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研究生:黃昌鼎
研究生(外文):Ching-Ting Huang
論文名稱:(一)921地震與懷孕結果相關性之探討(二)台灣地區死產危險因子分析
論文名稱(外文):Pregnancy outcome after 921 earthquake in Taiwan
指導教授:陳保中陳保中引用關係
指導教授(外文):Pau-Chung Chen
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:100
中文關鍵詞:地震災難早產低出生體重死產胎兒死亡危險因子病例對照研究
外文關鍵詞:earthquakediasterinfantprematurelaborlow birth weightstillbirthfetal deathrisk factorscase-control study
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一)921地震與懷孕結果相關性之探討
研究目的:本研究的目的是觀察九二一大地震時孕程有經歷大地震而居住在不同震度地區的孕婦,是否會增加早產及低出生體重的危險性。
材料與方法:總共有678,581個孕程在20到44週的單胞胎新生兒被收入到本研究中。我們定義的暴露族群是在懷孕的過程中有經歷過九二一大地震的孕婦,我們再把暴露在震度六級及六級以上的孕婦定義為高暴露組,四級到五級的定義為中暴露組,四級以下的定義為低暴露組。另外我們也選擇懷孕過程有經歷過1996、1997、1998和2000年的9月21日的孕婦當作非暴露組來比較。最後,我們找出同一母親有經過地震的胎次和之前或之後的胎次,來做比較。我們使用多變項logistic迴歸模式計算早產或低出生體重的危險勝算比及95%信賴區間,以及使用多變項線性迴歸計算經地震胎次與同一孕婦前後胎次懷孕週數差之b係數及標準誤。
結果:不論是空間方面、時間方面或同一母親有無經歷地震前後胎次的比較,我們並未發現不同震度會明顯有意義的增加早產或低出生體重的危險性,即使是在進一步校正了其他干擾因子和細分成三個孕程來看時,結果都是一樣。
結論:我們認為有一些不好生育結果如早產和低出生體重,在本研究中並未發現與地震有相關性。
(二)台灣地區死產危險因子分析
研究目的
本研究的目的是使用台灣地區2001年的出生檔(包含死產)來找出台灣地區死產的危險因子。此外,我們另外選取了五家醫院的死產病例,做一個病例對照研究,來重新評估死產的危險因子。
材料方法
我們從2001年台灣地區的出生資料檔找出死產的個案。死產是定義為出生週數大於20週或出生體重大於500公克的才算是死產個案。我們將研究分成兩部分。第一部份,我們設立一個包括2001年1月1日到2001年12月31日所有出生的活產或死產的族群,共有1979個死產和246513個活產。第二部分,我們在台北和高雄共選了五家醫院,作為病例對照研究的案例來源,共選了307個死產和307個活產。接著我們執行一個病歷對照研究,以電訪來獲得個案與對照組的基本人口學因子,以病歷摘錄方式從醫院病歷上來獲得懷孕史、母親疾病史和生產併發症等資料。我們利用這些資料來計算在主要族群和病例對照研究族群的每一個危險因子的勝算比和95%信賴區間,
結果
第一部份常規資料分析: 發現母親年齡以25~29歲為基準,較大(OR=1.89; CI=1.65-2.16)和較小(OR=2.00, CI=1.62-2.46)的死產危險性都較大。外籍新娘比起台灣新娘也有較低的危險性(OR=0.70; CI=0.59-0.84),母親居住地區的危險性在台北(OR=1.50, CI=1.07-2.11)和高雄(OR=1.38, CI=0.98-1.95)也比東部高。其他許多母親疾病,像是貧血、肺部疾病、羊水過多或過少、血色素疾病、慢性高血壓、子癲前症、子癲症、子宮頸閉鎖不全、之前早產病史和紅斑性狼瘡,還有生產併發症像是發燒、羊水胎便、早期破水、胎盤早期剝離、前置胎盤、急產、臀位或胎位不正、臍帶脫垂、臍帶繞頸和產前出血也都是有意義的危險因子。
第二部分病例對照研究: 我們發現母親35或小於20歲、多胎產、母簽疾病急產前併發症也都是有意義的危險因子。
結論
我們發現了許多台灣地區許多的死產危險因子,像是母親年齡、男性胎兒、多胎產、和許多母親疾病和生產併發症。但是仍有許多爭議的點需要進一步確認,像是不預期的區域差距、外籍新娘的較低危險性和一些與其他研究不符的危險因子,這都需要更進一步的研究設計(比如前瞻性的研究)來確認本研究的結果。

(1)Association between the 921 Earthquake and Pregnancy Outcome
Objectives: The purpose of this study was to determine whether there was an increased risk of having an adverse birth outcome, such as preterm delivery and low birth weight among the pregnant woman who experienced the 921 earthquake.
