孕婦對唐氏症篩檢和遺傳診斷過程中知識、態度和經驗及其相關因素之探討

Abstract

在台灣地區，引起智能障礙最常見的染色體異常疾病就是唐氏症，隨著產前唐氏症檢查技術日新月異，檢查的項目有多種不同的選擇，孕婦應該對於產前遺傳診斷的基本認知有所了解。故在進行產前遺傳檢測時，應對孕婦提供正確且完整資訊之相關知識，使其了解產前遺傳檢查及檢查結果的意義，再行最佳判斷並能夠做出適宜之決定，以減少孕婦的壓力和焦慮，使其更能充分瞭解到相關資訊。 本研究目的在探討懷孕婦女對產前唐氏症篩檢和診斷過程中知識、態度與經驗的相關性研究，研究工具採用在澳洲使用過的公開結構式問卷「產前篩檢和產前診斷的調查」翻譯而成，為提高問卷之可信度，先進行信效度的檢定。自2014年11月1日至2015年4月30日期間，於台北市某區域教學醫院婦產科門診收案。對象為懷孕週數滿20週以上到生產前的孕婦，本研究總計實際回收有效問卷共計207份，回收率96.28%。 研究結果：孕婦的年齡平均34.3歲，為高齡孕婦，在接受產前唐氏症篩檢和診斷的知識量表經標準化之後平均得分為62.77分（滿分為100分），知識程度不是很高，得分欠理想，需有加強之必要。孕婦產前唐氏症篩檢和診斷知識之主要相關因素為：年齡、懷孕次數、生產次數其結果皆達統計上顯著意義。態度量表顯示平均得分為68.92分（滿分為100分），顯示孕婦之態度趨向於正向、積極。經驗量表在第一孕期和第二孕期唐氏症篩檢在大部分的孕婦都有聽說過、醫護人員也都有建議、自己也有瞭解檢驗項目目的，差別在第一孕期自己有做佔多數，第二孕期母血唐氏症篩檢自己並沒有做佔多數；絨毛膜取樣術大部分的孕婦都認為有聽說過但是醫護人員沒有建議、也不瞭解檢驗項目目的、自己也並沒有做；羊膜穿刺術方面在大部分的孕婦都表示有聽說過、醫護人員也都有建議、自己也有瞭解檢驗項目目的但是自己並沒有做。孕婦在產前唐氏症篩檢和診斷達顯著相關的因素為知識與態度，而知識與態度、年齡、懷孕次數及生產次數之間的關係達統計上顯著相關，態度與懷孕次數亦達統計上顯著相關。 本研究結果可為臨床實務、醫護教育、政府政策、孕婦健康手冊產檢相關資訊等方面及臨床醫護人員、遺傳諮詢師等相關人員參考，並能夠給予孕婦最適時的協助，以提高孕婦產前唐氏症篩檢和診斷的相關知識，減少國人對遺傳疾病之恐慌及醫療成本的浪費。

In Taiwan, the most common cause of chromosomal disorder causing mental retardation is Down syndrome. Along with rapid advanced technology of prenatal Down syndrome screening and diagnosis, there are a number of different options of examination. Pregnant women should possess basic knowledge for understanding their prenatal genetic diagnosis. Therefore, during prenatal genetic examinations, women should be provided accurate and complete relevant information to understand the meaning of prenatal genetic examination results, so that while reducing stress and anxiety, the appropriate decisions could be made. This study aimed to explore the relation between pregnant women’s prenatal Down syndrome screening and diagnosis process knowledge, attitude and experience. A structured questionnaire used in Australia 'prenatal screening and prenatal diagnosis' was translated into Chinese. The reliability and validity were established. Data were collected from November 1st 2014 to April 30th 2015, at maternity clinics in a regional teaching hospital in Taipei. A total of 207 pregnant women over 20 weeks gestation were recruited, the response rate was 96.28%. The study results showed the average age of pregnant women was 34.3 years old, average prenatal screening and diagnosis of Down syndrome knowledge scale standardized score of 62.77 points, which is not satisfied and should be strengthened. The main factors related to prenatal screening and diagnosis of Down syndrome knowledge including age, number of pregnancies, and the parity. Attitude scale showed an average standardized score of 68.92 points, revealing the attitude of pregnant women tend to be positive and active. As to experience scale, majority of pregnant women have heard the first trimester and the second trimester screening for Down syndrome, also have recommended by health care workers, and have an understanding of the purpose, most of them have done in the first trimester. Most of the pregnant women did not do second trimester maternal serum screening for Down syndrome. Most pregnant women have heard of chorionic villus sampling technique but health care workers did not recommend, do not understand the purpose, and did not do it. Most pregnant women have heard amniocentesis, recommended by health care workers, understanding of the purpose but did not do it. Significant factors of pregnant women’s Down syndrome prenatal screening and diagnostic knowledge and attitude were examined. Age, number of pregnancies, parity were significantly correlated to knowledge. The attitude and the number of pregnancies also significantly statistical correlated. The results of this study may be useful to clinical practice, nursing education, governmental policy, genetic counselors etc. We suggest that timely information of prenatal Down syndrome screening and diagnosis should be given to most pregnant women, thereby reducing panic effectively to the genetic diseases and related medical costs.