體外受精之懷單雙胞胎產婦孕期體重與新生兒出生結果

The gestational weight and neonatal outcomes between singleton and twin gestation after in vitro fertilization

張蔚瀅(Wei-Ying Chang)

指導教授 ： 郭碧照

中山醫學大學/護理學院/護理學系碩士班/碩士(2010年)

https://doi.org/10.6834/CSMU.2010.00063

摘要

孕前體重為婦女營養健康狀況的重要指標，透過懷孕前身體質量指數(BMI)、妊娠期體重增加幅度以評估產婦與新生兒週產期健康，並可做為預測新生兒出生結果的重要因素。許多研究證實，懷孕前BMI過重及妊娠期間體重增加不適當，對母體及新生兒出生結果皆有不利的影響。
本研究目的一為瞭解體外受精胚胎植入懷單胞胎與雙胞胎產婦之孕前不同BMI、妊娠期體重增加與新生兒出生之結果；二為探討其孕前不同BMI及妊娠期增加體重與新生兒出生結果之差異性；三為探討新生兒體重之預測因子。
本研究設計採病歷對照研究法(case control study)，研究地點為中部某試管嬰兒中心，以立意取樣法(purposive sampling)收取自2007年01月至2009年12月接受體外受精胚胎植入之懷單胞胎與雙胞胎產婦各100位，共計收取200位產婦。
研究工具為單胞胎、雙胞胎產婦與新生出生結果的紀錄表，研究者依照孕婦健康手冊、兒童健康手冊及病歷之數據，完成登錄體重紀錄表之內容，包括產婦之人口學、產科史及新生兒出生結果之相關資料。資料登錄電腦後以SPSS 16.0版進行分析，使用描述性統計及t-test、one-way ANOVA、χ2 test分析單雙胞胎、懷孕前不同BMI、妊娠期體重增加幅度、妊娠合併症、產婦年齡與新生兒出生結果之差異；新生兒體重預測因子以複迴歸分析法分析。
研究結果顯示依據孕前不同BMI符合妊娠期的體重建議標準，無論單雙胞胎其新生兒發生低出生體重、早產及入住加護病房率較低。單胞胎產婦的平均年齡為(33.63±4.52歲)，孕前BMI平均為21.70±3.61(kg/m2)，妊娠期平均增加體重(14.81±5.07公斤)；雙胞胎產婦的平均年齡為(32.57±3.66歲)，孕前BMI平均為21.42±2.57(kg/m2)，妊娠期平均增加體重(16.77±5.77公斤)。單胞胎與雙胞胎產婦孕前正常BMI 18.5-23.99(kg/m2)皆為最多，分別各佔74%，78%；妊娠期增加體重，雙胞胎產婦比單胞胎產婦體重多增加1.96公斤(p=.01)。可見單胞胎產婦符合我國行政院衛生署建議妊娠期體重增加10-15公斤，雙胞胎產婦則略低於美國醫學會建議17-25公斤。單胞胎新生兒出生週數平均為(38.28±1.42週)，出生體重平均為(3,114.76±509.61公克)；雙胞胎新生兒出生平均週數為(35.48±2.01週)，出生體重平均為(2,271.66±423公克)。雙胞胎負向出生結果高於單胞胎(p<.01)，故雙胞胎比單胞胎有較高比例出現早產、低出生體重及入住新生兒加護病房。單胞胎與雙胞胎產婦體重增加符合建議標準分別各佔41人、31人。單胞胎與雙胞胎產婦有合併症者分別各佔28人、34人。雙胞胎母親有無妊娠合併症者，其Apgar score出生第一分鐘小於7分以下、新生兒有入住加護病房，達統計上的顯著差異(p<.05)，而對單胞胎新生兒則無明顯差異。單胞胎產婦年齡大於等於35歲者其剖腹產率較高，且達統計顯著意義(p<.05)，雙胞胎產婦97%為剖腹產。胎數、妊娠期增加體重及懷孕前BMI為新生兒出生體重之影響因子，此三個因子解釋新生兒出生體重43.9%的變異量。
本研究結果可提供依懷孕前不同BMI，於妊娠期增加體重與新生兒結果之相關實證資料數據，提供臨床醫護人員與妊娠婦女，有效控制妊娠期增加體重，以促進新生兒出生結果之健康。

