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研究生:周佑安
研究生(外文):Yu-An Chou
論文名稱:精神疾病孕婦懷孕結果之研究
論文名稱(外文):Medical Outcomes of Pregnancy among Mentally Ill Women
指導教授:藍忠孚藍忠孚引用關係
指導教授(外文):Chung-Fu Lan
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:43
中文關鍵詞:生產併發症懷孕結果精神疾病精神分裂異常
外文關鍵詞:obstetric complicationpregnancy outcomemental illnesschizophrenia
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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.
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