體外受精胚胎植入之台灣婦女懷孕早期母胎依附及其影響因子

郭碧照

doi:10.6342/NTU.2008.00731

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體外受精胚胎植入之台灣婦女懷孕早期母胎依附及其影響因子

Influencing factors on attachment among Taiwanese IVF women in their early pregnancy

郭碧照 , Ph.D　　Advisor：陳月枝　　

繁體中文 DOI： 10.6342/NTU.2008.00731

母胎依附；體外受精胚胎植入；懷孕婦女；社會支持；生育態度； maternal fetal attachment ； in vitro fertilization/embryo transfer (IVF/ET) ； pregnant women ； social support ； Chinese childbearing attitude

Abstract │ Reference (150) │ Times Cited (2) │ Altmetrics

Abstract 〈TOP〉

依附理論之主要核心概念是嬰兒與主要照顧者之間所建立的情感連結，依附關係的品質會從父母影響到出生後小孩的情緒、認知的成長和身體的安適感。母嬰依附之起源為母胎依附，為孕婦在懷孕期間對未出生小孩的知覺和情感的行為投入，許多研究證實與產後的依附相關。體外受精胚胎植入治療懷孕比自然懷孕婦女不易獲得，同時也比自然懷孕面臨更多妊娠合併症及懷孕早期之成為母親身心過渡反應。對這群婦女懷孕早期的產前照護，需要關注其之母胎依附的狀況。
本研究目的為了解體外受精胚胎植入婦女懷孕早期之妊娠第9、12、20週之社會支持、孕期身心症狀、懷孕焦慮、孕期壓力、胎兒認知、生育態度與母胎依附的趨勢變化和相關性，妊娠第9、12、20週之母胎依附之影響因子，及妊娠第9至20週母胎依附改變差異之影響因子。
研究設計採縱貫性、相關性調查法，根據母胎依附理論測試研究架構之變項關係與影響因子。研究情境為台灣中部某不孕症中心，研究對象為體外受精胚胎植入治療懷孕之婦女。研究工具為結構式問卷，包括個案之基本資料、產前親子依附量表修改版、社會支持量表、孕期身心症狀量表、懷孕焦慮量表、胎兒認知量表、生育觀念量及孕期壓力量表等，以立意取樣，共計160位研究樣本，於妊娠9、12及20週時完成三次自填問卷，有效回收率為91%。資料以SPSS/PC(+) 14.0 window套裝軟體分析，主要以頻率、百分比、標準差、Pearson相關分析、一般線性模式的重複測量之單因子變異性分析分析、單一樣本t檢定分析及複迴歸等分析法。
研究結果：母胎依附得分均隨著妊娠週數增加而增加，胎兒認知與孕期壓力等變項得分均隨著妊娠週數增加而增加，孕期身心症狀妊娠12週大於20週，懷孕焦慮妊娠9週大於20週，均達統計顯著差異。研究變項之相關性為：妊娠9週的母胎依附與生育態度、社會支持呈正相關；妊娠12週的母胎依附與社會支持、胎兒認知呈正相關；妊娠20週的母胎依附與社會支持、孕期壓力呈正相關，與9週之社會支持、生育態度呈正相關，與12週之社會支持、胎兒認知呈正相關，與9、12週的母胎依附與呈正相關。不同妊娠週數之影響因子為：第9週母胎依附影響因子為生育態度、社會支持與懷孕焦慮等，解釋17.5 %的變異量；第12週母胎依附影響因子為第9週之母胎依附與第12週之胎兒認知，解釋46 %的變異量；第20週母胎依附模式一影響因子為第9週之母胎依附與第20週之孕期壓力、社會支持，解釋40.7 %的變異量；第20週母胎依附模式二影響因子為第12週之母胎依附與第20週之孕期壓力、社會支持，解釋51.4 %的變異量。9至20週母胎依附差異之影響因子為第9週之母胎依附、懷孕胎數與社會支持，解釋45.8 %的變異量。
本研究結果提供台灣體外受精胚胎植入懷孕婦女，在懷孕早期之母胎依附形成趨勢、相關與影響因子的實證資料，可作為發展相關模式與護理措施的理論基礎，促進體外受精胚胎植入懷孕婦女與胎兒的依附，提升這群懷孕婦女產前照顧品質，以增進母嬰之福祉。

