妊娠糖尿病是懷孕期間常見的併發症，而持續增高卻控制不佳的高血糖對產婦與胎兒都會產生併發症造成危險，先前文獻指出妊娠糖尿病的發生與激素分泌造成胰島素抗性，有強烈關聯性存在，尤其是胎兒-胎盤單位所分泌的懷孕相關荷爾蒙；然而妊娠糖尿病的檢測必需等到懷孕第24-28週進行，因為至今尚未有明確的指標在懷孕初期即可預知妊娠糖尿病的發生。因此我們利用在妊娠中期15-20+6 週進行的唐氏症母血四指標篩檢，分別是AFP、total hCG 、uE3及inhibin-A，期望能更早預測妊娠糖尿病的發生。本篇研究選自奇美醫學中心2009年8月起至2012年07月到院產檢孕婦4293人次中，以隨機選出正常妊娠者117位為對照組，口服葡萄糖耐性試驗正常者110位、口服葡萄糖耐性試驗一筆異常者38位，確診為妊娠糖尿病者60位，探討四指標在不同程度的血糖不耐及妊娠糖尿病發生的相關聯性。妊娠糖尿病的確認依據美國糖尿病學會(ADA, 2009)的100 g口服葡萄糖耐性試驗的診斷標準。統計結果顯示妊娠糖尿病盛行率約為4.05%，妊娠糖尿病組其體重與年齡皆較其他組別為高(體重 p=0.000，年齡 p=0.036)，高唐氏症危險率者比正常者罹患妊娠糖尿病的比例也較高(5.9％: 2.4％；p=0.005)，而四指標中僅有uE3具有統計上的顯著差異 (uE3: 0.93 MoM , 95％CI : 0.87-0.99 ; control: 1.02 MoM , 95％CI : 0.97-1.06; p=0.022)，ROC的曲線下面積(AUC)為0.612 ( p=0.015)。由我們的結果顯示，唐氏症危險率偏高者罹患妊娠糖尿病的比例比危險率正常者為高；在妊娠中期進行的唐氏症母四指標篩檢中的uE3，其濃度偏低時與妊娠糖尿病的發生最具有關聯性，可預測併發妊娠糖尿病的發生。

Gestational diabetes mellitus(GDM) is a common complication that may occur during pregnancy. Continuously rising and poorly controlled hyperglycemia can endanger both mother and fetus because of adverse pregnancy outcome. Previous studies have shown that GDM is strongly correlated to insulin resistance that is induced by hormone secretions, particularly pregnancy-associated hormones relevant to the fetal-placental unit (FPU). However, GDM cannot be diagnosed until 24-28 weeks of gestation because specific markers are unavailable for predicting the development of GDM during the first trimester. This study used Down’s syndrome screening that are during the second trimester using quadruple test (ie, AFP, total hCG, uE3, and inhibin-A) to facilitate the early prediction of GDM. The research participants were randomly selected from 4293 pregnant women who received prenatal examinations in Chi-Mei Medical Center between August 2009 and July 2012. In this study, 117 healthy pregnant women were included into the control group; 110 participants were within all normal glucose range on the oral glucose tolerance test (OGTT); 38 women received one abnormal result on the OGTT; and 60 were confirmed to have GDM. This study explores the correlation of the quad markers to varying glucose intolerance levels and the development of GDM. GDM was confirmed based on the diagnostic criteria for the 100-g OGTT established by the American Diabetes Association (ADA, 2009). The statistical results showed that the prevalence of GDM was 4.05%. The group with GDM all demonstrated heavier weights and older ages compared to other groups (weight: P = 0.000; age: P =0 .036). Pregnant women at high risk of Down’s syndrome had a higher GDM incidence rate compared to healthy pregnant women (5.9%:2.4%；p=0.005). Only uE3 among the quad markers presented statistically significant differences (uE3: 0.93 MoM, 95% CI: 0.87-0.99; control: 1.02 MoM, 95% CI: 0.97-1.0; P =0 .022). The area under the receiver operating characteristic (ROC) curve was 0.612 (P =0.015). The results indicated that pregnant women at high risk for Down’s syndrome tended to have a higher incidence rate of GDM compared to pregnant women with normal risks. In the second trimester screening for Down’s syndrome using the quad markers, uE3 in a low concentration can to prediction the development of GDM.

目次
中文摘要 i
英文摘要 ii
誌謝 iv
目次 vi
表目錄 vii
圖目錄 viii
縮寫對照表 ix
第一章 緒論 1
1.1 妊娠糖尿病(Gestational Diabetes Mellitus) 1
1.1.1妊娠糖尿病的發生 2
1.1.2妊娠性糖尿病的診斷 3
1.2 唐氏症 (Down syndrome) 5
1.2.1母血唐氏症篩檢 (Maternal Serum Down syndrome screening) 5
1.3 文獻回顧 7
第二章 研究動機與目的 9
第三章 材料與方法 10
3.1 研究流程設計與分組 10
3.2 研究對象來源 11
3.3 研究資料來源 11
3.4 統計分析 11
第四章 實驗結果 12
4.1 研究族群分析 12
4.2 妊娠糖尿病盛行率 13
4.3 高唐氏症篩檢危險率與罹患妊娠糖尿病的比例 13
4.4 唐氏症四指標與罹患妊娠糖尿病的相關性 13
第五章 討論 15
5.1 妊娠糖尿病與年齡、體重的相關性 15
5.2 妊娠糖尿病盛行率 15
5.3唐氏症篩檢危險率與併發妊娠糖尿病的探討 16
5.4 uE3與罹患妊娠糖尿病的相關性 16
5.5 研究限制 17
第六章 結論 18
第七章 參考文獻 28
附錄 35

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