Material and methods: A total of 678,581 singletons with 20-44 weeks of gestational age were included in this study. We defined the exposure group was the subjects experienced the 921 earthquake in 1999 during their pregnancy periods. We defined the subjects resided in the area which intensity level was 6 or greater than 6 as the high intensity exposure group, the subjects resides in the area which intensity level was between 4 and 5 as the moderate intensity exposure group, the subjects resided in the area which intensity level lower than 4 as the low intensity exposure group. We also selected the subjects whose pregnancy period passed through September 21 of 1996, 1997, 1998 or 2000 as the non-exposure group. Furthermore, we compared the parity experienced the earthquake with previous or later parities of the same mother. We used multiple logistic regression models to calculate odds ratios and 95% confidence intervals for preterm delivery or low birth weight and multiple linear regression models to calculate b coefficients and standard errors for the difference of gestational age between the earthquake-experienced parities and their prior or later parities.
Results: We cannot find obvious significant difference of preterm delivery and low birth weight in high, moderate and low exposure area in space dimension, time dimension or compare with previous or later parity, even after further separate with different trimester and adjusted the potential confounders.
Conclusions: This study suggests that adverse pregnancy outcomes such as preterm delivery and low birth weight may not associated with the earthquake in our study
(2)Risk Factors of Stillbirth in Taiwan
Objectives - The objective of this study was to determine the risk factors of stillbirths in Taiwan, 2001 by using birth and stillbirth certificates. In addition, we reevaluated the risk factors in selected five metropolitan hospitals by a case-control design.
Material and Methods - Stillbirth was defined as fetal death with birth weight of 500 gm or more or 20 completed weeks of gestational age. We divided the study into two phases. First, we set the main study including all stillbirths (N=1979) and live births (N=246513) between January 1, 2001 and December 31, 2001. Second, we choose five metropolitan hospitals in Taipei and Kaohsiung areas as the source of the case-control study. There were 307 stillbirth cases and selected 307 controls from 13,235 live births in the hospitals. We conducted telephone interviews to obtain the information of life-style risk factors from and medical abstracts to obtain the information of pregnancy history, maternal medical diseases, and obstetric complications. We calculated odds ratios (ORs) with 95% confidence interval (CI) for each risk factor of stillbirths in the main group, and the case-control study.
Results - In the main study, we found that mothers with 35 years old or more (OR=1.89; CI=1.65-2.16) and teenage pregnancy (OR=2.00, CI=1.62-2.46) increases the risk of stillbirth comparing with maternal age between 25 to 29 years. Foreign mothers (OR=0.70; CI=0.59-0.84) had a lower risk comparing with Taiwanese mothers. Maternal residential area was higher in north and south area compare with east area.(OR=1.50, CI=1.07-2.11) (OR=1.38, CI=0.98-1.95). Many medical diseases and obstetric complications were still significant risk factors. such as anemia, lung disease, amino fluid too much or too less, hematin disease, chronic hypertension, preeclampsia, eclampsia, cervical incompetence, previous preterm delivery history and systemic lupus erythematosus , and obstetrics complication such as fever, meconium stained, premature rupture of membrane, placenta abruptio, previa placenta, urgent delivery, breech or malpresentation, umbilical cord prolapse, umbilical cord around neck and antepartum were also significant compare with the births free of these maternal medical disease and obstetrics complication. In the case-control study, we found maternal age greater than 35 years old or less than 20 years old, multiple births, maternal disease and obstetric complications were significant and showed higher risk compared with the reference group.
Conclusions - We identify many risk factors of stillbirth in Taiwan in our study, such as maternal age, male infant, multiple births, many maternal diseases and obstetric complications. But there were many controversial points need to confirm, such as the unexpected regional difference of stillbirth, the lower risk of foreign mother, and some risk factors not compatible to the previous studies which need more aggressive study design to confirm the results of this study.

(1)Association between the 921 Earthquake and Pregnancy Outcome
Contents
Chinese Abstract ii
English Abstract iii
Contents iv
List of Tables v
List of Figure viii
1. Introduction 1
2. Material and Methods 3
2.1. Study Population 3
2.2. Study Design 5
2.3. Exposure measurement 5
2.4 Outcome measurement 6
2.5. Statistical Analysis 6
3. Results 8
3.1. Basic characteristics of birth cohort 8
3.2. Preterm Delivery 14
3.3. Low Birth Weight 27
3.4. Comparison with previous or later parities in preterm delivery and low birth weight 40
4. Discussion 45
5. References 47
List of Tables
Table 1. Infant sex in high, moderate and low intensity exposure area classification with different year 9
Table 2. Parity in high, moderate and low intensity exposure area classification with different year 10
Table 3. Marital status in high, moderate and low intensity exposure area classification with different year 11
Table 4. Maternal age in high, moderate and low intensity exposure area classification with different year 12
Table 5. Maternal education level in high, moderate and low intensity exposure area classification with different year 13
Table 6. Prevalence of preterm delivery in high, moderate and low intensity exposure area classification with different year 15
Table 7. Space dimension: Crude and Adjusted odds ratio of preterm delivery in high, moderate and low intensity exposure area classification with different year 16
Table 8. Adjusted odds ratio of preterm delivery classification with different year 17
