人工生殖技術所生嬰兒至18個月大成長與相關因子之研究-台灣出生世代研究

Growth and its Correlated Factors of Babies Born after Assisted Reproductive Technology – Results of Taiwan Birth Cohort Study

李淑杏(Shu-Hsin Lee)

指導教授 ： 李茂盛

中山醫學大學/醫學院/醫學研究所/博士(2011年)

https://doi.org/10.6834/CSMU.2011.00078

摘要

背景：人工生殖治療週期數有上升趨勢，母親孕期醫療照護需求增加及其新生兒較高的不良出生結果之特殊性，人工生殖技術出生嬰兒之成長及其影響因子值得探討，國內缺少此長期性的追蹤資料。
目的：本研究目的在探討及比較經由人工生殖技術治療出生與自然受孕出生嬰兒其出生、6個月及18個月之成長及趨勢，並分析影響18個月嬰兒成長的預測因子。
研究設計：採縱貫性研究方法，以台灣出生世代（Taiwan Birth Cohort Study; TBCS）全國性之資料；經多層次隨機抽樣方法，共抽出24,200名嬰兒。第一波於2005年完成21,234名6個月嬰兒之調查資料（完訪率87.74%），第二波於2007年完成20,159名18個月嬰兒之調查資料（完訪率94.9%），經由人工生殖技術出生嬰兒共366位，佔出生比例之1.7%。資料以SPSS/PC 15.0套裝軟體進行分析，統計方法含次數、百分率、平均值±標準差、t檢定、X2檢定、Z檢定及Repeated measure ANOVA，並以廣義估計方程式（Generalized Estimating Equation；GEE）進行含時間因素之多變項分析，分析影響嬰兒長期成長的預期因子。
結果：人工生殖技術出生嬰兒之低出生體重（<2500g）者佔33.1%，自然受孕出生嬰兒之低出生體重佔6.4%，二者顯著差異（p<.001）。人工生殖技術出生嬰兒，早產（<37週）佔42.1%，自然受孕出生嬰兒早產佔10.8%，二者達顯著差異（p<.001）。整體來說，人工生殖技術出生嬰兒至18個月時其體重持續落後自然受孕出生嬰兒體重，在6個月時頭圍已追上自然受孕出生嬰兒頭圍，在18個月時身高已追上自然受孕出生嬰兒身高。
人工生殖技術母親之年齡較高（33.16±4.12）及教育程度較高（大專以上佔61.4%）、與自然受孕母親比較，多胞胎及剖腹產比率亦較高，二者分別為44.3 % vs. 1.93% （p < .001）及66.9% vs. 33.8%（p < .05）。
GEE的預測結果顯示：早期母親照護對18個月嬰兒的成長預測，整體評估起來母嬰相處/母親為白天主要照顧者對嬰兒成長（頭圍）是正向因子。母親母乳哺育6個月之嬰兒在18個月時體重與身高雖然仍落後，但其差距是呈現縮小的趨勢。多胞胎是負向因子。人工生殖技術治療本身對於18個月嬰兒的體重、身高及頭圍均無顯著影響。
結論：雖然人工生殖技術出生嬰兒有較高低出生體重及早產發生率，但從出生至18個月，人工生殖技術出生嬰兒比自然受孕出生嬰兒有類似或較快的成長速率。母嬰相處/母親為白天主要照顧者及母乳哺育是預測嬰兒成長的正向因子，而多胞胎是預測嬰兒成長的負向因子。瞭解經由人工生殖技術出生嬰兒之成長及母育照護之特性與影響，能提供民眾生殖教育、醫療照護與公共政策之參考。

關鍵字

人工生殖技術 ； 嬰兒 ； 成長 ； 台灣出生世代

並列摘要

Background: Pregnancy after assisted reproductive technology (ART) carries a high risk of adverse birth outcomes. So far, there have been very few longitudinal studies of the growth of children born after ART.
Objective: The purpose of this study was to explore the determinants of growth of children born after ART.
Design, setting and participants: Using data of Wave I (6months old) and II (18 months old) of the Taiwan Birth Cohort Study (TBCS), a national sample of 21,248 pairs of mothers and their babies were included for analysis, including 366 pairs resulting from ART (1.7%).
Methods: Data were collected through field interviews with structured questionnaires, and with references to each child’s birth certificate and Passport of Well-baby Care. Data were analyzed with SPSS/PC for Windows v. 15.0. Percentage, Mean, Standard Deviation, t-test, X2 test, Repeated Measures ANOVA, Generalized Estimating Equation (GEE) were used in this study.
Results: Compared to babies born with conceived spontaneously pregnancy, babies born after ART had a significantly higher incidences of low birth weight (33.1 vs. 6.9%; p < .001) and prematurity (42.1 vs. 11.3%; p < .001). Overall babies born after ART had a similar trend of growth in body weight from birth to 18 months old, but did not achieve catch-up of body weight by 18 months old. On the other hand, they had a faster growth and evidence of catch-up in both body height and head circumference from 6 months to 18 months old.
Compared to mothers who had conceived spontaneously, mothers of infants conceived with ART were more likely to be older (33.2±4.1 vs. 28.79±4.85; p < .001), have a higher educational level(61.4% vs. 45.8%; p < .001), have a higher rate of delivery via cesarean section (66.9% vs. 33.8%, p < .05), and have a high rate of multiple gestations (44.3% vs. 1.93%; p < .001).
Analysis using generalized estimating equationmodeling showed that multiple pregnancy and breastfeeding as well as having the mother herself as the caregiver in daytime through 18 months old are the negative and positive contributing factors, respectively for both growth and the change of growth with time among children born after ART. ART per se did not show to be a significant predictor for body weight, body height and head circumference.
Conclusion: Though exhibiting a higher rate of low birth weight and prematurity, but babies born with ART still has a similar or faster rate of growth from birth to 18 months old when compared to those babies born through spontaneously conceived pregnancies. While multiple gestation is always a negative contributing factor, continuous breastfeeding and having the mother herself as the caregiver in daytime are positive contributing factors for the growth and/or change of growth for the children born after ART.

並列關鍵字

ART ； Baby ； Growth ； TBCS

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