臺灣博碩士論文加值系統

研究背景:隨著人類物質文明的進步，罹患第2型糖尿病和妊娠糖尿病的人口有逐年增加的趨勢，研究證實妊娠糖尿病和婦女日後發生第2型糖尿病有顯著的關連性，且會提高其子女罹患糖尿病的風險，也會影響其子女的健康；但卻缺乏長期系列追蹤探討的相關研究。
研究目的:本研究計畫進行非同時期世代追蹤與個案控制，目的為探討妊娠糖尿病於21年內(1995-2016)對婦女演變為第2型糖尿病的危險因子和對其子女健康的影響。
研究方法:以1995年至2011年這十七年期間在南部二家教學醫院被診斷為妊娠糖尿病的婦女作為本研究母群體。首先採用病歷回顧與登錄1995年至2011年間懷孕生產被診斷為妊娠糖尿病的婦女，她們於懷孕時的生理指標、生產結果以及其產後期的血糖數值與相關之合併症；於2016年再邀請這些婦女和其子女返院參加「妊娠糖尿病婦女回娘家」活動，在徵得其同意參與本研究之後，進行抽血檢查婦女的空腹血糖、胰島素、糖化血色素、三酸甘油酯、總膽固醇、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、體脂肪與 75公克口服葡萄糖耐性檢驗，填寫糖尿病管理之自我效能、憂鬱和健康狀況等相關問卷，以及測量身高、體重、身體質量指數、與血壓並且完成三代家族樹。同時也收集其子女的基本資料和測試生理指標包括身高、體重、身體質量指數、血壓以探討妊娠糖尿病對其子女的長期影響。
研究結果:本研究對象共有57位婦女與57位子女返院參加活動。妊娠糖尿病婦女在後續追蹤期的口服75公克葡萄糖耐性試驗的空腹血糖值與2小時的血糖值、三酸甘油酯、總膽固醇的數值比產後42天高，而且高密度脂蛋白膽固醇的數值較低。在妊娠糖尿病婦女的後續追蹤期，糖尿病組婦女的冠心病危險因子，包括體重、身體質量指數、體脂肪、腰圍、三酸甘油酯、口服75公克葡萄糖耐性試驗空腹血糖值、口服75公克葡萄糖耐性試驗 2小時血糖值、空腹胰島素、口服75公克葡萄糖耐性試驗2小時胰島素和收縮壓，皆比血糖正常組婦女高，並且高密度脂蛋白膽固醇較低。妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子包括產前身體質量指數、產前口服100公克葡萄糖耐性試驗空腹血糖值和產後口服75公克葡萄糖耐性試驗2小時血糖值；產前和產後的共同危險因子包括產前身體質量指數和產後口服75公克葡萄糖耐性試驗2小時血糖值。妊娠糖尿病婦女演變成第2型糖尿病對其小孩身體質量指數影響的產前或產後的危險因子包括生產次數、產前口服100公克葡萄糖耐性試驗空腹血糖值和產後糖化血色素值；產前和產後共同的危險因子包括生產次數、產前口服100公克葡萄糖耐性試驗空腹血糖值和產後糖化血色素值。妊娠糖尿病婦女演變成第2型糖尿病對其小孩體脂肪影響的產前或產後危險因子包括產前口服100公克葡萄糖耐性試驗空腹血糖值和產後糖化血色素值；產前和產後共同的危險因子包括產前懷孕總增加體重和產後糖化血色素值。
結論:本研究結果發現妊娠糖尿病婦女演變為第2型糖尿病和影響其子女健康的產前或產後與產前和產後共同危險因子，臨床醫護人員可以提供完善的護理措施，透由宣導和衛生教育策略，讓她們重視這些危險因子，督促她們帶著自己的子女定期回診追蹤和檢查，以促進婦女及其子女的健康。

