懷孕期間身體質量指數變化與初次非計畫性剖腹生產風險之相關性研究

Abstract

研究背景：近年來歐美等國家之剖腹產率有逐年增加的趨勢，而臺灣地區在全民健保施行後剖腹生產的比率仍然居高不下。文獻回顧顯示懷孕前肥胖與懷孕期間體重增加過多可能與提高剖腹生產的風險有關。 研究目的：檢視懷孕期間身體質量指數變化與初次非計畫性剖腹生產風險之相關性。 研究設計：蒐集所有從2003年12月1日至2005年4月30日於臺北縣某一區域教學醫院生產之產婦及其生產資料進行回顧性世代研究。排除早產與計畫性剖腹生產之案例，如前胎剖腹生產、胎位不正、多胞胎等。利用單變項以及多變項邏輯性迴歸分析(1)懷孕前身體質量指數、(2)懷孕期間增重量、(3)懷孕期間增重比例、(4)懷孕期間身體質量指數變化等四項因素與初次非計畫性剖腹生產風險之相關性。 研究結果：研究期間共有1960人次產婦生產，總剖婦產率為33.5%。排除早產與計畫性剖腹生產之案例後，共有產婦1392人次，初次非計畫性剖腹產率為11.35%。多變項邏輯性迴歸分析顯示：懷孕前身體質量指數越高 (OR:1.10, 95% CIs: 1.04~1.15)及懷孕期間增重量越多 (OR:1.05, 95% CIs: 1.01~1.09)之孕婦，初次非計畫性剖腹生產的風險越高。懷孕期間身體質量指數增加越多也與初次非計畫性剖腹生產的風險提高相關，但顯著相關僅限於未滿35歲之非高齡產婦 (OR:1.13, 95% CIs: 1.03~1.25)。 結論：非高齡產婦之懷孕期間身體質量指數變化與初次非計畫性剖腹生產風險存在顯著相關性。

Background: Over the last few years, cesarean delivery rates have increased in several well-industrialized countries, such as the United States and England. According to the data of the National Health Insurance in Taiwan, the rates of cesarean delivery maintained high from 33.68% in 1995 to 32.67% in 2003. Obesity and excess gestational weight gain have been associated with multiple adverse perinatal outcomes, including increased rates of cesarean delivery. Objective: The purpose of this study was to investigate effect of BMI change during pregnancy on risk for cesarean delivery. Study design: A retrospective cohort study was conducted from December 1, 2003 to April 30, 2005. All women delivered in a regional hospital in Taipei County were eligible. Preterm deliveries and planned cesarean deliveries were excluded. Univariate and multivariate logistic regressions were introduced. Results: During study period, 1960 women delivered and total cesarean delivery rate was 33.5%. After exclusion, 1392 women were retained in this study. Primary unplanned cesarean delivery rate was 11.35%. Increased risks of cesarean delivery was associated with higher pre-pregnancy BMI (OR:1.10, 95% CIs: 1.04~1.15) and excessive gestational weight gain (OR:1.05, 95% CIs: 1.01~1.09). Among women aged less than 35 year, risks of cesarean delivery was associated with BMI increase during pregnancy (OR:1.13, 95% CIs: 1.03~1.25). Conclusion: BMI change during pregnancy is an important risk factor for cesarean delivery, especially among women aged less than 35 year.