懷孕後期婦女妊娠糖尿病、尿失禁與睡眠品質之關係性

Abstract

研究背景 妊娠期間的睡眠障礙與母體併發症及胎兒預後不佳具有關聯性；妊娠糖尿病是孕期一種葡萄糖代謝異常的疾病，會對孕婦及胎兒健康造成短期與長期的危害；婦女尿失禁症狀的干擾可能會影響睡眠品質。然而目前缺乏探討懷孕後期婦女妊娠糖尿病、尿失禁及睡眠品質的關係性研究。 研究目的 描述並比較懷孕後期婦女有無妊娠糖尿病在尿失禁和睡眠品質上的差異；確認懷孕後期婦女發生尿失禁的影響因子；以及確認妊娠糖尿病和尿失禁是否為懷孕後期婦女睡眠品質的影響因子。 研究方法 為橫斷式設計，採方便取樣，於臺灣北部某醫學中心婦產科門診進行收案，於參加者懷孕後期（28週以後）以結構式問卷收集資料：人口學與產科學變項、尿失禁量表（ICIQ-UI SF）、匹茲堡睡眠品質量表（PSQI）。總共有435名懷孕後期婦女納入研究，運用 SPSS 統計軟體進行分析。描述性統計呈現人口學資料、產科學變項、尿失禁及睡眠品質分佈情形；再以妊娠糖尿病分組，分為：妊娠糖尿病組（GDM 組）與無妊娠糖尿病組（Non-GDM組）；使用卡方檢定及獨立樣本t檢定進行比較兩組之間的差異；使用羅吉斯迴歸及多元線性迴歸分別確認懷孕後期婦女尿失禁及睡眠品質的影響因子。 研究結果 在懷孕後期，妊娠糖尿病婦女的年齡、身體質量指數及懷孕前身體質量指數皆顯著高於沒有妊娠糖尿病婦女 （p < 0.001）。 全體懷孕後期婦女中，有尿失禁的比例為58.9%，患有妊娠糖尿病的婦女比沒有妊娠糖尿病的婦女尿失禁的比例較高（65.8% vs 54.9%，p = 0.026），且她們的尿失禁嚴重程度也較高（1.25 ± 1.00 vs 1.02 ± 1.08，p = 0.023）。 全體懷孕後期婦女中，睡眠品質差（PSQI > 5）的比例為69%，匹茲堡睡眠品質總分平均為7.73 ± 3.63；患有妊娠糖尿病的婦女比沒有妊娠糖尿病的婦女睡眠品質分數高（7.84 ± 3.70 vs 7.67 ± 3.60），但未達統計上的差異。 婚姻狀態和陰道分娩經驗對尿失禁風險有顯著影響；相較於已婚者，無婚姻狀態者的尿失禁風險較低（OR = 0.18, 95% CI = [0.05, 0.75], p = 0.015）；相較於無陰道分娩經驗者，有陰道分娩經驗者的尿失禁風險顯著較高（OR = 2.33, 95% CI = [1.35, 3.83], p = 0.002）。 此外，年齡越高的婦女，睡眠品質越差（β = 0.12, p = 0.023）；工作狀態為非全職工作的婦女，睡眠品質較差（β = 0.12, p = 0.016）；胎兒數為雙胞胎的婦女，睡眠品質較差 （β = 0.12, p = 0.017）；有剖腹產經驗的婦女，睡眠品質較差（β = 0.13, p = 0.014）；有尿失禁的婦女，睡眠品質較差（β = 0.10, p = 0.047）。 結論與建議 妊娠糖尿病婦女有尿失禁比例高且症狀較嚴重；有陰道分娩經驗是懷孕後期婦女尿失禁的重要影響因子。懷孕後期婦女睡眠品質差，無論是否有妊娠糖尿病；年齡越大、非全職工作、雙胞胎妊娠、有剖腹產經驗及有尿失禁是懷孕後期婦女睡眠品質的影響因子。 建議於懷孕後期評估婦女尿失禁與睡眠品質的情形，藉由識別尿失禁的風險因子與睡眠品質的影響因子，及早給予懷孕婦女預防與改善尿失禁及睡眠障礙的策略，以提升懷孕婦女的生活品質與睡眠品質。另外未來可採縱貫式研究設計，追蹤整個懷孕過程中尿失禁及睡眠品質的變化，考慮檢視孕婦心理因素與睡眠品質的關係性、增加血糖生化值及睡眠參數等客觀數據。

