早產及低出生體重新生兒之危險因素分析：單、雙、多胞胎之影響

Abstract

雙胞胎實為早產及低出生體重之高風險族群，早產及低出生體重更為新生兒健康及死亡之重要中介因子，過去在探究其風險因子時，欠缺將單胞胎及雙胞胎分開探討之研究。 本研究透過「衛生體系出生通報資料庫」，研究資料為93至94年度所有通報之出生資料，使用SPSS12.0統計軟體，藉以釐清胎性在新生兒健康狀態中的影響。 研究結果：首先在早產比率方面，妊娠週數小於37周者依全體、單胞胎、雙胞胎及多胞胎為9.6%、8.0%、63.3%、97.3%，以出生體重來看，小於2500公克為低出生體重，依全體、單胞胎、雙胞胎及多胞胎為8.2%、6.6%、66.0%、96.3%。 其次發現不論在全體、單胞胎及雙胞胎上，在早產方面，新生兒性別為男性、產婦身分為本國、產婦年齡、低出生體重、產婦心臟疾病、產婦肺病、產婦羊水異常、產婦海洋性貧血、產婦孕期抽煙、產婦孕期酗酒、產婦藥癮、產婦曾生早產或低出生體重兒、產婦糖尿病、產婦妊娠糖尿病、產婦梅毒、產婦妊娠毒血症、產婦腎臟病、產婦懷孕高血壓、產婦子宮頸閉鎖不全皆會增加早產的風險。在低出生體重危險因子方面，新生兒性別為女性、產婦年齡、早產、產婦肺病、產婦羊水異常、產婦海洋性貧血、產婦孕期抽煙、產婦孕期酗酒、產婦藥癮、產婦曾生早產或低出生體重兒、產婦妊娠毒血症、產婦腎臟病、產婦懷孕高血壓、產婦子宮頸閉鎖不全皆會增加低出生體重的風險。唯雙胞胎及單胞胎間之OR值略有不同。 其他不一致的結果包括，母親年齡上，對雙胞胎早產沒有影響，對雙胞胎低出生體重方面，母親年紀越小風險越大，母親年紀越大風險越小和單胞胎不同。剖腹生產與單胞胎的早產及低出生體重有關，雙胞胎則呈現相反結果。產婦貧血及慢性高血壓為單胞胎早產及低出生體重的危險因子，雙胞胎則無。在低出生體重方面，產婦身份為本國、產婦心臟疾病、產婦不曾生過重兒、產婦糖尿病、產婦妊娠糖尿病、產婦梅毒亦會增加單胞胎的低出生體重的風險，雙胞胎則無。本研究將早產及低出生體重進行交叉分組分析，並做單、雙、多胞胎的比較。 本研究建議未來應進行單、雙、多胞胎的健康相關的比較研究。

The purpose of this study was to understand the risk factors of Preterm and Low Birth Weight Newborn on Singleton and Multiple Births. Twins are usually divided into high risk population of Preterm and Low birth Weight Newborns. However, the previous studies rarely concentrate on the cooperation between singleton and twins. This study based on the birth registration data between 2004 and 2005 from bureau of health promotion, department of health, R.O.C. (Taiwan). The analysis method is used SPSS12.0, The results as followed: First of all, the percentage of Preterm for those pregnant weeks less than 37 weeks are listed as all (9.6%), singleton (8.0%), twins (63.3%) and multiple births (97.3%). Under the consideration of Low birth weight (under 2500g), the percentage of all is 8.2% when singleton is 6.6%, twins at 66% and multiple births at 96.3%. Moreover, this study founds that no matter of all newborn ,singleton and twins, the risk of preterm birth (<37 weeks’ gestation) is increased by the factors of male sex, Taiwanese gravida, maternal age, low birth weight, heart disease, pneumonopathy, amniotic fluid anomaly, thalassemia, interogestate smoking, interogestate drink, interogestate drug addiction, previous preterm or low birth weight experience, diabetes mellitus, gestational diabetes mellitu, syphilis, pre-eclampsia, nephritic disease, gestation hypertension and cervical incompetence. Furthermore, the significant risks of low birth weight among all newborns are female sex , maternal age, preterm, maternal pneumonopathy, amniotic fluid anomaly, thalassemia, interogestate smoking, interogestate drink, interogestate drug addiction, had preterm or birth weight, pre-eclampsia, nephritic disease, chronic hypertension, gestation hypertension and cervical incompetence. No matter preterm or low weight birth, singleton has similar situation as all birth, but twins has slightly differences on OR rates compared with singleton. Other differences between twins and singleton are included that maternal age has no relation with preterm birth on twins, while the rate of twins’ low weight birth has changing by maternal age. When maternal age is younger, the risk of low weight birth for twins becomes higher. Otherwise, caesarean will increase preterm and low birth weight risk on singleton, but twins is opposite. Maternal anemia and chronic hypertension also increase preterm and low birth weight risk on singleton ,but not in twins. In the sector of low birth weight, Taiwanese Nationality gravida, maternal anemia, heart disease, gestational diabetes mellitu,no experience on overweight birth, diabetes mellitus and syphilis will increase low birth weight risk on singleton ,but twins is not. This result is different with those analyses on singleton. This study uses cross analysis between preterm birth and low weight birth group, as well as compares the differences within singleton, twins and multiple births. I suggest that further researches can focus on the health relative studies on singleton, twins and multiple birth comparison.