Table 9. Space dimension: Crude and Adjusted odds ratio of preterm delivery during 1st trimester in high, moderate and low intensity exposure area classification with different year 18
Table 10. Space dimension: Crude and Adjusted odds ratio of preterm delivery during 2nd trimester in high, moderate and low intensity exposure area classification with different year 19
Table 11. Space dimension: Crude and Adjusted odds ratio of preterm delivery during 3rd trimester in high, moderate and low intensity exposure area classification with different year 20
Table 12. Time dimension: Crude and Adjusted odds ratio of preterm delivery in high, moderate and low intensity exposure area classification with different year 21
Table 13. Time dimension: Crude and Adjusted odds ratio of preterm delivery during 1st trimester in high, moderate and low intensity exposure area classification with different year 24
Table 14. Time dimension: Crude and Adjusted odds ratio of preterm delivery during 2nd trimester in high, moderate and low intensity exposure area classification with different year 25
Table 15. Time dimension: Crude and Adjusted odds ratio of preterm delivery during 3rd trimester in high, moderate and low intensity exposure area classification with different year 26
Table 16. Prevalence of low birth weight in high, moderate and low intensity exposure area classification with different year 28
Table 17. Crude and Adjusted odds ratio of low birth weight in high, moderate and low intensity exposure area classification with different year 29
Table 18. Adjusted odds ratio of low birth weight classification with different year 32
Table 19. Space dimension: Crude and Adjusted odds ratio of low birth weight during 1st trimester in high, moderate and low intensity exposure area classification with different year 33
Table 20. Space dimension: Crude and Adjusted odds ratio of low birth weight during 2nd trimester in high, moderate and low intensity exposure area classification with different year 34
Table 21. Space dimension: Crude and Adjusted odds ratio of low birth weight during 3rd trimester in high, moderate and low intensity exposure area classification with different year 35
Table 22. Time Dimension: Crude and Adjusted odds ratio of low birth weight in high, moderate and low intensity exposure area classification with different year 36
Table 23. Time dimension: Crude and Adjusted odds ratio of low birth weight during 1st trimester in high, moderate and low intensity exposure area classification with different year 37
Table 24. Time dimension: Crude and Adjusted odds ratio of low birth weight during 2nd trimester in high, moderate and low intensity exposure area classification with different year 38
Table 25. Time dimension: Crude and Adjusted odds ratio of low birth weight during 3rd trimester in high, moderate and low intensity exposure area classification with different year 39
Table 26. Linear regression of the difference of gestational age between earthquake experienced parity and previous parity and the association of the different intensity exposure area 41
Table 27. Linear regression of the difference of gestational age between earthquake experienced parity and later parity and the association of the different intensity exposure area 42
Table 28. Linear regression of the difference of birth weight between earthquake experienced parity and previous parity and the association of the different intensity exposure area 43
Table 29. Linear regression of the difference of birthweight between earthquake experienced parity and later parity and the association of the different intensity exposure area 44
List of Figure
Figure 1. Time dimension: Adjusted odds ratio of preterm delivery in high, moderate and low intensity exposure area classification with different year 22
Figure 2. Time dimension: Adjusted odds ratio of low birth weight in high, moderate and low intensity exposure area classification with different year 30
(2)Risk Factors of Stillbirth in Taiwan
Contents
Chinese Abstract i
English Abstract iii
Contents v
List of Tables vi
1. Introduction 1
2. Material and Methods 3
2.1. Study Population and Outcome Measurement 3
2.2. Study Design 5
2.3. Exposure measurement 6
2.4. Statistical Analysis 6
3. Results 7
3.1. Phase I: Routine data analysis 7
3.2. Phase II: Case-control study 11
4. Discussion 18
5. Reference 21
Appendix A 病歷摘錄表 24
Appendix B 電訪問卷 27
Appendix C 死產證明書 30
Appendix D 出生證明書 32
List of Tables
Table 1 Study design and population 4
Table 2 Unadjusted and adjusted odds ratios for stillbirth within categories of maternal characteristics in Phase I Routine data analysis (All stillbirth numbers: 1979; all live birth numbers: 246513) 8
Table 3 Unadjusted and adjusted odds ratios for stillbirth within categories of maternal medical disease in Phase I Routine data analysis (All stillbirth numbers: 1979; all live birth numbers: 246513) 9
Table 4 Unadjusted and adjusted odds ratios for stillbirth within categories of obstetrics complication in Phase I Routine data analysis (All stillbirth numbers: 1979; all live birth numbers: 246513) 10
Table 5 Response and non-response compare (All stillbirth numbers: 307; all live birth numbers: 307) 12
Table 6 Unadjusted odds ratios for stillbirth within categories of maternal characteristics (All stillbirth numbers: 307; all live birth numbers: 307) 13
Table 7 Unadjusted odds ratios for stillbirth within categories of maternal medical disease (All stillbirth numbers: 307; all live birth numbers: 307) 14
Table 8 Unadjusted odds ratios (ORs) for stillbirth within categories of obstetrics complications 15
Table 9 Adjusted odds ratios (ORs) for stillbirth by logistic regression 16
Table 10 Adjusted odds ratios (ORs) for stillbirth by logistic regression (without adjusted maternal body mass index, maternal education, maternal smoking and maternal alcohol drinking) 17

(1)Association between the 921 Earthquake and Pregnancy Outcome
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(2)Risk Factors of Stillbirth in Taiwan
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