Background: Sleep disturbances during pregnancy, which are a common problem, are recognized to be linked with maternal complications and adverse fetal outcomes. Gestational diabetes mellitus (GDM), a glucose metabolic disease, poses short-term and long-term health risks for both mother and fetus. Urinary incontinence (UI) symptoms in women may impact sleep quality. However, limited research explores the link between gestational diabetes mellitus, urinary incontinence, and sleep quality in late pregnancy women. Purpose: The aim of this study is to examine UI and sleep quality in late-stage pregnant women with and without GDM, identify the factors influencing UI in these women, and determine whether GDM and UI are risk factors affecting sleep quality during late pregnancy. Methods: This is a cross-sectional study that employed convenience sampling. Pregnant women who came to our hospital, a medical center in northern Taiwan, for routine prenatal follow-up and were at or after 28 weeks of gestation were included. Participants provided socio-demographic and health information and completed the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and the Pittsburgh Sleep Quality Index (PSQI). A total of 435 late-stage pregnant women were included in the study and divided into two groups (GDM and non-GDM). The analysis was conducted using the chi-squared test for categorical variables and Student’s t-test for quantitative variables, utilizing SPSS statistical software. Additionally, binary logistic regression and multiple linear regression were employed to identify factors affecting urinary incontinence and sleep quality in late-pregnancy women. Results: In late pregnancy, women with GDM have significantly higher age, body mass index (BMI), and pre-pregnancy BMI compared to women without GDM (p < 0.001). Among all women in late pregnancy, the prevalence of UI is 58.9%. Women with GDM have a higher prevalence of UI compared to those without GDM (65.8% vs. 54.9%, p = 0.026), and the severity of UI is also greater in women with GDM (1.25 ± 1.00 vs. 1.02 ± 1.08, p = 0.023). Among all women in late pregnancy, 69% have poor sleep quality (PSQI > 5), with a mean PSQI score of 7.73 ± 3.63. Women with GDM have a higher mean PSQI score compared to those without GDM (7.84 ± 3.70 vs. 7.67 ± 3.60), but this difference is not statistically significant. Marital status and vaginal delivery experience have a significant impact on the risk of UI. Compared to married women, those with no marital status have a significantly lower risk of UI (OR = 0.18, 95% CI = [0.05, 0.75], p = 0.015). In contrast, women with vaginal delivery experience have a significantly higher risk of UI compared to those without vaginal delivery experience (OR = 2.33, 95% CI = [1.35, 3.83], p = 0.002). Advanced age women have poorer sleep quality (β = 0.12, p = 0.023); women who are not in full-time employment have poorer sleep quality (β = 0.12, p = 0.016); women with a twin pregnancy have poorer sleep quality (β = 0.12, p = 0.017); women with a history of cesarean delivery have poorer sleep quality (β = 0.13, p = 0.014); and women with UI have poorer sleep quality (β = 0.10, p = 0.047). Conclusion and Recommendations: Women with GDM have a higher prevalence and greater severity of UI. Marital status and vaginal delivery experience are identified as influencing factors for UI in late pregnancy. Poor sleep quality is prevalent among pregnant women, regardless of whether they have GDM. Factors influencing sleep quality during late pregnancy include advanced age, nonf-ull-time employment, twin pregnancy, history of cesarean delivery, and UI. It is recommended to assess UI and sleep quality in late-stage pregnant women. By identifying the factors influencing UI and sleep quality, strategies for the prevention and improvement of UI and sleep disorders can be provided early to enhance both the quality of life and sleep quality for pregnant women. Additionally, future studies could adopt a longitudinal design to follow changes in UI and sleep quality throughout pregnancy. They should consider examining the relationship between psychological factors, such as depression or anxiety, and sleep quality, as well as incorporating objective data, such as blood glucose levels and sleep parameters. This would provide a more comprehensive understanding of sleep quality in pregnant women.