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研究生:吳惠琤
研究生(外文):Hui-Chen Wu
論文名稱:一、出生體重與懷孕週數常模二、重金屬對胎兒成長與神經發育的影響
論文名稱(外文):1. Birth Weight by Gestational Age2. Heavy Metals on Fetal Growth and Neurodevelopment
指導教授:陳保中陳保中引用關係
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:2005
畢業學年度:93
語文別:英文
論文頁數:66
中文關鍵詞:出生體重懷孕週數生長遲滯胎兒成長神經行為發展
外文關鍵詞:birth weightgestational agesmall for gestational agearseniccadmiummercurymanganeseleadbehaviorpregnancy
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一、出生體重與懷孕週數常模
研究目的:
本篇研究使用內政部出生登記檔建立新生兒出生體重與懷孕週數的常模。並以此常模預測在各懷孕週數出生嬰兒第五、第十、第二十五、第五十、第七十五、第九十、及第九十五百分比的出生體重,並以此估計台灣生長遲滯胎兒在各週數的出生體重。

材料與方法:
使用polynomial regression model 預測內政部出生登記檔中的出生體重與懷孕週數的常模。

結果:
懷孕週數平均值為三十九週,平均出生體重為3150克到3106克,而外籍新娘在每年都有上升的趨勢,而單胞胎、低出生體重和早產也隨著每年有輕微上升的傾向。在常模方面,出生體重皆會隨著懷孕週數上升而增加,但在單胞胎時則在超過四十二週時則有下降的趨勢。

二、重金屬對胎兒成長與神經發育的影響
研究目的:
觀察母親懷孕期間重金屬暴露對於新生兒出生結果與神經行為動作的相關性。
材料方法:
將2004年5月至2004年12月於台北盆地地區分娩的母親與新生兒進行追蹤調查。以臍帶血樣進行砷、鎘、汞、錳以及鉛之暴露評估,並於出生後二至三天以中文版神經行為評估量表進行新生兒行為評估。

研究結果:
在出生結果方面,並沒有發現與臍帶血重金屬的濃度具有相關性。而以中文版新生兒神經行為評估量表評估後發現在本研究族群中屬於低得分的百分之十之新生兒,背景的重金屬暴露並沒有發現與出生結果和神經行為發展有相關。
1. Birth Weight by Gestational Age
Aims:
The study is using registered birth data to establish the model between birth weight and gestational age. Prediction of birth weight at every gestational age, each of which classified into the fifth, tenth, 25th, 50th, 75th, 90th, and 95th percentiles, is made using this model. Thereafter we evaluate the small for gestational age (SGA) in Taiwan with their birth weight at every gestational age.

Research design and methods:
The data set obtained from the birth registries in Ministry of the Internal, was used to predict the percentage of birth weight at every gestational age under the polynomial regression model.

Results:
The average of gestational age is 39 week and the mean birth weight ranges from 3106g to 3150g. We found increasing populations of mothers with foreign nationalities every year, and also slight increase in the percentage of primipara, low birth weight, and preterm labor. Mean birth weight decreased year by year.

For singleton births, birth weight rises with the gestational age up to 42nd week and starts to decrease after the 43rd week. However, for multiple births, birth weight increases following the step up of gestational age.


2. Heavy Metals on Fetal Growth and Neurodevelopment
Aims:
The objective in this study is to estimate the relation between fetal growth and neurodevelopment and low level heavy metal exposure in general population by using umbilical cord blood metal levels.

Research design and methods:
The subjects in this study are chosen pregnant women and their neonates from the participants in the pilot of Taiwan Birth Cohort Study. We used fetal cord blood As, Cd, Hg, Mn, and Pb concentrations to detect the relation between pregnant women blood metal levels and fetal cord blood metal levels. For all neonates, neonatal neurobehavioral performance at two or three days after delivery is detected by neonatal neurobehavioral examination in Chinese Version (NNE-C).

