婦女孕期體重控制行為與體重增加及其影響因素之探討

Abstract

背景：孕期增加適當的體重對孕婦與胎兒、新生兒的健康是重要的，懷孕期間婦女增加不足或過多的體重均易導致合併症的發生。孕婦體重增加過多是全球日趨嚴重的現象，其所引發的產後體重存留及日後婦女體重過重或肥胖，進而增加罹患慢性疾病的危險是近年來公共衛生重要的議題。隨著生殖時期婦女肥胖盛行率增加與高比例的婦女孕期體重增加超過建議標準，研究焦點應轉移到關注母親長期的健康。 目的：本研究目的在探討懷孕婦女體重控制行為與體重增加，並分析個人、人際間以及環境因素對其之影響。 方法：本研究採重複測量設計法，研究對象為18歲以上在台北市產前檢查的308位健康婦女。資料的收集是以問卷的方式進行，在婦女懷孕8-12週時收集第一次，問卷包括：基本資料，個人的障礙評估、孕期心理壓力、心理社會結構測量，人際間的孕期社會支持，以及環境的運動可利用性，孕期體重控制行為則收集三次分別於懷孕8-12週、24-28週與36-40週時各收集一次，追蹤研究對象的生產紀錄包含三個妊娠時期的體重增加與新生兒健康，並以廣義估計方程進行資料分析。 結果：婦女於懷孕8-12週、24-28週與36-40週的體重控制行為有差異，隨著妊娠時間增長，懷孕婦女其體重控制行為越困難。第二與三個妊娠期體重增加較多，其平均增加的體重依序分別為2.1、9.6和13.6公斤。婦女孕期總體重增加值與國民健康局所建議的10-14公斤，具有一致性的婦女佔43.8%。無論妊娠週期，婦女執行孕期體重控制的障礙越低、心理壓力越低、心理社會面越積極、得到越多的支持、身體活動之環境評估越適合，其在體重控制行為方面越良好。婦女其個人懷孕週數、障礙評估、心理社會因素、人際間的社會支持等因素影響孕期體重控制行為。婦女其個人的職業、小孩數、抽菸史、人際間的社會支持以及環境的因素和體重控制行為分別影響三個妊娠期之體重增加。 結論：第二妊娠期後，懷孕婦女其體重控制行為越困難。孕期體重增加值符合國民健康局所建議的10-14公斤的婦女佔約4成。懷孕婦女其個人生理心理社會的、人際間的社會支持和環境運動可利用性的因素以及體重控制行為分別影響三個妊娠期之體重增加。本研究結果的相關知識可作為日後醫護人員在指導懷孕婦女之依據，並提供未來發展健康促進研究介入策略以及相關健康政策之參考。

Background: Inappropriate gestational weight gain may increase the risk of perinatal complications. Weight retention after childbirth may increase risks for overweight or obesity which are important issues for public health. Appropriate weight gain during pregnancy has a positive impact on the health of mother, fetus and newborn. With the rising prevalence of obesity among women of childbearing ages and the high proportion of women who are gaining in excess of recommendations, research focus should move to take the mother's long-term health status into account. Purpose: The purpose of this study was to investigate the gestational weight gain behavior, weight gain and the physical, psychosocial, interpersonal and environmental determinants to them. Methods: The research utilized a repeated measurement design. Three hundred and eight healthy women who were above 18 years old, singleton pregnancy and had their prenatal checks in Taipei were recruited. Women were excluded if they had medical problems during the period of pregnancy. Self-reported questionnaires were used for collection of data. Data collection started at the 8-12th gestational week. Factors such as: personal demographic data, perceived barriers for gestational weight control, pregnancy stress rating scale, psycho-social construct, gestational weight control behavior, maternity social support scale and availability of physical environment for exercise were measured. The gestational weight control behavior was collected again at the 24-28th, and the 36-40th gestational week. Weight gain information and newborn health were followed after delivery from medical chart. Data were analyzed using the method of generalized estimating equations. Results: Behavioral control of gestational weight became more and more difficult with the increase of gestational week. Women had more weight gain during the second and third trimester. The mean gestational weight gain was 2.1, 9.6, and 13.6 kg at each trimester respectively. About forty-four percent of the investigated women had gained weights within the range of 10-14 kg, which met the standard suggested by the Bureau of Health Promotion, Department of Health, R. O. C. (Taiwan). Factors of Perceived low barriers for gestational weight control, low pregnancy stress, positive psycho-social construct, maternity social support and more availability of physical environment for exercise were found to be significantly associated with the gestational weight control behavior. The determinants for gestational weight control behavior were personal factor (gestational week, barriers for gestational weight control, psycho-social construct), and interpersonal factor (maternity social support). Personal factor (occupation, number of children, smoking history), interpersonal factor (maternity social support), availability of physical environment for exercise, and weight control behavior were determinants for gestational weight gain. Conclusions: Gestational weight control behavior became more difficult after the second trimester. There are about forty percent of women whose total gestational weight gains were within the range of 10-14 kg, which met the standard suggested by the Bureau of Health Promotion, Department of Health, R. O. C. (Taiwan). Personal factors (physical, psychosocial), interpersonal factor (maternity social support), availability of physical environment for exercise, and weight control behavior were shown to be the determinants for gestational weight gain. Knowledge gains in this study may be useful for development of suitable interventions to design required gestational weight gains for pregnant women and for governments in making policies.