Background: With the advancement of human material civilization, the population suffering from type 2 diabetes and gestational diabetes has an increasing trend year by year. Studies have proven that gestational diabetes mellitus (GDM) and type 2 diabetes have significant correlation. Gestational diabetes mellitus is associated not only with the later risk of type 2 diabetes in mothers, but also with metabolic changes that may lead to the development of diabetes and negative health impact on their offspring. Obviously, a series of systematic long-term follow-up studies are warranted.
Purpose: The purpose of the study, designed with a non-concurrent cohort study and a case-control study, is to explore the consequence of GDM for women’s and their offsprings’ health status over twenty one years (1995-2016).
Method: The accessible population is women who were diagnosed with GDM in two teaching hospitals of southern Taiwan from 1995 to 2011. First, a medical chart review from 1995 to 2011 from those women’s medical charts were conducted in the two hospitals. Research data including women’s physiological indicators for their pregnancy, childbirth outcomes, postpartum complications, and blood sugar after childbirth were collected. In 2016 we invited those women and their children back to the hospitals for a diabetes event that was held to follow up on their health status. After the study was approved by the institutional review board and a signed consent form was completed by the participants, a fasting blood withdrawal for sugar, insulin, HbA1c, triglyceride, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, body fat and a 75g oral glucose tolerance test (OGTT) were conducted. Then body height, body weight, body mass index, and blood pressure were taken after they completed three questionnaires including diabetes management self-efficacy scale, Taiwanese depression questionnaire, and Chinese health questionnaire. A family pedigree involving three or more generations was collected. Their children’s demographic characteristics, body height, body weight, body mass index, and blood pressure were collected at the same time.
Result: A total of 57 women and 57 children participated in the diabetes event. Women with gestational diabetes had higher result values for 75g OGTT 2 hour fasting blood sugar, triglyceride, and total cholesterol in followup examinations than they had at 42 days postpartum, but lower result values for high density lipoprotein cholesterol. During the follow-up period for women with gestational diabetes, the risk factors for coronary heart disease in women in the diabetic group were higher than those in the normal blood glucose group, including weight, body mass index, body fat, waist circumference, triglyceride, 75g OGTT fasting blood sugar, 75g OGTT 2 hours blood sugar, fasting insulin, 75g OGTT 2 hours insulin and systolic pressure. The diabetic group also had lower high density lipoprotein cholesterol. Prenatal or postnatal risk factors for women with gestational diabetes who later developed type 2 diabetes include prenatal body mass index, prenatal 100g OGTT fasting blood glucose level, postnatal 75g OGTT 2 hours blood sugar level; shared prenatal and postnatal risk factors include prenatal body mass index and postnatal 75g OGTT 2 hours blood sugar level. Prenatal or postpartum risk factors for the forementioned women to have a negative impact on their offspring's body mass index include the number of births, prenatal 100g OGTT fasting blood glucose level, and postnatal glycated hemoglobin level; shared prenatal and postnatal risk factors include the number of births, prenatal 100g OGTT fasting blood glucose level, and postnatal glycated hemoglobin level. Prenatal or postpartum risk factors for these women to have a negative impact on their offspring's body fat include prenatal 100g OGTT fasting blood glucose level, and postnatal glycated hemoglobin level; shared prenatal and postnatal risk factors include prenatal weight gain and postnatal glycated hemoglobin level.
Conclusion: The findings of this study reveal prenatal or postnatal and shared prenatal and postnatal risk factors for women with gestational diabetes mellitus to develop type 2 diabetes and to consequently affect their offspring’s health. Medical healthcare providers should offer comprehensive nursing measures and education, alert these women to the potential risk factors and urge them to bring their children for follow-up visits and inspections regularly for the sake of themselves and their children.

第一章 緒論 1
第一節 問題背景及重要性 1
第二節 研究問題 9
第三節 名詞定義 9
第二章 文獻查證 21
第一節 妊娠糖尿病 21
第二節 妊娠糖尿病與第2型糖尿病之關係 27
第三節 妊娠糖尿病婦女產後血糖值與生化值的變化 30
第四節 妊娠糖尿病婦女產後血糖與冠心病之關係 32
第五節 妊娠糖尿病婦女對子女健康的影響 36
第六節 妊娠糖尿病婦女演變成第2型糖尿病並對其子女健康的影響 38
第七節 妊娠糖尿病婦女產後心理狀態與自我健康管理 39
第八節 概念架構 41
第三章 研究方法 43
第一節 研究設計 43
第二節 研究對象 44
第三節 研究工具 47
第四節 資料收集過程 51
第五節 研究對象保護權益 53
第六節 資料分析方法 54
第四章 研究結果 56
第一節 妊娠糖尿病婦女和其子女之人口學資料 57
第二節 妊娠糖尿病婦女於產後42天與後續追蹤期的血糖和生化數值的差異 62
第三節 妊娠糖尿病婦女於後續追蹤期不同血糖狀態在冠心病相關危險因子之差異 64
第四節 血糖正常組婦女與糖尿病組婦女的產前生理指標之差異分析 65
第五節 血糖正常組婦女與糖尿病組婦女的產後生理和心理指標之差異分析 67
第六節 小孩不同的身體質量指數其母親產前生理指標之差異分析 69
第七節 小孩不同的身體質量指數其母親產後生理和心理指標之差異分析 72
第八節 小孩不同的體脂肪其母親產前生理指標之差異分析 73
第九節 小孩不同的體脂肪其母親產後生理和心理指標之差異分析 76
第十節 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後影響因子之分析 78
第十一節 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同的影響因子之分析 79
第十二節 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子對其小孩身體質量指數的影響之分析 81
第十三節 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩身體質量指數的影響之分析 82
第十四節 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子對其小孩體脂肪的影響之分析 84
第十五節 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩體脂肪的影響之分析 85
第五章 討論 87
第一節 妊娠糖尿病婦女於產後42天與後續追蹤期的血糖和生化數值的差異 87
第二節 妊娠糖尿病婦女於後續追蹤期不同血糖狀態在冠心病相關危險因子之差異 90
第三節 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後影響因子 92
第四節 妊娠糖尿病婦女演變成第2型糖尿病之產前和產後的共同影響因子 94
第五節 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子對其小孩身體質量指數的影響 95
第六節 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩身體質量指數的影響 98
第七節 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子對其小孩體脂肪的影響 99
第八節 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後的共同危險因子對其小孩體脂肪的影響 100
第六章 結論、研究限制與建議 103
第一節 研究結論 103
第二節 研究限制 104
第三節 研究建議 105
參考文獻 107
圖表附件目錄