Results:
Relation of fetal growth and neurodevelopment with heavy metal levels were shown in table 4, 5 and 6. As was positive related to tone and motor pattern, and Hg was positive related to head circumference by linear regression models. But for categorical analysis, As and Hg were shown the significant protection for low birth weight. Pb was observed the significant negation for the levels between 11.51 and 21.90 µg/L. But for tone and motor pattern, Cd and Pb were displayed negative for the levels of 0.35 to 0.57 µg/L, and 7.90 to 11.51 µg/L.
1. Birth weight by Gestational Age

CHINESE ABSTRACT 1
ABSTRACT 2
INTRODUCTION 6
MATERIALS AND METHODS 6
RESULTS 7
DISCUSSION 7
REFERENCE 9
APPENDIX 16

List of tables
Table 1. Characteristics of s newborns between 21 weeks and 44 week in Taiwan from 1998 to 2002 10
Table 2. Raw birth weight percentiles of gestational ages for male singleton births in Taiwan between 1998 and 2002 16
Table 3. Raw birth weight percentiles of gestational ages for female singleton births in Taiwan between 1998 and 2002 17
Table 4. Raw birth weight percentiles of gestational ages for male twin births in Taiwan between 1998 and 2002 18
Table 5. Raw birth weight percentiles of gestational ages for female twin births in Taiwan between 1998 and 2002 19
Table 6. Raw birth weight percentiles of gestational ages for triplet births in Taiwan between 1998 and 2002 20
Table 7. Smoothing birth weight percentiles of gestational ages for male singleton births in Taiwan between 1998 and 2002 by polynomial smoothing method 21
Table 8. Smoothing birth weight percentiles of gestational ages for female singleton births in Taiwan between 1998 and 2002 by polynomial smoothing method 22
Table 9. Smoothing birth weight percentiles of gestational ages for male twin births in Taiwan between 1998 and 2002 by polynomial smoothing method 23
Table 10. Smoothing birth weight percentiles of gestational ages for female twin births in Taiwan between 1998 and 2002 by polynomial smoothing method 24
Table 11. Smoothing birth weight percentiles of gestational ages for triplet births in Taiwan between 1998 and 2002 by polynomial smoothing method 25

List of Figures
Fig 1. Birth weight curves for male singleton births between 21 weeks and 44 weeks by polynomial smoothing
method 11
Fig 2. Birth weight curves for female singleton births between 21 weeks and 44 weeks by polynomial smoothing
method 12
Fig 3. Birth weight curves for male twin births between 21 weeks and 43 weeks by polynomial smoothing method 13
Fig 4. Birth weight curves for female twin births between 21 weeks and 42 weeks by polynomial smoothing
method 14
Fig 5. Birth weight curves for triplet births between 22 weeks and 41 weeks by polynomial smoothing method 15


2. Heavy metals on Fetal Growth and Neurodevelopment

CHINESE ABSTRACT 27
ABSTRACT 28
INTRODUCTION 31
MATERIAL AND METHODS 33
Study population 33
Data collection 33
Growth and neurodevelopment measurements 33
Heavy Metal Levels Analysis 34
Statistical Analysis 34
RESULT 36
DISCUSSION 37
CONCLUSION 39
REFERENCE 40
APPENDIX 51
Neonatal Neurobehavioral Examination in Chinese Version (NNE-C) 51
Inform consent 58

List of Tables
Table 1. Characteristics of participants from four locations 44
Table 2. Geometric mean and IQR of five heavy metals levels form four locations 45
Table 3. fetal growth and neurodevelopmental outcomes from four locations 46
Table 4. Linear regression models of fetal growth and neurodevelopmental outcomes and each log-transformed metal level 47
Table 5. Logistic regression of categorical fetal growth outcomes and each metal level 48
Table 6. Logistic regression of categorical fetal neurodevelopmental outcomes and each metal level 50
Table 7. The summary of literatures about heavy metals and birth outcomes 53
Table 8. The summary of literatures about heavy metals and neurobehavior 55
Table 9. The summery about relation between metals and fetal or infant outcomes 56
Table 10. Correlation of log-transformed eight metals levels 57
1. Birth Weight by Gestational Age
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2.Heavy Metals on Fetal Growth and Neurodevelopment

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