administration, Ministry of Health and Welfary, R.O.C. (Taiwan). (2014). Maternal Health Booklet. Retrieved from http://health99. hpa.gov.tw/educ Zone /edu_detail.aspx?Catid=21766］
謝美芬、顏兆熊（2008）‧慢性便秘‧基層醫學，6，172-177。[Sie, M. F., & Yan, J. S. (2008). Chronic Constipation.Primary Medical Care & Family Medicine, 6, 172-177.]
盧姿君、吳翰德（2015）‧婦女便秘的中醫藥治療‧中醫內科醫學雜誌，13（l），64-71。[ Lu, Z. J., & Wu, H. D. (2015). Chinese Medicine Treatment of Women with Constipation.Journal of Traditional Chinese Internal Medicine, 13(1), 64-71.]
魏柏、余保平（2006）‧大學生便秘情況的流行病學調查及危險因素分析‧胃腸病學和肝病學雜誌，15（2），167-169。[Wei, B., & Yu, B. P. (2006). An Epidemiological Study of Functional Constipation in Undergraduates. Chinese Journal of Gastroenterology and Hepatology, 15(2), 167-169.]
蘇子華、蔡毓源、文士祺、項正川（2009）‧常見疾病－便秘的探討‧當代醫學‧432，796-800。[ Su, Z. H., Cai, Y. Y., Wun, S. J., & Siang, J. C. (2009). Common diseases - Discussion of constipation. Medicine Today, 432, 796-800.]

英文部分
Anderson, A. S., & Whichelow, M. J. (1985). Constipation during pregnancy: dietary fibre intake and the effect of fibre supplementation. Human Nutrition. Applied Nutrition, 39(3), 202-207.
Anderson, A. S. (1986). Dietary factors in the aetiology and treatment of constipation during pregnancy. British Journal of Obstetrics And Gynaecology, 93(3), 245-249.
Borodulin, K.M., Evenson, K.R., Wen, F., Herring, A.H., & Benson, A.M. (2008). Physical activity patterns during pregnancy. Medicine And Science In Sports And Exercise, 40 (11), 1901-1908. doi: 10.1249/MSS.0b013e318 17f1957
Bradley, C. S., Kennedy, C.M., Turcea, A. M., Rao, S. S. C., & Nygaard, I. E. (2007). Constipation in pregnancy: prevalence, symptoms, and risk factors.Obstetrics & Gynecology, 110(6), 1351-1357.
Broussard, B. S. (1996). Constipation During Pregnancy. International Journal of Childbirth Education. 11(1), 40-46.
Broussard, B.S. (1998). The constipation assessment scale for pregnancy. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27, 297–301.doi:10.1111/j.1552-6909.1998.tb02652.x
Buysse, D. J., Reynold, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburge sleep quality index: A new instrument for psychiatric practice and research. Psychiatric Research, 28(2), 193-213.
Chasan-Taber, L., Schmidt, M.D., Roberts, D. E., Hosmer, D., Markenson, G., & Freedson, P. (2004). Development and Validation of a pregnancy physical activity questionnaire. Medicine & Science in Sports & Exercise, 36, 1750-1760. doi: 10.1249/01.mss.0000142303. 49306.od
Cremonini, F., Camilleri, M., Zinsmeister, A. R., Herrick, L. M., Beebe, T., & Talley, N. J. (2009). Sleep disturbances are linked to both upper and lower gastrointestinal symptoms in the general population. Neurogastroenterology & Motility, 21(2), 128-135.
Cullen, G., & O’ Donoghue, D. (2007). Constipation and pregnancy. Best Practice & Research Clinical Gastroenterology, 21(5), 807–818. doi: 10.1016 / j.bpg. 2007.05.005
Derbyshire, E. J., Davies, J., & Detmar, P. (2006). Diet, physical inactivity and the prevalence of constipation through out and after pregnancy.Maternal & Child Nutrition, 2(3), 127-134.
Derbyshire, E. J., Davies, J., & Detmar, P. (2007). Changes in bowel function: pregnancy and the puerperium.Digestive Diseases And Sciences, 52(2), 324-328.
Drossman, D. A. (2006). The functional gastrointestinal disorders and the Rome III process. Gastroenterology, 130(5), 1377-1390.
European Food Safety Authority (2010). Scientific Opinion on Dietary Reference Values for Water. EFSA Journal, 8(3), 1459. doi:10.2903/j.efsa. 2010.1459
Ford, F. (2008). Constipation in pregnancy. Practising Midwife, 11(10), 28-31.
Gwee, K. A. (2011). Disturbed sleep and disturbed bowel functions: implications for constipation in healthy individuals. Journal of Neurogastroenterology and Motility, 17(2), 108-109. doi：10.5056 / jnm. 2011. 17.2.108
Hall, V., Owens, C., & Blackwel, R. (2015). Physiological and hormonal changes and GI problems experienced in pregnancy. Gastrointestinal Nursing, 13(4), 17-25. doi: http://dx.doi.org/10.12968/gasn.2015.13.4.17
Hung, H. M., Ko, S. H., & Chen, C. H. (2014). The association between prenatal sleep quality and obstetric outcome. Journal of Nursing Research, 22(3), 147-154.
Jamshed, N., Lee, Z. E., & Olden, K. W. (2011). Diagnostic approach to chronic constipation in adults. American Family Physician, 84 (3), 299-306.
Johnson, P., & Mount, K. (2014). Functional bowel disorders in pregnancy: effect on quality of life, evaluation and management. Acta Obstetricia Et Gynecologica Scandinavica , 93(9), 874-879. Doi：10.1111 / aogs.12434
Jones, K. (2002). Treatment of heartburn and constipation during pregnancy. British Journal Of Midwifery, 10(8), 514-517. doi: http://dx.doi.org/10. 12968 /bjom.2002.10.8.10601
Lamb, K., & Sanders, R. (2015). Constipation and haemorrhoids: A midwifery perspective for the child bearing continuum. British Journal of Midwifery, 23(3), 171-177.
