新移民婦女產前照護服務利用情形與懷孕結果之相關性

Prenatal Care among Immigrant Spouses in Taiwan and Association with Pregnancy Outcomes

廖若雯(Juo-Wen Liao)

指導教授 ： 林恆慶

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

摘要

為保障產婦及胎兒的健康，健保自開辦以來，提供十次免費產前檢查服務；且據衛生署的統計，近年來，產檢利用率皆維持在九成以上。然近幾年來，臺灣異國聯姻的情形日益普遍，新移民婦女及新臺灣之子逐漸增加，儼然成為一新興族群。因此，本研究目的在於分析新移民婦女與本國籍婦女在產檢利用情形和懷孕結果之差異，並進一步探討新移民產婦其產前健康照護利用與懷孕結果之相關性。

本研究以全國性出生通報檔及健保資料庫之次級資料進行分析，在2005年至2006間產下單胞胎且活產之孕婦：新移民婦女共42,166位；而本國籍產婦則依新移民產婦年齡層之比例進行分層抽樣，抽樣結果共84,332位，總研究樣本數為126,498位產婦。在產檢適當性上，本研究以Kessner指標為參考依據，並依健保建議孕程之產檢時間，將產檢利用分為適當、中等及不適當三類。並以羅吉斯迴歸分析新移民婦女之產檢利用與懷孕結果之相關性。

結果顯示新移民婦女的平均年齡為26.17歲；且近九成二的新移民產婦來自越南、大陸及印尼地區。與本國籍產婦相比，新移民產婦其生產方式為剖腹產之比例較低；在新生兒上，有早產、低出生體重、胎兒小於妊娠年齡及情形之比例皆較低。在產檢利用方面，新移民產婦與本國籍產婦其平均初次產檢時間分別為13.49週（±7.23）及10.17週（±3.84）； 平均產檢次數上，新移民產婦與本國籍產婦分別為7.63次（±2.4）與8.22次（±2.24）。初次產檢低於14週者：新移民產婦為69.27%、本國籍產婦為90.77%；產檢為不適當者：新移民產婦為6.53%、本國籍產婦為1.01%。進一步分析新移民產婦其產檢適當性與新生兒出生結果之相關性，新生兒有早產、低出生體重及胎兒小於妊娠年齡情形以產檢不適當之比例較高；與產檢適當的孕婦相比，其勝算比依序為1.532（p<0.001）、1.341（p<0.01）及1.282（p<0.001），皆達顯著差異。

據研究結果顯示，新移民產婦初次產檢時間較本國籍產婦晚，且產檢不適當之比例較高；而產檢不適當的新移民孕婦會增加新生兒有早產、低出生體重及胎兒小於妊娠年齡之風險。因此，建議相關衛生單位針對新移民婦女加以宣導及給予協助，積極落實產檢政策之推動。

關鍵字

新移民產婦 ； 產前檢查服務 ； 新生兒出生結果

並列摘要

Background: To ensure the maternal and fetal health, Taiwan's National Health Insurance (NHI) provides ten prenatal care visits for free to the pregnant women. However, immigrant spouses and their children have increased and became a new ethnic group in Taiwan in recent years. Therefore, the goal of this study was to analyze the differences in prenatal care utilization and pregnancy outcome between immigrant spouses and Taiwan-born women. Further, to determine the relationship between prenatal care and pregnancy outcomes among pregnant immigrant women in Taiwan.

Methods: The study was based on the childbirth reporting system and National Health Insurance Research Database, and only included the women who had singleton live births from 2005 to 2006 in Taiwan. The total sample size was 126,498 pregnant women, including 42,166 immigrant women, and 84,332 Taiwan-born women who were in accordance with the proportion of pregnant immigrant women’s age in stratified random sampling. The adequacy of prenatal care utilization was based on the Kessner Index and in accordance with the recommended time schedule of prenatal care visit from Taiwan's NHI, and was classified into adequate, intermediate and inadequate. A Logistic regression analysis was then used to examine the association between the prenatal care and pregnancy outcomes among pregnant immigrant women in Taiwan.

Results: The mean of age of immigrant women was 26.17, and about 92% of 42,166 pregnant immigrant women are from Vietnam, China and Indonesia. Compared with Taiwan-born women, foreign-born women had a lower rate of caesarean section, preterm labor, low birth weight and small-for-gestational-age infants. With regard to prenatal care utilization, the immigrant women and Taiwan-born women in the mean time of first prenatal care visit were13.49 weeks (SD=7.23) and 10.17 weeks (SD=3.84), respectively. The average number of prenatal care visits of immigrant women and Taiwan-born women were respectively 7.63 (SD=2.4) and 8.22 (SD=2.24). 69.27% of foreign-born women initiated prenatal care within 13 weeks, while 90.77% represent Taiwan-born women. Some 6.53% of foreign-born women received inadequate prenatal care and 1.01% for the other. Compared the foreign-born women who received adequate prenatal care, the foreign-born women received inadequate prenatal care was associated with an increased risk of preterm delivery (OR=1.532, p<0.001), low birth weight (OR=1.341, p<0.01) and small-for-gestational-age infants (OR=1.282, p<0.001).

Conclusions: The foreign-born women in Taiwan were more likely to have their initiation prenatal care later and a higher rate of inadequate prenatal care. About foreign-born women, inadequate prenatal care had a higher risk of having preterm delivery, low birth weight and small-for-gestational-age newborns than those who received the adequate prenatal care. Therefore, it is to suggest that related public health units should provide assistance to immigrant spouse regarding prenatal care utilization in terms of the promotion of prenatal care utilization program.

並列關鍵字

Immigrant Spouses ； Prenatal care ； Pregnancy Outcomes

參考文獻

行政院衛生署（2010）。表5 歷年預防保健統計概況。2010年6月20日，取自：

邱冠斌（2008）。新竹市外籍配偶與低體重新生兒之相關性研究－以民國九十三年為例。中華行政學報，5，123-142。

張嘉莉（2007）。新移民的懷孕健康、生產結果及其新生兒出生健康狀況分析—以臺北市為例。未出版碩士論文。臺北醫學大學醫務管理學研究所。

黃元德、黃瓊瑩、馬作鏹、郝宏恕（2006）。本國籍和外國籍產婦生產方式之差異及探討。臺灣公共衛生雜誌，26(3)，169-176。

廖宗志、林俊龍、詹婉瑜、宋鴻樟、廖建彰（2006）。外籍新娘與本地婦女的低出生體重嬰兒比較。臺灣家庭醫學雜誌，16(4)，226-236。