臺灣博碩士論文加值系統

人工生殖雙胞胎新生兒的出生體重對低出生體重盛行率、早產盛行率及嬰兒死亡率皆有影響。相關研究顯示，母親孕期的體重增加與胎兒出生體重有顯著相關，且受母親孕前身體質量指數的影響。本研究目的在探討人工生殖懷雙胞胎孕婦之孕前不同身體質量指數，在妊娠期體重及增加量與新生兒出生結果的關係。
本研究採回顧式研究設計，研究母群體為中部某不孕症研究中心，自2004年08月01日至2007年07月31日，接受人工生殖懷孕的雙胞胎孕婦。排除不符合本研究收案條件者後，將300位孕婦全部納入本研究收案對象，收集其病歷相關資料，研究結果共收集有效體重及新生兒出生資料共100份，回收率30%。
研究工具依回溯性研究方法設計不同妊娠期孕婦體重及新生兒出生結果紀錄表，研究者依病歷及孕婦健康手冊登錄上述資料。資料以SPSS 12.0版整理，並以描述性統計、皮爾森相關、卡方檢定、獨立t檢定和單因子變異量分析等方式進行分析。
本研究結果發現：人工生殖懷雙胞胎孕婦的平均年齡（32.3±3.9歲），除了第一孕期的體重增加量（2.2±2.4公斤）之外，妊娠期體重總增加量（19.5±5.1公斤）、第二孕期的體重增加量（0.65±0.23公斤/週），以及第三孕期的體重增加量（0.78±0.30公斤/週），皆與美國醫學會（1991）建議雙胞胎孕婦體重增加量相符合。新生兒的出生週數是36.4±1.4週及出生體重為2353± 404.2公克，依孕前不同BMI分類，妊娠期體重增加隨著懷孕週數增加而增重，且不同BMI組孕婦之體重增加達顯著差異。比較孕前不同BMI孕婦的新生兒出生結果發現低出生體重兒出現在體重過重組的百分比明顯低於正常體重組，達顯著差異。孕前BMI值與產前體重（r=0.91）、妊娠12週（r=0.86）、20週（r=0.83）、24週（r=0.85）、28週（r=0.83）、32週（r=0.81）、生產體重（r=0.77）成顯著高度正相關；和第ㄧ孕期體重增加量（r=0.14）呈正相關，與第三孕期體重增加量呈負相關（r= -0.20），但與妊娠總增加量及第二孕期增加量則無關。孕前BMI與新生兒出生結果之關係為：除了與出生週數無相關外，與Agpar score分數、出生體重、頭圍、胸圍、和身高皆呈正相關。
人工生殖懷雙胞胎孕婦妊娠體重與新生兒出生結果有顯著相關，且兩者皆受孕婦的孕前BMI影響，因此建議在人工生殖懷雙胞胎孕婦在體重增加控制需重視孕前BMI，經合適的體重增加範圍，減少早產兒及低出生體重兒，進而降低週產期死亡率及嬰兒死亡率，促進人工生殖雙胞胎兒的健康。

