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母親危險因子對低出生體重嬰兒、早產兒、及生長遲滯嬰兒之影響-前瞻性懷孕世代研究

Influence of Maternal Risk Factors on Low Birthweight, Preterm Delivery, and Small for Gestational Age - A Prospective Cohort Study of Pregnancy

摘要


目標:本前瞻性世代研究以探討母親危險因子對低出生體重兒、早產兒、及生長遲滯兒的影響,包括生物學背景、母親產科史、懷孕中疾病及吸菸的可能影響。方法:1984至1987年間,針對在台北市立婦幼醫院產前檢查的所有懷孕六個月以上孕婦使用結構化問卷進行訪視,並於嬰兒出生後閱覽孕婦及新生兒的病歷進行摘錄。總共使用12,273單胞胎活產兒進行出生結果logistic迴歸分析。結果:關於低出生體重兒方面,母親產前出血及高血壓是最強的危險因子,瘦小及肥胖的母親、二次以上的自然流產經驗、以前有低出生體重或早產兒、以及梅毒感染是中度的危險因子,女嬰及初產婦亦與低出生體重兒有顯著相關。關於早產兒方面,母親產前出血亦是是最強的危險因子,肥胖的母親、矮小的父親、二次以上的自然流產經驗、及以前有低出生體重或早產兒則有中等程度的影響。母親高血壓、低懷孕前體重、及初產婦皆是為對稱及非對稱生長遲滯兒的危險因子,除初產婦外對非對稱生長遲滯兒有較大的影響,矮小母親或父親及以前有低出生體重或早產兒亦與對稱生長連滯兒有顯著相關。結論:已知的危險因子持續存在,未來需要進行介入性預防措施。

並列摘要


Objectives: This prospective cohort study investigated low birthweight (LBW), preterm delivery (PTD), and small for gestational age (SGA) in Taipei, Taiwan. Effects of maternal risk factors on birth outcomes were examined, including biological background, maternal obstetric history, as well as medical events and smoking during pregnancy. Methods: Between 1984 and 1987, each pregnant woman who came to the Taipei Municipal Maternal and Child Hospital for prenatal care was interviewed using a structured questionnaire. Maternal and newborn medical records were abstracted after delivery. A total of 12,273 singleton livebirths were analyzed. Potential risk factors associated with birth outcomes were examined using logistic models. Results: Antepartum hemorrhage and hypertension were the strongest risk factors for LBW or PTD history, and infection with syphilis had moderately increased risks. Female gender and primiparae were were also significantly associated with the risk of LBW infants. Antepartum hemorrhage was the strongest risk factor for PTD infants, whereas obese mothers, short fathers, two or more prior spontaneous abortions, and previous LBW or PTD history gave moderately increased risks. Maternal hypertension, low pre-pregnancy weight, and primiparae were the risk factors for both symmetric and asymmetric SGA infants Those effects except primiparae were considerably greater on asymmetric than symmetric SGA infants. Low parental height and previous LBW or PTD history were also significantly associated with the risk of symmetric SGA infants. Conclusions: The relationship between several known risk factors and birth outcomes consistently remains, and interventions should be promoted in Taiwan.

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