婦女懷孕三期飲食狀況、膳食評估法與影響新生兒體型之前瞻性研究分析

A prospective study of nutrient intakes in pregnancy, maternal dietary assessment methods and infant outcomes

許祐寧(Yu-Ning Hsu)

指導教授 ： 盧立卿

國立臺灣師範大學/教育學院/人類發展與家庭學系/碩士(2004年)

摘要

本研究以四種膳食評估法(個人飲食頻率問卷、一週飲食及活動頻率問卷、三天飲食紀錄本、24小時飲食回憶)收集婦女懷孕期間飲食相關資料，並比較四種方法的優劣處及相對效度，探討婦女懷孕期間飲食狀況與新生兒體型之間的關係。本研究於民國91年10月至11月及民國92年12月至93年2月於台北市立婦幼醫院分別招募懷孕20週以內及12週以內健康孕婦共181名，利用問卷調查飲食狀況、基本資料、身體測量值、新生兒健康狀況、產檢紀錄等。最後完成研究的婦女人數為167人，平均年齡30.4±3.8歲，懷孕前平均體重53.2±7.8公斤，BMI值20.9±2.8 kg/m2，懷孕期間體重平均增加13.8±4.3公斤。新生兒平均出生週數38.7±1.4週，平均出生身長49.3±1.9公分，平均出生體重3153.5±402.6公克，平均出生頭圍34.1±2.6公分。男新生兒出生體重平均比女新生兒多182公克。研究結果顯示，四種膳食評估法皆有其優缺點；個人飲食頻率問卷雖可代表長期飲食狀況，但易高估熱量與三大營養素，需使用營養素密度呈現數據，一週飲食及活動頻率問卷也有類似缺點；三天飲食紀錄由於需請受試者自行郵寄回本研究室，因此會有回收率較低的問題；24小時飲食回憶與前三者相較，所得到的熱量與營養素攝取較接近實際情形，只是易受受試者記憶力影響。透過斯皮爾曼相關係數與kappa統計分析發現，相對於24小時飲食回憶，其餘三種方法的相對效度高低依序為：三天飲食紀錄、個人飲食頻率問卷、一週飲食及活動頻率問卷；相對於個人飲食頻率問卷，其餘三種方法的相對效度高低依序為：一週飲食及活動頻率問卷、24小時飲食回憶、以及三天飲食紀錄。利用24小時飲食回憶所得到的懷孕三期熱量攝取分別為1924大卡、1980大卡、2172大卡，校正干擾因子後，懷孕中期比初期熱量高出89大卡，後期比中期高267大卡。三大營養素佔熱量百分比為醣類54%、蛋白質15%、脂質31%。由個人飲食頻率問卷發現，懷孕全期蛋白質、維生素C、鉀、鈣、鎂、磷、鋅、異黃酮、茄紅素、生物素、草酸、膽鹼、植物性蛋白、動物性脂肪等顯著高於懷孕前一年；維生素K、槲皮酮則顯著低於懷孕前一年。此外，婦女懷孕期間較懷孕前顯著攝取較多奶類、蛋類、深綠色蔬菜、水果(p<0.05)，攝取較少魚貝類、豬肉與植物油。母親懷孕週數、未懷孕BMI值、孕期總體重增加量、新生兒性別與新生兒體型呈顯著正相關；孕期血壓及血糖值、父母教育年數、家庭總月收入、家庭社經地位與新生兒體型間沒有顯著相關性存在。由多元迴歸發現，母親懷孕全期營養素與食物對新生兒出生身長影響力較小，主要還是決定於父親身高、新生兒性別、母親未懷孕BMI值、孕期體重增加量以及新生兒出生週數等因素(解釋力為34.6%)。在新生兒出生體重迴歸模式發現，新生兒出生體重與維生素A、維生素E營養素密度呈顯著負相關(p<0.05)，與深黃色蔬菜重量百分比呈顯著正相關(p<0.05)，此三種營養素與食物種類的解釋力為12.5%。表示母親在懷孕期間攝取的蔬菜以及植物油、黃豆類與新生兒出生體重有負相關性存在，而富含醣類的深黃色蔬菜則與新生兒出生體重呈顯著正相關。

