懷孕婦女三期營養攝取及飲食喜好之相關研究

An association study of nutrient intakes and dietary preferences of the three trimesters during pregnancy

陳葵蓉(Kuei-Jung Chen)

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(2011年)

摘要

本研究目的希望藉由前瞻性研究設計追蹤收集並評估現今懷孕婦女三期營養攝取與飲食喜好之變化情形，進而探討兩者之相關性，並分析營養素攝取情形及飲食喜好對懷孕期間體重增加及新生兒出生體型（出生體重、身長、頭圍）之影響。自民國98年11月至99年3月中於台北市立聯合醫院婦幼院區婦產科門診，招募151位懷孕20週以內的健康婦女參加研究，利用面對面、電話訪談、郵寄及電子郵件等方式收集相關資料，包括孕婦基本資料、飲食相關問卷（24小時飲食回憶、3日飲食紀錄、飲食喜好問卷）及新生兒基本資料。利用統計軟體SPSS 12.0及STATA 8.0版進行統計分析。
扣除中途退出者，研究分析以122位孕婦及其新生兒資料為主。孕婦平均年齡31歲、平均身高160公分、懷孕前平均體重55公斤、BMI為21.4 公斤/公尺2，平均總體重增加量為14公斤。分析120位新生兒出生資料，新生兒平均出生週數38.7週，平均出生體重3163公克、出生身長50公分、出生頭圍34公分。
研究結果發現利用24小時飲食回憶分析營養素攝取情形，孕婦懷孕第一、二、三期平均熱量攝取分別為1682、1910、2003大卡，醣類、蛋白質、脂質三大營養素比例分別為15~16%、29~31%、53~56%。而分析孕婦飲食喜好發現，婦女懷孕後對大部分食物飲食喜好分數均較懷孕前低，僅水果類及酸味食物飲食喜好分數在懷孕第一期較懷孕前上升。婦女懷孕期間飲食喜好分數最高之食物項目分別為水果類、蔬菜類、奶類及其製品；喜好分數最低之食物項目分別為羊奶、咖啡、生鮮魚類。利用開放式問項分析結果，本研究婦女懷孕第一期最常見最喜歡吃的食物為澱粉類(14.6%)，最不喜歡吃的食物為油膩食物(18.8%)；懷孕第二期最常見最喜歡吃的食物為水果類(20.5%)，最不喜歡吃的食物為蔬菜類(9.0%)；懷孕第三期最常見最喜歡吃的食物為水果類(27.7%)，最不喜歡吃的食物為油膩食物(5.3%)。
探討孕婦營養攝取與飲食喜好之相關性發現，蛋白質攝取量與蛋白質含量高之食物（豬肉、禽肉、奶類及奶製品、西式速食）飲食喜好呈顯著正相關(r=0.20~0.26, p<0.05)；脂肪攝取量與一般熟知脂肪含量高之食物（澱粉類、烘焙類、奶類、西式速食）飲食喜好呈顯著正相關(r=0.20~0.35, p<0.05)；膽固醇攝取量則與烘焙類、牛肉、禽肉、奶類及奶製品、油炸食物、西式速食、香辛料等7項飲食喜好呈顯著正相關(r=0.20~0.40, p<0.05)；維生素B12攝取量與牛肉、羊肉、禽肉、生鮮魚類、香辛料等飲食喜好呈顯著正相關(r=0.19~0.26, p<0.05)，由此推測懷孕期間飲食喜好的確影響營養素攝取。
分析孕婦營養素攝取情形及飲食喜好對孕期體重增加量及新生兒出生體型的影響，發現僅懷孕第三期營養素攝取量與體重增加有較顯著相關，而飲食喜好與孕期體重增加無明顯相關；懷孕期間營養素攝取量對新生兒出生體型較少有顯著影響，而飲食喜好與新生兒出生體型無關。多元迴歸分析結果顯示，在線性狀況下，懷孕週數每增加1週，出生體重增加132公克；媽媽懷孕前體重每多1公斤，出生體重增加10公克。而此研究中新生兒出生體重與懷孕第三期維生素A攝取呈顯著負相關，與維生素C攝取呈顯著正相關 (p<0.05)。
綜合以上結果發現孕婦飲食喜好的確影響營養素攝取情形，而飲食喜好對孕期體重增加及新生兒出生體型則未發現直接明確的影響。

