人工生殖技術治療婦女懷孕健康及嬰兒出生結果－臺灣出生世代研究

The pregnancy health and birth outcomes of women who underwent Assisted Reproductive Technology(ART)：Taiwan Birth Cohort Study; (TBCS)

10.6834/CSMU.2011.00122

黃梨香

台灣出生世代研究 ； 人工生殖技術 ； 懷孕健康 ； 出生結果 ； 影響嬰兒生長因素 ； Taiwan Birth Cohort Study(TBCS) ； Assisted reproductive technique(ART) ； the pregnancy health ； birth outcomes

中山醫學大學醫學研究所學位論文

2011年

博士

周明智;李孟智

繁體中文

背景：現代有愈來愈多的不孕症夫妻藉由人工生殖技術治療(Assisted reproductive technique; ART)達到受孕和生育之目的，而其懷孕過程、生產結果及所生子女之生長發育與健康狀態，極待瞭解與分析。 方法：本研究以台灣出生世代研究(Taiwan Birth Cohort Study; TBCS)第一波正式調查經多層次隨機抽樣所得24,200名六個月大嬰兒為對象，2005年7月至2006年6月共計完成田野調查21,234名(87.74%)嬰兒之資料，進行描述性和分析性統計。 結果：樣本中經由人工生殖技術治療所生之嬰兒共366名(1.72%)，其母親與自然受孕母親相較；年齡顯著較高(33.16+4.12歲vs.28.79+4.85歲)、大專以上(61.4 % vs.45.8 %)教育程度顯著較高、妊娠併發症(糖尿病、高血壓、毒血症) (12.02 % vs.4.84 %)之發生率明顯較多，多胞胎比率高(44.3% vs.1.9% )，採剖腹生產顯著較多(66.9% vs.33.8%)，然而在妊娠前吸菸者(3.8 % vs.7.8 %)明顯較少。就六個月大嬰兒之出生結果而言；經人工生殖技術治療較自然受孕者其早產發生率 (42.1% vs.10.8%)、發生早產兒相關疾病(9.6% vs.4.9%)顯著較高，平均出生體重顯著較低(2752±603公克vs.3110±443公克)。在六個月大時，兩組體重雖仍有明顯差距(7714±1084公克vs. 8002±1012公克)但差異已減少，而在行為動作發展上仍顯著不如自然受孕組（4.13分vs.4.26分）。另兩組在出生後六個月內之罹病率(1.9 % vs.1.2%)、急診(16.4 % vs.15.8%)稍高於自然受孕組但無顯著差異，而預防接種率(100% vs.99.99％)兩組幾乎達百分百。就嬰兒之養育情形而言，經人工生殖技術治療組曾餵食母乳者(86.1 % vs.82.1%)及持續餵食母乳至六個月大者(59.3 vs.21.5)顯著高於自然受孕組且達顯著差異；母親在嬰兒滿月前或至六個月大仍為白天主要照顧者，兩組並無顯著差異。邏輯斯迴歸統計結果顯示；當控制其他相關自變項時，母親於懷孕前抽菸（OR=5.37；95％CI=1.48∼27.92）、產檢少於10次者（OR=2.46；95%CI=1.36∼5.72）及多胞胎者（OR=19.4；95%CI=14.24∼48.47）為接受人工生殖技術治療母親所生新生兒之低出生體重(<10 percentile)之危險因子。低出生體重與母親低學歷（OR=4.71；95%CI=1.64∼13.54）、沒吃副食品與低出生體重（OR=4.21；95%CI=1.26∼14.05）是人工生殖技術六個月大嬰兒發生體重偏低(<10 percentile)機率增高的原因。 結論：經由人工生殖技術治療母親所生嬰兒之多胞胎、早產與低出生體重發生率顯著高於自然受孕組，且隨著嬰兒成長至六個月大時，體重落後雖仍存在，但已逐漸趕上。另兩組間罹病率並無顯著差異，此是否經由人工生殖技術治療母親給予較久母乳餵食或其它不一樣的養育方式所致，值得吾人進一步探討。

Objectives This study investigates the pregnancy health and birth outcomes of women who underwent Assisted Reproductive Technology (ART) and analyzes the factors that influence birth weight to become <10 percentile when undergoing ART. Methods Through stratified systematic sampling, 24,200 mother-and-child sampling pairs were obtained from the 206,741 total number of live births in Taiwan in 2005; 21,234(87.74%) sampling pairs were complete interviewee, 366(1.72%) of the babies were born with the use of ART. Results During pregnancy, mothers who used ART suffered from higher relative risks (RR) than their spontaneous pregnancy counterparts from the following pregnancy complications: gestational diabetes mellitus (GDM)RR:2.95, 95%CI:1.95-4.45, pregnancy induced hypertension (PIH) RR:2.08,95%CI:1.25-3.46,pregnancy induced toxemia RR:2.28, 95%CI:1.03-5.04, and placenta previa RR:0.31,95%CI:0.20-0.48. Additionally, babies born through ART had more negative birth outcomes than their spontaneous pregnancy counterparts: the average birth weight of ART-born babies was 2752±603g as opposed to 3110±443g for babies born from spontaneous pregnancy , while low birth weight (<2500g) was at 33.1% and 6.4% respectively; their birth heights were 47.8±3.6cm and 49.6±2.6cm, and their head circumferences were 33±1.7cm and 33.3±1.7cm. Single births made up 55.7% of ART-born babies, and 44.3% for multiple births. Premature babies (<37 weeks) accounted for 42.1% of ART births at an RR of 5.69 (95%CI: 4.65-6.97). The RR of diseases related to premature birth was 5.8, 95%CI:3.27-10.26. Logistic regression was used to analyze the factors that influence birth weight to become <10 percentile when undergoing ART. The odds ratio (OR) of multiple births was OR=19.4 (95%CI, 14.24-48.47), the OR for smoking during pregnancy was OR=5.37 (95%CI, 1.48-27.92), the OR for doing less than 10 prenatal care was OR=2.46 (95%CI, 1.36-5.72), and the OR of the expectant mother’s weight was OR=.95 (95%CI, .95-.96). Conclusion The pregnancy health and birth outcomes of women who underwent ART were worse than those who spontaneous pregnancy. Multiple births was the most important factor that causes low birth weight in babies. The results of this study can be used as a reference for the health and care of mothers and babies who use ART.

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