Langer, B., Grima, M., Coquard, C., Bader, A. M., Schlaeder, G. & Imbs J. L. (1998). Plasma active rennin, angiotensin I, and angiotensin II during pregnancy and in preeclampsia. Obstetrics and Gynecology, 91, 196–202.
Longo, S. A., Moore, R. C., Canzoneri, B. J., & Robichaux, A. (2010). gastrointestinal conditions during pregnancy. Clinics in Colon and Rectal Surgery, 23 (2), 80-89. doi:10.1055/s-0030-1254294
Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006). Functional Bowel Disorders.Gastroenterology, 130(5), 1480-1491. doi: http://dx.doi.org/10.1053/j.gastro.2005.11.061
Lu, W. Z., Gwee, K. A., & Ho, K. Y. (2006). Functional bowel disorders in rotating shift nurses may be related to sleep disturbances. European journal of gastroenterology & hepatology, 18(6), 623-627.
Markland, A. D., Palsson, O., Goode, P. S., Burgio, K. L., Busby-Whitehead, J., &; Whitehead, W. E. (2013). Association of low dietary intake of fiber and liquids with constipation: evidence from the National Health and Nutrition Examination Survey. The American journal of gastroenterology, 108(5), 796-803. doi: 10.1038/ajg.2013.73
Marshall, K., Thompson, K. A., Walsh, D.M., & Baxter, G.D. (1998). Incidence of urinary incontinence and constipation during pregnancy and postpartum: survey of current findings at the Rotunda Lying-In Hospital. British Journal of Obstetrics And Gynaecology, 105(4), 400-402. doi:10.1111/j.1471-0528.1998.tb10123.x
McMillan, S. C., & Williams, F. (1989). Validity and reliability of the Constipation Assessment Scale. Cancer Nursing, 12, 183–188.
Mostafa, R. (2008). Rome III: The functional gastrointestinal disorders, third edition, 2006.World Journal Gastroenterol, 14(13), 2124–2125.
National Institute for Health and Care Excellence (2010). Women before, during and after pregnancy. Retrieved from http://pathways.nice.org.uk/pathways/ physical-activity/encouraging-physical-activity-to-prevent-or-treat-specific-conditions#content=view-node%3Anodes-all-women.
National Sleep Foundation (1998). pregnancy and sleep. 取自https://sleep fo -undation. org/sleep- topics/ pregnancy-and-sleep.
Polo‐Kantola, P., Aukia, L., Karlsson, H., Karlsson, L., & Paavonen, E. J. (2016). Sleep quality during pregnancy: associations with depressive and anxiety symptoms. Acta Obstetricia et Gynecologica Scandinavica.
Ponce, J., Martinez, B., Fernandez, A., Ponce, M., Bastida, G., Pla, E., …Ortiz, V. (2008). Constipation during pregnancy: a longitudinal survey based on self-reported symptoms and the Rome II criteria. European Journal of Gastroenterology & Hepatology, 20(1), 56–61.
Rubin, R. (1984) Maternal identity and the maternal experience. New York: Springer Publishing.
Rungsiprakarn, P., Laopaiboon, M., Sangkomkamhang, U. S., Lumbiganon, P., & Pratt, J. J. (2015). Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews, 9, 1-42. doi:10.1002/ 14651858. CD011448. pub2.
Saha, S., Manlolo, J., McGowan, C. E., Reinert, S., Degli Esposti, S. (2011). Gastroenterology consultations in pregnancy. Journal of Womens Health (Larchmt), 20(3), 359–363. doi:10.1089/jwh.2010.2345
Shi, W., Xu, X., Zhang, Y., Guo, S., Wang, J., & Wang, J. (2015). Epidemiology and Risk Factors of Functional Constipation in Pregnant Women. PLoS ONE, 10(7) : e0133521. doi: 10. 1371/journal.pone.0133521.t002
Suares, N. C., & Ford, A. C. (2011). Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis.The American journal of gastroenterology, 106(9), 1582- 1591
Sut, H. K., Asci, O., & Topac, N. (2016). Sleep Quality and Health-Related Quality of Life in Pregnancy. The Journal of perinatal & neonatal nursing. 30(4), 302-309.
Tam, Y. H., Li, A. M., So, H. K., Shit, K. Y., Pang, K. K., Wong, Y. S., . . . Lee, K. H. (2012). Socioenvironmental factors associated with constipation in Hong Kong children and Rome III criteria. Journal of pediatric gastroenterology and nutrition, 55(1), 56-61. doi:10.1097/MPG.0b013e318 24741ce
Tiran, D. (2003). Product focus. Self help for constipation and haemorrhoids in pregnancy.British Journal of Midwifery, 11(9), 579-581.
Tomfohr, L. M., Buliga, E., Letourneau, N. L., Campbell, T. S., & Giesbrecht, G. F. (2015). Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period. Sleep, 38(8), 1237-1245.
Trottier, M., Erebara, A., & Bozzo, P. (2012). Treating constipation during pregnancy. Canadian Family Physician, 58(8), 836-838.
World Gastroenterology Organisation. (2011). WGO Practice Guideline – Constipation. Journal of Clinical Gastroenterology, 45(6), 483-487. Retrieved from http://www.worldgastroenterology.org/guidelines/global -guidelines/constipation.
World Health Organization. (1997). Physical activity, Retrieved from http:// www. who.int/ topics /physical_activity/en/.