人工生殖懷雙胞胎孕婦體重增加型態與新生兒結果之相關

The relationship between maternal weight gain pattern and neonatal outcomes of twin gestation women undergoing assisted reproductive technology

賴文雅(Wen-Ya Lai)

指導教授 ： 郭碧照

中山醫學大學/護理學院/護理研究所/碩士(2008年)

https://doi.org/10.6834/CSMU.2008.00094

摘要

人工生殖雙胞胎新生兒的出生體重對低出生體重盛行率、早產盛行率及嬰兒死亡率皆有影響。相關研究顯示，母親孕期的體重增加與胎兒出生體重有顯著相關，且受母親孕前身體質量指數的影響。本研究目的在探討人工生殖懷雙胞胎孕婦之孕前不同身體質量指數，在妊娠期體重及增加量與新生兒出生結果的關係。
本研究採回顧式研究設計，研究母群體為中部某不孕症研究中心，自2004年08月01日至2007年07月31日，接受人工生殖懷孕的雙胞胎孕婦。排除不符合本研究收案條件者後，將300位孕婦全部納入本研究收案對象，收集其病歷相關資料，研究結果共收集有效體重及新生兒出生資料共100份，回收率30%。
研究工具依回溯性研究方法設計不同妊娠期孕婦體重及新生兒出生結果紀錄表，研究者依病歷及孕婦健康手冊登錄上述資料。資料以SPSS 12.0版整理，並以描述性統計、皮爾森相關、卡方檢定、獨立t檢定和單因子變異量分析等方式進行分析。
本研究結果發現：人工生殖懷雙胞胎孕婦的平均年齡（32.3±3.9歲），除了第一孕期的體重增加量（2.2±2.4公斤）之外，妊娠期體重總增加量（19.5±5.1公斤）、第二孕期的體重增加量（0.65±0.23公斤/週），以及第三孕期的體重增加量（0.78±0.30公斤/週），皆與美國醫學會（1991）建議雙胞胎孕婦體重增加量相符合。新生兒的出生週數是36.4±1.4週及出生體重為2353± 404.2公克，依孕前不同BMI分類，妊娠期體重增加隨著懷孕週數增加而增重，且不同BMI組孕婦之體重增加達顯著差異。比較孕前不同BMI孕婦的新生兒出生結果發現低出生體重兒出現在體重過重組的百分比明顯低於正常體重組，達顯著差異。孕前BMI值與產前體重（r=0.91）、妊娠12週（r=0.86）、20週（r=0.83）、24週（r=0.85）、28週（r=0.83）、32週（r=0.81）、生產體重（r=0.77）成顯著高度正相關；和第ㄧ孕期體重增加量（r=0.14）呈正相關，與第三孕期體重增加量呈負相關（r= -0.20），但與妊娠總增加量及第二孕期增加量則無關。孕前BMI與新生兒出生結果之關係為：除了與出生週數無相關外，與Agpar score分數、出生體重、頭圍、胸圍、和身高皆呈正相關。
人工生殖懷雙胞胎孕婦妊娠體重與新生兒出生結果有顯著相關，且兩者皆受孕婦的孕前BMI影響，因此建議在人工生殖懷雙胞胎孕婦在體重增加控制需重視孕前BMI，經合適的體重增加範圍，減少早產兒及低出生體重兒，進而降低週產期死亡率及嬰兒死亡率，促進人工生殖雙胞胎兒的健康。

關鍵字

人工生殖 ； 雙胞胎 ； 體重增加型態 ； 新生兒結果

並列摘要

The birth weight of the new born twins born to mothers with ART is correlated with the prevalence of low birth weight, premature birth and infant mortality. Previous research indicates that the weight gain of pregnant women relates positively not only to their pre-pregnancy BMI, but also their babies’ birth weight. This research aimed at studying the relationship between the BMI and their weight gains in various gestational age of twin gestation women undergoing ART, and the birth outcomes.
The research was designed as a retrospective study. The subjects were 100 twin gestation women undergoing ART in a infertility treatment center in Central Taiwan from August 1st, 2004 to July 31st, 2007. The researcher accomplished a gestational weight-gain chart and a birth outcome record, both designed on a retrospective basis, with data from each subject’s medical record and the birth outcomes. The collected data were then analyzed by the package software SPSS12.0.
The research results reveal that the average age of the subjects is 32.3 ± 3.9 years. Except the average weight gain from the first gestational week (2.2 ± 2.4kgs), those of the second gestational age （0.65±0.23kgs / week）, the third gestational age （0.78±0.30kgs / week）, and the whole gestational period （19.5±5.1kgs）comply with the ideal weight gains suggested by the American Medical Association (1991) for women with twin pregnancy. The average gestational age of the newborns is 36.4 ± 1.4 weeks and the birth weight are 2353 ± 404.2grams. All subjects, grouped up by the BMI measured before pregnancy, gained weight with the gestational ages. However, their weight gain are significantly different among the different BMI groups. The percentage of low-birth-weight newborn from overweight mothers is significantly lower than that of mothers with normal weight before pregnancy. The pre-pregnancy BMI relates positively to the subject’s body weight in various gestational age: before pregnancy (r=0.91), in the 12th week of gestation (r=0.86), in the 20th week of gestation (r=0.83), in the 24th week of gestation (r=.85), in the 28th week of gestation (r=0.83), in the 32nd week of gestation (r=0.81), before the deliver (r=0.77), and in the first gestational age (r=0.14). It relates negatively to the weight gain in the third gestational age (r=-0.20), and appears non-relevant to the weight gain in the second gestational age and the whole gestational age. The subject’s pre-pregnancy BMI also relates positively to Agpar score, birth weight, head circumstance, chest circumstance, and height.
The study finds that there is a significant relationship between the gestational weight and the various birth outcomes from babies of twin gestation women with ART. In addition, both the gestational weight and the neonatal outcomes relate positively to these women’s pre-pregnancy BMI. The findings suggest that medical care providers pay more attention on these women’s pre-pregnancy BMI and their weight gain patterns during the gestational age in order to promote the health of the twins delivered by ART women, reduce the deliveries of pre-mature or low-weighted babies, and further decrease incidences of newborns and infants.

並列關鍵字

Assisted Reproductive Technology ； twins ； weight-gain ； birth outcomes

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