關鍵字

前瞻性研究 ； 24小時飲食回憶 ； 懷孕三期營養攝取 ； 孕婦飲食喜好 ； 孕期體重增加 ； 新生兒出生體型

並列摘要

The purpose of this study is to collect and evaluate the current nutrient intakes and changes of dietary preferences during the three trimesters for pregnancy by a prospective study. This thesis explores the interrelationships between the two, and analyzes the impact of the nutrient intakes and dietary preferences on gestational weight gain and birth outcomes including weight, length and head circumference. We recruited 151 health pregnant women less than 20 weeks from the Taipei City Hospital, Women and Children Branch. We collected basic characteristics, dietary information (including 24 hour recalls, 3 day records, dietary preferences questionnaires with 25 food items and two open questions for favorite and disliked foods) and the neonatal information by using face-to-face, telephone, mail and e-mail interviews. The statistical analyses were performed by SPSS 12.0 and STATA 8.0.
The final analyses included 122 women and their newborns. Before pregnancy, the average age was 31 years old, height was 160 cm, weight was 55 kg, BMI was 21.4 kg/m2, and the total gestational weight gain was 14 kg. The average gestational age of 120 newborns was 38.7 weeks, birth weight was 3163 g, height was 50 cm, and head circumference was 34 cm.
By 24 hour recalls, the means of three trimesters energy intake were 1682 Kcal, 1910 Kcal and 2003 Kcal, respectively. The percentage of energy was 15~16% of protein, 53~56% of carbohydrate, and 29~31% of fat. The fruit and acidity food preference scores were higher during the first trimester than the pre-pregnancy, although the most of food preference scores were lower during pregnancy. During pregnancy, the food items with highest food preference scores were fruits, vegetables, milk and dairy products. The food items with lowest food preference scores were goat milk, coffee and raw fish. The answers from the open question of the most favorite food during the first trimester was starchy foods (14.6%), most disliked food was greasy foods (18.8%). In the second trimester, the most favorite food was fruits (20.5%), most disliked food was vegetables (9.0%). In the third trimester, the most widely favored food was fruits (27.7%), and the most commonly disliked food was greasy foods (5.3%).
The results for the interrelationships between the nutrient intakes and the food preference scores showed that the protein intake and the food preference scores for high-protein foods including pork, poultry, milk and dairy products, western-style fast food, were positively correlated (r=0.20~0.26, p<0.05). The fat intake and generally well-known high-fat foods (such as starchy, bakery, dairy, western-style fast food) dietary preferences were positively correlated (r=0.20~0.35, p<0.05). Cholesterol intake was positively correlated with food preference scores for bakery, beef, poultry, milk and dairy products, fried foods, western-style fast food and spices (r=0.20~0.40, p<0.05). Vitamin B12 intake and food preference scores such as beef, mutton, poultry, raw fish, spices were positively correlated (r=0.19~0.26, p<0.05). Therefore, these results indicated that dietary preferences do affect the nutrient intakes during pregnancy
Regarding the impact of maternal nutrient intakes and dietary preferences on gestational weight gain and birth outcomes, we found that the nutrient intakes during the third trimester were more significantly correlated with gestational weight gain than the first and second trimesters. However, the dietary preferences were unrelated with gestational weight gain. In addition, we found that the nutrient intakes during pregnancy do not have strong impact on the birth outcomes, and the dietary preferences have no effect on the birth outcomes. By the multiple regression analyses, the results showed that when gestational age increases 1 week, birth weight increases 132 g. Moreover, an increase for 1 kilogram per maternal pre-pregnant weight, birth weight increased by 10 grams. Birth weight has a significant negative correlation with the third trimester vitamin A intake, and a significant positive correlation with the vitamin C intake in the third trimester (p<0.05).
The above results showed that the maternal dietary preferences do affect the nutrient intakes; however, the dietary preferences during pregnancy did not show relationships with the gestational weight gain and birth outcomes.

並列關鍵字

prospective study ； 24 hour recalls ； nutrient intakes during trimesters ； dietary preferences during pregnancy ； gestational weight gain ； birth outcomes

參考文獻

行政院衛生署國民健康局（民98）。孕婦健康手冊（2版）。台中市：作者。

廖苑秀（民96）。孕婦第三孕期營養狀況與新生兒營養及生理之應用－以台南地區婦產科診所為例。台南科技大學生活應用科學研究所碩士論文，未出版，台南市。

莊政衡（民97）。以懷孕期飲食品質指數(Diet Quality Index for Pregnancy, DQI-P)評估懷孕婦女整體飲食品質。靜宜大學食品營養研究所碩士論文，未出版，台中縣。

許祐寧（民94）。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。國立台灣師範大學人類發展與家庭學系碩士論文，未出版，台北市。

張雪子（民92）。影響孕婦服用營養補充劑行為之相關因素研究。國立台灣師範大學衛生教育研究所碩士論文，未出版，台北市。