The birth weight of the new born twins born to mothers with ART is correlated with the prevalence of low birth weight, premature birth and infant mortality. Previous research indicates that the weight gain of pregnant women relates positively not only to their pre-pregnancy BMI, but also their babies’ birth weight. This research aimed at studying the relationship between the BMI and their weight gains in various gestational age of twin gestation women undergoing ART, and the birth outcomes.
The research was designed as a retrospective study. The subjects were 100 twin gestation women undergoing ART in a infertility treatment center in Central Taiwan from August 1st, 2004 to July 31st, 2007. The researcher accomplished a gestational weight-gain chart and a birth outcome record, both designed on a retrospective basis, with data from each subject’s medical record and the birth outcomes. The collected data were then analyzed by the package software SPSS12.0.
The research results reveal that the average age of the subjects is 32.3 ± 3.9 years. Except the average weight gain from the first gestational week (2.2 ± 2.4kgs), those of the second gestational age （0.65±0.23kgs / week）, the third gestational age （0.78±0.30kgs / week）, and the whole gestational period （19.5±5.1kgs）comply with the ideal weight gains suggested by the American Medical Association (1991) for women with twin pregnancy. The average gestational age of the newborns is 36.4 ± 1.4 weeks and the birth weight are 2353 ± 404.2grams. All subjects, grouped up by the BMI measured before pregnancy, gained weight with the gestational ages. However, their weight gain are significantly different among the different BMI groups. The percentage of low-birth-weight newborn from overweight mothers is significantly lower than that of mothers with normal weight before pregnancy. The pre-pregnancy BMI relates positively to the subject’s body weight in various gestational age: before pregnancy (r=0.91), in the 12th week of gestation (r=0.86), in the 20th week of gestation (r=0.83), in the 24th week of gestation (r=.85), in the 28th week of gestation (r=0.83), in the 32nd week of gestation (r=0.81), before the deliver (r=0.77), and in the first gestational age (r=0.14). It relates negatively to the weight gain in the third gestational age (r=-0.20), and appears non-relevant to the weight gain in the second gestational age and the whole gestational age. The subject’s pre-pregnancy BMI also relates positively to Agpar score, birth weight, head circumstance, chest circumstance, and height.
The study finds that there is a significant relationship between the gestational weight and the various birth outcomes from babies of twin gestation women with ART. In addition, both the gestational weight and the neonatal outcomes relate positively to these women’s pre-pregnancy BMI. The findings suggest that medical care providers pay more attention on these women’s pre-pregnancy BMI and their weight gain patterns during the gestational age in order to promote the health of the twins delivered by ART women, reduce the deliveries of pre-mature or low-weighted babies, and further decrease incidences of newborns and infants.

論文審定書 i
致謝 ii
中文摘要 iv
英文摘要 vi
目錄 viii
圖目錄 xii
表目錄 xiii
第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 3
第三節 研究問題 4
第四節 名詞界定 5
一、不孕症 5
二、人工生殖懷雙胞胎孕婦 5
三、身體質量指數 6
四、妊娠週數 6
第二章 文獻查證 7
第一節 前言 7
第二節 人工協助生殖懷孕結果對雙胞胎之影響 7
第三節 雙胞胎妊娠對新生兒出生體重影響 9
第四節 雙胞胎孕婦妊娠期增重對新生兒出生結果影響 11
第五節 婦女孕前身體質數對妊娠期增重及新生兒出生體重影響 13
第三章 研究架構 16
第四章 研究方法 17
第一節 研究設計 17
一、研究工具 17
二、工具信效度 17
第二節 研究對象 18
一、收案條件 18
二、排除條件 18
第三節 收案流程 19
一、預試 19
二、正式收案 19
第四節 研究個案權益維護與倫理考量 20
第五節 資料分析 21
第五章 研究結果 22
第一節 研究對象基本屬性 22
一、懷雙胞胎孕婦之基本資料 22
二、雙胞胎新生兒之基本資料 23
第二節 孕前不同BMI體重分類之孕婦在妊娠期體重的變化趨勢 23
第三節 孕前不同BMI體重分類之孕婦在妊娠體重、體重增加量與新生兒出生結果差異之比較 28
一、孕前不同BMI孕婦妊娠期體重及增加量之比較 28
二、孕前不同BMI孕婦之新生兒出生結果比較 29
第四節 孕前BMI、妊娠體重及增加量、與新生兒出生結果之相關性 33
一、孕前BMI與妊娠體重及增加量之相關 33
二、孕前BMI與新生兒出生結果之相關 34
三、新生兒出生結果與妊娠體重及增加量之相關 34
第六章 討論 39
第一節 研究對象的基本屬性 39
一、孕婦基本屬性分析 39
二、新生兒出生結果之分析 40
第二節 討論研究變項在孕前不同BMI之差異性 43
一、孕前不同BMI體重分類孕婦妊娠體重、體重增加量差異之比較 43
二、孕前不同BMI體重分類孕婦的新生兒出生結果差異之比較 45
第三節 孕前BMI、妊娠體重及增加量、與新生兒出生結果相關性之討論 46
一、孕前BMI與妊娠體重及增加量之相關性討論 46
二、孕前BMI與新生兒出生結果之相關性討論 47
三、新生兒出生結果與妊娠體重及增加量之相關性討論 47
第七章 結論與建議 49
第一節 結論 49
第二節 研究應用 51
第三節 研究限制與建議 52
一、研究限制 52
二、未來研究建議 52
參考文獻 53
中文部份 53
英文部份 55
【附錄一】體重紀錄表 61
【附錄二】研究說明書 62

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