台灣地區妊娠糖尿病母親其新生兒與先天性缺陷之相關

Congenital Malformations in the First Offspring of Women with Gestational Diabetes Mellitus in Taiwan

蔡亭儀(Ting-Yi Cai)

指導教授 ： 邱政元

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00148

摘要

研究背景：
國外雖然已有多篇研究探討母親患有妊娠糖尿病與先天性缺陷的相關性，但其結果卻存有爭議性，而於台灣地區探討此相關性的研究也非常少。另外本研究所使用的資料庫為具有全國代表性。

研究目的：
本研究目的在探討患有妊娠糖尿病母親，其與第一胎新生兒健康狀態及患先天性缺陷疾病之相關性。以及探討使用不同治療方式的妊娠糖尿病母親，其與第一胎新生兒健康狀態及發生先天性缺陷疾病之相關性。

研究方法：
以2004-2009年出生通報檔、全民健康保險研究資料庫為主，輔以出生登記檔進行分析。本研究將出生通報檔2000年至2003年有生產記錄者共188798人予以排除，再排除患有孕前糖尿病者共3356人，接續篩選出於懷孕期間患有妊娠糖尿病者共19430人，再細分為使用胰島素治療者共793人，以及飲食控制者共18637人，分別探討其第一胎新生兒的健康狀態與缺陷情形。

研究結果：
本研究結果發現台灣地區妊娠糖尿病的盛行率大約為3%。大約有4%妊娠糖尿病者使用胰島素治療。患有妊娠糖尿病者共有19430人，其平均年齡為31歲，平均懷孕週數為38.3週，其新生兒平均出生體重為3163克。患有妊娠糖尿病母親其新生兒患有全缺陷的危險性是沒有糖尿病母親的1.23倍，耳、面、頸缺陷為1.51倍，心臟缺陷為1.30倍，泌尿系統缺陷為1.49倍，四肢缺陷為1.36倍。 

研究結論：
患有妊娠糖尿病的母親，其新生兒患有先天性缺陷風險比沒有糖尿病母親其新生兒顯著較高，尤其是耳面頸缺陷、心臟系統缺陷、泌尿系統缺陷、四肢缺陷。而使用胰島素的妊娠糖尿病母親，其新生兒患有先天性缺陷風險比使用飲食控制的妊娠糖尿病母親其新生兒顯著較高。尤其是神經系統缺陷、耳面頸缺陷、心臟系統缺陷、呼吸系統缺陷、口面裂缺陷、泌尿系統缺陷、染色體異常。期望本研究結果可喚醒國人對妊娠糖尿病篩檢的重視，並運用在妊娠糖尿病篩檢的相關保健政策制定上。

關鍵字

妊娠糖尿病 ； 先天性缺陷 ； 胰島素治療 ； 健保資料庫

並列摘要

Background：
Several recent studies have demonstrated that the association between gestational diabetes mellitus (GDM) in mothers and the presence of congenital malformations in their offsprings. The results of these studies appear to be in controversial to each other. Very few studies have been conducted locally in Taiwan on the association between gestational diabetes mellitus (GDM) in mothers and the congenital malformations in their offsprings. The database used in this study was a nationally representative.

Objective：
This study is to analyze the congenital malformations and health status of the first offspring of pregnant women with GDM. It is also to analyze the effect of different treatments on pregnant women with GDM as well as the risk of congenital malformations and health status in their first child.

Method：
The data from the year 2004 to 2009 was obtained from the Birth Certificate Application, National Health Insurance Research Database, and the Birth Registration database. From the data obtained, a total of 188798 women who ever delivered newborns were excluded and a further 3356 women were excluded as these women have already been suffering from diabetes prior to pregnancy. The final number for analysis was 19430 pregnant women with GDM. 793 women were on insulin treatment and the remaining 18637 women were on diet control.

Results：
The prevalence of gestational diabetes in Taiwan is about 3% of the total population. Among 19430 pregnant women suffering from GDM; the average age was 31 years old and the average gestational age was 38.3 weeks. The average birth weight of their offspring was 3163g. The results indicate that pregnant women suffering from GDM had a 1.23 times higher risk for total congenital malformations to occur in their offspring when compared with non-diabetes women. Women with GDM when compared to non-diabetes women had a 1.51 times higher risk for ear face and neck defects to occur in their offspring; had a 1.30 times higher risk for congenital heart defects; had a 1.49 times higher risk for urinary bilateral renal agenesis and had a 1.36 times higher risk for limb defects.

Conclusion：
Pregnant women with GDM had higher risk for total congenital malformations in their offspring when compared with non-diabetes women. The birth defects in first offspring of pregnant women with GDM, such as ear face and neck defects, congenital heart defects, urinary bilateral renal agenesis, and limb defects had higher risk than any other birth defects. Pregnant women with GDM who were treated with insulin had higher risk for total congenital malformations in their offspring when compared with pregnant women with GDM who were on diet control. This is especially true in birth defects of nervous system defects, ear face and neck defects, congenital heart defects, respiratory defects, Oro‐facial clefts, urinary bilateral renal agenesis, chromosome abnormality. The results of this study can be used in the related health management policy.

並列關鍵字

congenital abnormalities ； gestational diabetes mellitus ； treated with insulin ； National Health Insurance Research Database

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