關鍵字

體外受精胚胎植入 ； 雙胞胎 ； 單胞胎 ； 妊娠期增加體重 ； 新生兒結果

並列摘要

The prepregnancy weight is an important health indicate of women, using body mass index (BMI), gestational weight gain and gestational age to estimate the perinatal health of gravidas and neonate, and it is also an important element to forecast the outcome of the neonate.As many researches are confirmed, there are bad effects to mother and neonate while the prepregnancy weight is too over and owned excessive gestational weight gain.
The purpose of this research first is to understand the singleton and twin in the differences prepregnancy body mass index, gestational weight gain, and neonatal outcomes by in vitro fertilization embryo transfer (IVF/ET). Second is to treat differences prepregnancy body mass index, gestational weight gain, and neonatal outcomes.Third is to treat forecast factor of neonatal body weight.
The research was designed as a case control study of purposive sampling. The subjects were 200 twin gestation women undergoing in vitro fertilization embryo transfer (IVF/ET) in a infertility treatment center in Central Taiwan from January, 2007 to December, 2009. Among them, there were 100 singleton and 100 twin gravidas, and total collected 200 gravida.The collected data were of singleton, twin and neonatal outcomes.The researcher accomplished a gestational weight chart and a birth outcome record, using the data from each maternal health handbook and the child health handbook and subject’s medical record, inclusion demography, obstetrics history and neonatal outcomes.The collected data were then analyzed by the package software SPSS16.0 using descriptive statistics with t-test, one-way ANOVA, and χ2 test to analyze the relationship of different prepregnancy weight, gestational weight gain range, pregnancy complications, gestational age and neonatal outcomes analyze forecast factor of neonatal outcomes by multiple regression analyze. According to different prepregnancy BMI who tally with recommended prepregnancy weight, the neonatal outcomes have lower rates in low birth weight, premature birth and reside to ICU.
The result of study show that proposes the standard according to the differences prepregnancy body mass index and answer the gestational period, no matter single twins neonate had low birth weight , premature delivery and is it provide special care to ward , serious rate relatively lower ward to move in.Results of this research revealed that the average age of singleton gestation women is 33.63±4.52 years old, and the average prepregnancy BMI is 21.70±3.61(kg/m2), and the average gestation weight gain is 14.81±5.07 kg.Then, the average age of twin gestation women is 32.57±3.66 years old, and the average prepregnancy BMI is 21.42±2.57(kg/m2), and the average gestation weight gain 16.77±5.77 kg.Most gestation women in normal prepregnancy BMI 18.5-23.99 (kg/m2), 74% in singleton gestation women, 78% in twin gestation women. The average gestation weight gain in twin gestation women is 1.96kg which is heavier than singleton gestation women, tally with Department of health recommended gestation weight gain standard(10-15kg) in singleton gravidas, but the twin gravidas average gestation weight gain is lower than American medical association recommended 17-25kg. The average gestational age in singleton is 38.28±1.42 weeks and the average weight 3114.76±509.61g. In twins, the average gestational age is 35.48±2.01 weeks, the average birth weight is 2271.66±423g. The adverse outcomes of twins are more than those of singletons(p<.01).There are 41 singleton gravidas and 31 twins gravidas tally with recommended gestation weight gain standard and have good neonatal outcomes. The singleton gravidas were 28% with pregnancy complications, and 34% with the twin gravidas. There is an outstanding statistics difference (p<.05) that the Apgar score is under 7 at first 1 minute and 5 minute, reside to ICU in twin gestation women with pregnancy complications, no outstanding different in singleton. The singleton gestation women have higher rate of doing caesarean section with the age over 35, and have an outstanding statistics difference (p<.05) that twin gestation women 97% accepted the caesarean section.Gestation times, gestation weight gain, and preconception BMI are effective factor of neonatal outcomes. These three factors explain the 43.9% variation of the neonatal outcomes.
This research provides the data of neonatal outcomes with different pregnancy BMI, gestational weight gain standard, which helps the clinic staffs and gestation women to control gestational weight gain, and advance health of neonatal outcomes.

並列關鍵字

in vitro fertilization embryo transfer (IVF/ET) ； twins ； gestational weight gain ； neonatal outcomes

參考文獻

行政院衛生署國民健康局 (2009)．孕婦健康手冊日期2010年01月22日．摘自:

行政院衛生署國民健康局 (2008)．民國九十七年出生通報資料日期2010年07月12日．摘自:

行政院衛生署國民健康局 (2007)．民國九十六年台灣地區人工協助生殖施行結

行政院衛生署國民健康局 (2006)．民國九十五年台灣地區人工協助生殖施行結

熊明禮、蔣忠慈、王鍵慰、徐美惠、劉茂東 (2009)．不同身體質量指數大學生健康促進生活型態的比較研究．蘭陽學報 (8): 11。