第三孕期身體活動、懷孕前身體質量指數和孕期體重增加量對生產結果之影響

Physical Activity during the Third Trimester, Maternal Pre-pregnancy Body Mass Index, Gestational Weight Gain, and Pregnancy Outcomes

陳嘉慧(Chia-Hui Chen)

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(2013年)

https://doi.org/10.6834/CSMU.2013.00095

摘要

適度的身體活動有益於懷孕婦女及胎兒的健康，但多數孕婦可能因不確定適當的身體活動量而減少懷孕後的身體活動，需要護理人員在實證的基礎下指導並依不同孕期提供身體活動諮詢。然而懷孕期身體活動的危險因子與效益尚有爭議，近年來的研究也提出懷孕前身體質量指數是孕期體重增加與周產期結果的關係中的重要調節因子，孕婦孕期體重管理與產後健康的議題也逐漸被重視，故進行以台灣懷孕婦女為對象的研究來澄清懷孕期身體活動和育齡婦女體重管理對周產期結果的益處和風險是必要的。
本研究目的主要是探討不同產次的懷孕婦女在懷孕前身體質量指數和懷孕期體重增加量之分佈和差異性、懷孕期母體體重增加量對新生兒出生體重和孕產婦生產方式的影響性、婦女懷孕前身體質量指數和新生兒出生體重的關係及懷孕第三孕期的身體活動與新生兒出生體重和孕產婦生產方式的關係。
本研究為縱貫式調查研究，在台中巿某醫學中心婦產科門診，採方便取樣，收取懷孕28週後的健康婦女為研究對象，共計123位。研究工具為孕期身體活動量表中文版，並由醫院的病歷記錄或以電話追蹤取得新生兒出生體重及生產方式等資料。資料以SPSS18.0套裝軟體分析，主要以描述性統計、Pearson相關分析、一般線性模式、單因子變異數分析、獨立樣本t檢定分析及邏輯斯迴歸等統計方法。
研究結果顯示，初產婦懷孕期體重增加量明顯高於經產婦（P=.022），懷孕期母體體重增加量為新生兒出生體重顯著的預測因子（R2=.048 ; P=.009）。懷孕前身體質量指數與新生兒出生體重呈正相關（R2=.026 ; P=.043），第三孕期總身體活動量與新生兒出生體重未達統計上的顯著相關；不同身體活動強度與新生兒出生體重也無統計上的顯著意義。懷孕期體重增加量與生產方式無統計上的顯著相關（OR=1.054 ; P=.274），雖然總身體活動量和生產方式未具統計上的顯著相關（OR=.997 ; P＞.05），但在活動強度上，孕產婦的中度身體活動量每增加1MET-hour/週，陰道生產對剖腹生產的勝算為1.01倍（OR=.990 ; P=.035）。
台灣婦女普遍在懷孕期間減少其身體活動量，但適度的身體活動及孕前、孕期體重管理可減少新生兒出生體重過重及剖腹生產的風險。本研究結果除可獲得孕期身體活動之專業知識，促使孕期健康諮詢與身體活動指導更具實證研究基礎，以提升婦女產前與產時之健康促進。

關鍵字

身體活動 ； 身體質量指數 ； 懷孕期體重增加量 ； 生產結果 ； 第三孕期

並列摘要

Regular moderate intensity physical activity has significant benefits for pregnant women and fetal health. Most pregnant women tend to reduce physical activities during pregnancy due to the uncertainty of the amount of moderate-level physical activity. Nurses should continue to guide and answer the concerns of pregnant women and provide appropriate amounts of physical activity based on existing evidence for pregnant women with different stages of pregnancy. However, risk factors and benefits of physical activity during pregnancy remain controversial. Previous studies also show that pre-pregnancy body mass index (BMI) is an important regulatory factor in relationship of gestational weight gain and perinatal outcomes. More attention has been placed on weight management during pregnancy and postpartum health issues. Therefore, it is necessary targeting on Taiwanese pregnant women to clarify the benefits and risks of perinatal outcomes on physical activity during pregnancy and weight management among women of childbearing age.
The aims of this study were to explore the different parities of pregnant women in the pre- pregnancy body mass index and gestational weight gain distribution and differentiation, to see whether maternal gestational weight gain affected birth weight and maternal delivery mode, to estimate the associations between maternal pre-pregnancy body mass index and birth weight, and to examine if an association existed between physical activity during the third trimester and birth weight or delivery mode.
A longitudinal study was performed. Participants of this study were between 28 to 40 gestational weeks and had a singleton fetus. Data were collected from 123 pregnant women at a medical center in Taichung City by using convenience sampling. The information was collected through the Chinese version of pregnancy physical activity questionnaire. Birth weight and delivery data were retrieved from medical records or by telephone interview. The data were coded and analyzed with SPSS for windows V.18.0. Descriptive analysis, pearson correlation, general linear model, one-way ANOVA, independent-sample t test, and logistic regression were used in this study.
The results revealed that primiparous women gained more weight during pregnancy than multiparous women(P =.022). In addition, maternal gestational weight gain was a significant predictor of birth weight (R2 =.048 ; P =.009). Pre-pregnancy body mass index was positively associated with birth weight (R2 =.026 ; P =.043). There was no association between total physical activity and birth weight. There was also no association between intensity of activity and birth weight. Results from logistic regression provided no consistent evidence for an association between maternal gestational weight gain and delivery mode (OR =1.054 ; P >.05) . Although there was no association between total physical activity and delivery mode (OR =.997 ; P >.05); however, with regards to intensity of activity, Moderate -intensity activity of pregnant women increased each 1 MET-hour / week, the odds of vaginal delivery to caesarean section was 1.01 times (OR =.990 ; P =.035).
In general , Taiwanese women reduce their physical activity during pregnancy. However, moderate-level physical activity and weight management can reduce the risk of newborn overweight and the caesarean section. In addition to obtaining professional knowledge in physical activity during pregnancy, the findings from this study also can provide solid evidence on health counseling during pregnancy as well as can offer physical activity guidance with more empirical research base, and thus improve the health promotion of antepartum and intrapartum women.

並列關鍵字

physical activity ； body mass index ； gestational weight gain ； pregnancy outcomes ； the third trimester

參考文獻

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