關鍵字

懷孕期飲食 ； 新生兒體型 ； 飲食頻率問卷 ； 膳食評估法

並列摘要

We used four dietary assessment methods including 24-hr recalls, 3-day food records, food frequency questionnaire (FFQ) and weekly dietary questionnaire to collect dietary information during pregnancy, discussed the advantages and disadvantages, and documented the relatively validity. Moreover, this study analyzed the correlations and explored the possible relationships between maternal dietary status and infant outcomes including birth weight, length and head circumference. We recruited healthy pregnant women less than 20 weeks from Taipei Municipal Women’s and Children’s Hospital, and collected information from food and diet consumptions, anthropometic assessments, prenatal care records by structured questionnaires. This study initially had 181 pregnant women participated and 14 women dropped out before delivery. Thus, there were total 167 women and their newborns included in the final analyses. Before pregnancy, the participants’ average age was 30.4 years old, weight was 53.2 kg, BMI was 20.9 kg/m2, and the gestational weight gain was 14 kg. Newborn’s average gestational age was 38.7 weeks. The average birth height, weight, and head circumference of the newborns was 49.3 cm, 3153.5 g, and 34.1 cm, respectively. These results showed that although the FFQ was a proper tool to assess nutrient intakes over a long time-period, it over-estimated total energy and nutrient intakes. The weekly dietary questionnaire also had the same over-estimation problem. Regarding the 3-day records, because participates were asked to mail the records back to us, the response rate was much lower. The 24-hr recall was the method relatively better to assess the average energy and nutrient intakes. Compared to the 24-hr recall, the relatively validity by correlation coefficients and kappa statistics from high to low orders were the 3-day records, the FFQ, and the weekly dietary questionnaire. With comparison to the FFQ, the relatively validity of the other methods in orders were the weekly dietary questionnaire, the 24-hr recall, and the 3-day records. The average energy intakes in the three trimesters were 1924Kcal, 1980 Kcal, and 2172 Kcal, respectively. After adjusting the confounding factors including mothers’ age, physical activity during pregnancy, and newborn gender, the energy intake in the second trimester was 89 kcal higher than in the first trimester ; in the last trimester was 267 kcal higher than in the first trimester. The percentage of energy sources was 54% from carbohydrate, 15% from protein and 31% from fat. By using the FFQ, we found that the nutrient densities of protein, vitamin C, potassium, calcium, magnesium, phosphorous, zinc, total isoflavone, lycopene, biotin, oxalate, choline, plant protein, and animal fat during pregnancy were higher than pre-pregnancy, while the nutrient densities of vitamin K and quercetin were lower than pre-pregnancy. In addition, subjects during pregnancy ate more milk, eggs, deep green vegetables, and fruit than pre-pregnancy (p<0.05), and they ate less fish, pork, and plant oil than pre-pregnancy. We also found that maternal gestational age, BMI before pregnancy, weight gain during pregnancy, and newborn gender were positively correlated with birth outcomes, but gestational blood pressure and blood sugar, parent’s education, family incomes, and family socioeconomic status had no correlation with birth outcomes. By multiple regression analysis, maternal nutrients and food consumption had less influence on newborn height than other factors, such as paternal height, newborn gender, maternal BMI before pregnancy, and weight gain during pregnancy explaining 34.6% of variation. The nutrient densities of vitamin A and vitamin E during pregnancy were negatively correlated with newborn weight (p<0.05), while the deep yellow vegetables during pregnancy was positively correlated with newborn weight (p<0.05) explaining 12.5% of variation. The data demonstrated that maternal intakes of vegetables, plant oil, and soybeans during pregnancy were negatively correlated with newborn weight, and deep yellow vegetables high in carbohydrate content was positively correlated with newborn weight.

並列關鍵字

diet during pregnancy ； infant outcomes ； food frequency questionnaire (FFQ) ； dietary assessment methods

參考文獻

行政院衛生署(民91)。國人膳食營養素參考攝取量。

行政院衛生署國民健康局(民94)。孕婦健康手冊。

李燕鳴、傅振宗(民90)。產婦年齡與不良懷孕結果的探討─花蓮縣三年生產紀錄分析。慈濟醫學，13，95-103。

白玉莊(民91)。台灣地區新生兒早產與低出生體重之研究。高雄醫學大學公共衛生學研究所碩士論文。

任倩儀(民91)。家庭親子間飲食與身體活動量之研究。國立台灣師範大學家政教育研究所碩士論文。