臺灣博碩士論文加值系統

目的：肥胖為全球性的議題，而孕前肥胖與過量孕期體重增加都將提高胎兒與母親不良妊娠結果及往後代謝異常等併發症的風險增加。本研究目的為：探討孕前BMI及各孕期體重增加對妊娠血糖耐受異常、妊娠糖尿病、妊娠及新生兒出生結果的影響;孕前BMI、孕期體重增加與產後體重滯留相關性之探討。
方法：本研究為孕期世代研究，立意取樣，以高雄市某地區醫院孕婦為對象，於妊娠29週後產檢時進行問卷收集，內容包含個人基本社經資料、生育史、孕前體位、孕期飲食行為、生活型態，並於產後1個月回診時進行病歷回顧資料包括妊娠血糖耐受試驗及妊娠糖尿病確診試驗結果、生產方式及生產與產後特殊併發症、新生兒出生結果、產檢體重紀錄及產後回診體重測量數值。
結果：總收案191人，平均年齡31.3±4.7歲、孕前BMI平均22.7±3.8 kg/m2、總孕期體重增加11.7±4.4 kg、產後一個月回診體重滯留3.3±4.2 kg。本研究發現GDM婦女孕前BMI較血糖正常婦女高，在診斷GDM後，孕婦顯著降低第三孕期及總孕期體重增加(p <0.05)與產後體重滯留(p <0.01)。懷孕初期體重增加、總體重增加與產後體重滯留三者呈現正相關(p <0.01)。單因子變異數分析顯示孕前BMI過重婦女有較低的總孕期體重增加(分別為10.5及13.7kg,10.5及11.8 kg, p <0.05)及產後體重滯留(分別為1.8及5.7kg,1.8及3.4 kg, p <0.05)顯著低於孕前體位過輕與正常的婦女；另外顯著正相關顯示孕期體重增加高於建議量將導致產後體重滯留情形，無論是依據孕期體重增加是否符合IOM (Institute of Medicine)建議與台灣目前的建議量，都與產後體重滯留有顯著影響(p<0.01)。以多元迴歸分析探討產後體重滯留影響因素，發現總孕期體重增加為影響產後體重滯留重要因素(R2=0.68, p<0.01)，而產後體重滯留顯著與孕前BMI呈負相關。而飲食生活習慣部份，孕期正餐外食頻率高者總孕期體重增加(p<0.01)與產後體重滯留(p <0.05)皆高於正餐多家中食用婦女；孕期超過半數有喝茶飲習慣，且其中高達70.3%婦女於懷孕期喝含糖茶飲習慣可能導致較高孕期體重增加，顯示應加強孕期飲食生活習慣及體重控制等相關衛生教育。
結論：研究結果表示孕前體位及控制懷孕期體重過量增加為避免GDM及母親產後體重滯留重要的控制點，為避免GDM及產後體重滯留，孕前與孕期的飲食生活相關營養教育介入以促進母嬰長期健康，是必需且非常重要的。

Objective: Obesity has emerged as a major public health problem around the globe. Pre-pregnancy obesity and excessive gestational weight gain will increase the risk of adverse pregnancy outcomes and increase the subsequent risk of metabolic disorders and complications. The main purpose of this study is to determine the relationship between pre-pregnancy body mass index (BMI), gestational weight gain to the gestational diabetes (GDM) and birth outcome. Moreover to determine the relationship of pre-pregnancy BMI, gestational weight gain to the postpartum weights retention. Methods: In this purposive sampling maternal cohort study, we recruit pregnant women, who are over, at the obstetrical and gynecological prenatal care clinic in the southern Taiwan. After 29 weeks of pregnancy, eligible pregnant women data were collected during their prenatal visit which included maternal socio-economic data, reproductive history, pre-pregnancy posture, pregnancy eating behavior, and lifestyle data. Moreover, a month after child birth we will review the result of their pregnancy glucose tolerance test, the production and post-natal special complications, neonatal birth outcomes, giving birth and postpartum weight record. Result: A total of 191 agreed to participate, the average maternal age was 31.3±4.7 years, mean prepregnancy BMI was 22.7±3.8 kg/m2、total gestational weight gain11.7±4.4kg,1 month postpartum weight retention3.3±4.2kg. Our study found that pregnant women with GDM had higher BMI compared with women with normal blood sugar. Weight gain in early pregnancy, total gestational weight gain and postpartum weight retention showed a positive correlation (p <0.01). One way ANOVA of variance showed pre-pregnancy overweight women had a lower total pregnancy weight gain (10.5 vs. 13.7 kg, 10.5 vs. 11.8 kg respectively, p <0.05) and postpartum weight retention (1.8 vs. 5.7 kg, 1.8 vs. 3.4 kg respectively, p <0.05) than pre-pregnancy underweight and normal women. A positive relationship showed that higher than the recommended amount of weight gain during pregnancy lead to higher postpartum weight retention either based on IOM’s recommendation or Taiwan’s recommendation. Multiple regression analysis of weight retention to factors of pregnancy weight status showed that total gestational weight gain is the most important contributor to postpartum weight retention. (R2=0.68, p<0.01), pre-pregnancy BMI had a significant but negative correlation to postpartum weight retention. High frequency eating out of pregnancy had significant higher total gestational weight gain (p <0.01) and postpartum weight retention (p <0.05) than women who eating at home. Up to 70.3% of women had sugary drinks habit during pregnancy might also contributed to a higher pregnancy weight gain in this study. Conclusion: The results indicate pre-pregnancy BMI and appropriate weight gain during pregnancy is significant control point to prevent GDM and postpartum weight retention. Pre and pregnancy Lifestyle and dietary habits, as well as promoting nutrition education intervention is necessary to maternal and child’s long-term health.

目錄
誌 謝 ……………………………………………… i
中 文 摘 要 ……………………………………………… ii
英 文 摘 要 ……………………………………………… iv
目 錄 ……………………………………………… vi
表 目 錄 ……………………………………………… viii
圖 目 錄 ……………………………………………… x
第一章 緒論 ……………………………………………… 1
第一節 研究動機………………………………………………… 1
第二節 研究目的………………………………………………… 7
第三節 名詞界定………………………………………………… 9
第二章 文獻探討 ……………………………………………… 13
第一節 懷孕前體位對於懷孕結果影響………………………… 13
第二節 懷孕期體重增加其對於妊娠結果及併發症影響……… 24
第三節 母親因懷孕造成血糖耐受異常與妊娠糖尿病………… 43
第四節 懷孕婦女孕期營養教育………………………………… 52
第三章 材料與方法 …………………………………………… 59
第一節 研究設計………………………………………………… 59
第二節 研究架構………………………………………………… 60
第三節 研究資料收集…………………………………………… 60
第四節 資料處理與統計分析…………………………………… 65
第四章 結果 ……………………………………………… 69
第一節 研究個案基本資料描述……………………………… 69
第二節 研究問題檢驗………………………………………… 70
第五章 討論 ……………………………………………… 90
第一節 孕期血糖耐受異常與妊娠糖尿病之現況及影響因素 90
第二節 懷孕婦女孕期體重增加之現況及影響因素………… 93
第三節 懷孕婦女產後體重滯留之現況及影響因素………… 95
第四節 國內孕期體重增加建議是否適當及孕期營養教育… 97
第六章 結論 ……………………………………………… 103
第一節 結論…………………………………………………… 103
第二節 未來展望……………………………………………… 104
第三節 研究限制……………………………………………… 105
參考文獻 ……………………………………………… 107
附件一 ……………………………………………… 138
附件二 ……………………………………………… 139

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