表1-1 懷孕期間葡萄糖檢測項目和正常值 11
表1-2 100g OGTT葡萄糖耐受性試驗異常之分類 14
表1-3 75g OGTT葡萄糖耐受性試驗異常之分類 16
表1-4 糖化血色素和平均血糖值對照表 17
表1-5 18歲以下兒童及青少年身體質量指數標準值 19
表2-1 國際糖尿病協會與懷孕研究小組(IADPSG)妊娠糖尿病診斷標準 26
表2-2 美國糖尿病協會( ADA)、Carpenter-Coustan及美國國家糖尿病資料小組(NDDG)妊娠糖尿病診斷標準 26
表2-3 世界衛生組織(WHO)妊娠糖尿病診斷標準 26
圖2-1 第2型糖尿病引起心臟血管疾病的病理變化 34
圖2-2 妊娠糖尿病婦女演變第2型糖尿病之危險因子及對子女健康影響之研究架構 42
表3-1 口服葡萄糖水測試標準 47
表3-2 研究資料收集 51
表3-3 資料收集流程 53
表3-4 研究問題與統計方法 55
圖4-1 研究樣本數流程圖 58
表4-1 研究對象的人口學資料 60
表4-2 正常血糖和糖尿病組婦女的人口學資料 62
表4-3 婦女產後42天與後續追蹤期生理指標之檢定 64
表4-4 血糖正常婦女與糖尿病婦女於後續追蹤期在冠心病相關危險因子的差異之檢定 65
表4-5 血糖正常組與糖尿病組婦女之產前生理指標之差異 67
表4-6 血糖正常組婦女和糖尿病組婦女之產後生理和心理指標之差異 69
表4-7 小孩不同的身體質量指數其母親產前生理指標之差異分析 71
表4-8 小孩不同的身體質量指數其母親產後生理和心理指標之差異分析 73
表4-9 小孩不同的體脂肪其母親產前生理指標之差異分析 76
表4-10 小孩不同的體脂肪其母親產後生理與心理指標之差異分析 78
表4-11 妊娠糖尿病婦女演變成第2型糖尿病的產前影響因子 78
表4-12 妊娠糖尿病婦女演變成第2型糖尿病的產後影響因子 79
表4-13 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同的影響因子(一) 80
表4-14妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同的影響因子(二) 81
表4-15妊娠糖尿病婦女演變成第2型糖尿病之產前危險因子對其小孩身體質量指數影響 82
表4-16妊娠糖尿病婦女演變成第2型糖尿病之產後危險因子對其小孩身體質量指數影響 82
表4-17妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩身體質量指數的影響(一) 83
表4-18妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩身體質量指數的影響(二) 84
表4-19妊娠糖尿病婦女演變成第2型糖尿病的產前危險因子對其小孩體脂肪的影響 85
表4-20妊娠糖尿病婦女演變成第2型糖尿病的產後危險因子對其小孩體脂肪的影響 85
表4-21妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩體脂肪的影響(一) 86
表4-22妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩體脂肪的影響(二) 86
表5-1 妊娠糖尿病婦女於產後42天與後續追蹤期的血糖和生化數值的差異 88
表5-2 妊娠糖尿病婦女於後續追蹤期不同血糖狀態在冠心病相關危險因子之差異 88
表5-2 妊娠糖尿病婦女於後續追蹤期不同血糖狀態在冠心病相關危險因子之差異 88
表5-4 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同的影響因子 88
表5-5 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子對其小孩身體質量指數的影響 88
表5-6 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩身體質量指數的影響 88
表5-7 妊娠糖尿病婦女演變成第2型糖尿病的產前或產後危險因子對其小孩體脂肪的影響 88
表5-8 妊娠糖尿病婦女演變成第2型糖尿病的產前和產後共同危險因子對其小孩體脂肪的影響 88
附件一 病歷回顧調查問卷 129
附件二 後續追蹤期調查問卷 132
附件三 人體試驗同意證明書 138

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