Parallel Abstract 〈TOP〉

Maternal-fetal attachment is a term used to describe behaviors that represent an affiliation and interaction between mother and their unborn child. The core concept of attachment theory is a lasting and positive bond between baby and caregiver. The quality of the reciprocal relationship affects the emotional, cognitive and physical aspects of children's development and wellbeing. Previous researches demonstrate that the development of this relationship has a correlation between prenatal and postnatal attachment. The women treated by in vitro fertilization/Embryo transfer (IVF/ET) would face higher incidence of high-risk pregnancy and more difficult transition time during their early pregnancy. It is important to determine factors which would influence the maternal fetal attachment among Taiwanese IVF/ET women in their early pregnancy in order to provide better prenatal care for them.
The aims of this study were to compare the social support, pregnancy psychosomatic symptoms, pregnancy anxiety, pregnancy stress, fetus cognition, Chinese childbearing attitude and maternal fetal attachment for IVF/ET women within 9th, 12th and 20th of their pregnancy, and to identify the factors that influenced the maternal fetal attachment.
This study was a longitudinal design. Data were collected from 160 IVF women gestation at 9th week, 12th week and 20th week at an Infertility Care Center by using convenience sampling. The self-report questionnaire included demographic data, The Symptoms Checklist, The Pregnancy Stress Rating Scale, The Pregnancy-related Anxiety Scale, The Cognition of Fetus Status Scale, The Modified Maternal-Fetal Attachment Scale, The Social Support Apgar and Chinese Childbearing Attitude Questionnaire. The data were coded and analyzed with SPSS/PC(+) for Windows v. 14.0.Frequency, Percentage, Mean, Standard Deviation, Pearson Correlation, One-way Repeated Measures ANOVA, One Sample t Test and Multiple Regression were used in this study.   
Results of this study present the level of fetus cognition, pregnancy stress and maternal fetal attachment were increased following by the gestation stages.  There were significantly decreased in pregnancy psychosomatic symptoms from 12th week of gestation to 20th week of gestation. The level of pregnancy anxiety at 9th of gestation was significantly higher than the level of pregnancy anxiety at 20th of gestation. In addition, there was a positive relationship between maternal fetal attachment, Chinese childbearing attitude and social support at 9th week of gestation. There was a positive relationship between maternal fetal attachment, social support and fetus cognition at 12th week of gestation. There was a positive relationship between maternal fetal attachment, social support and pregnancy stress at 20th week of gestation. The maternal fetal attachment at 20th week of gestation had positive relationship with social support, Chinese childbearing attitude and maternal fetal attachment at 9th week of gestation and social support, fetus cognition and maternal fetal attachment at 12th week of gestation. 
The results present that the main factors which influenced the 9th week of maternal fetal attachment were the level of social support, Chinese childbearing attitude and pregnancy anxiety (R2=17.5 %). The main factor which influenced the 12th week of maternal fetal attachment was the level of fetus cognition at 12th week of gestation and the level of maternal fetal attachment at 9th week of gestation (R2=46 %). The level of 20th week of maternal fetal attachment (model I) was influenced by the level of 9th week of maternal fetal attachment, level of 20th week of social support and level of 20th week of pregnancy stress (R2=40.7 %). The level of 20th week of maternal fetal attachment (model II) was influenced by the level of 12th week of maternal fetal attachment, level of 20th week of social support and level of 20th week of pregnancy stress (R2=51.4 %). In addition, The main factor which influenced the changes in maternal fetal attachment from 9th to 20th week of gestation was the level of the 9th week of maternal fetal attachment and social support and numbers of fetus (R2=45.8 %).
The findings from this study provide evidence based knowledge in order to understand the trends and factors in maternal fetal attachment for women treated by IVF/ET during their early pregnancy. This study could be used in developing and understanding the maternal fetal attachment theory between IVF/ET mother and their baby. This study could provide better nursing care and improve the quality of prenatal care service for IVF/ET women in Taiwan.

Reference ( 150 ) 〈TOP〉

李從業（1994）．正常和曾有不孕病史的懷孕婦女親子連結之比較．護理研究，2(1)，69-76。
連結：
李淑杏、郭碧照、黃梨香、王郁茗、李茂盛（2000）．接受試管嬰兒治療之不孕症婦女在不同治療過程的心理社會反應．護理研究，8(5)，515-528。
連結：
郭碧照、李麗珠、胡蓮珍、黃梨香（2003）．生殖科技治療婦女懷孕前期之生活經驗．中山醫學雜誌，15(1)，533-544。
連結：
陳惠敏、陳彰惠（1996）．比較青少年孕婦與育齡孕婦在妊娠第三期的心理壓力及社會支持．高雄醫學科學雜誌，12(3)，183-192。
連結：
劉玉秀、余玉眉（1997）．正常經產孕婦在第三孕期執行母性任務的行為反應．護理研究，5(3)，290-301。
連結：

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