妊娠紋相關因素探討

Abstract

研究背景 妊娠紋為孕期常見的似萎縮型疤痕之線狀皮膚變化，發生率約落在50%至90%，因似乎不會直接造成健康威脅，較少被健康照護人員關注。研究指出，妊娠紋可間接預測婦女的生產相關傷害；妊娠紋也會直接影響婦女之身體心像、生活品質，值得注意。現有研究顯示，妊娠霜等妊娠紋局部預防方式的效果有限；轉而探討妊娠紋的相關因素，可以避免或預測妊娠紋的發生。然而，現存文獻報告的妊娠紋相關風險因子仍有矛盾，國內亦缺少相關調查，仍值得進行探討。 研究目的 探討妊娠紋的發生率，及婦女的人口學、產科學因素、妊娠紋史等特性，以了解妊娠紋的相關因素。 研究方法 採用橫斷式研究設計，於北部某醫學中心之門診、產後病房進行收案。收案對象為單胞胎懷孕婦女，以自擬結構式問卷蒐集資料，問卷內容包含「人口學特性」、「產科學因素」、「妊娠紋調查」三部分，所得資料以統計軟體SPSS 19.0版本進行分析。將有、無妊娠紋兩群婦女之差異，以卡方檢定及獨立T檢定進行比較；另分組檢視全體個案、初產婦個案、經產婦個案，使用羅吉斯迴歸法檢定人口學特性、產科學屬性、妊娠紋史等因素，以確認妊娠紋之預測因子。 研究結果 全體妊娠紋發生率為66.0%，年齡、孕期體重增加是否過多、新生兒體重、新生兒性別，是孕期產生妊娠紋的預測因子。孕期體重增加過多(OR=1.951，95% CI=1.099~3.464)、新生兒體重較大(OR=1.001，95% CI=1.000~1.001)，是妊娠紋的危險因子；年齡較大(OR=0.936，95% CI=0.894~0.979)、新生兒性別為男性(OR=0.637，95% CI=0.448~0.905)，發生妊娠紋的風險較低。若將妊娠紋家族史納入考量，「母親妊娠紋史」是妊娠紋的唯一預測因子。母親孕期曾發生妊娠紋，自己發生妊娠紋的風險也會提升(OR=2.394，95% CI=1.516~3.780)。 在初產婦組中，年齡、新生兒體重是妊娠紋的預測因子。新生兒體重較大(OR=1.001，95% CI=1.000~1.001)是妊娠紋的危險因子；年齡較大(OR=0.909，95% CI=0.854~0.966)發生妊娠紋的風險較低。在經產婦組中，前胎妊娠紋史、孕期體重增加是否過多、新生兒性別，是妊娠紋的預測因子。前胎曾發生妊娠紋(OR=11.632，95% CI=6.045~22.384)、孕期體重增加過多(OR=5.856，95% CI=1.570~21.849)，為此胎妊娠紋的危險因子；新生兒性別為男性(OR=0.381，95% CI=0.196~0.743)，發生妊娠紋的風險較低。 結論 妊娠紋是孕期常見的皮膚變化，總體來說，年齡、孕期體重增加是否過多、新生兒體重、新生兒性別，是孕期產生妊娠紋的預測因子。對於初產婦，年齡、新生兒體重是妊娠紋的預測因子；對於經產婦，前胎妊娠紋史、孕期體重增加是否過多、新生兒性別，是妊娠紋的預測因子。臨床照護上，專業人員應協助婦女了解妊娠紋的可能因素，以減少不確定感，並將妊娠紋去疾病化，以促進孕產婦女心理健康。

Background Striae gravidarum (SG), which incidence is among 50% to 90%, is a common linear atrophic scar-like skin change during pregnancy. SG may not threaten our health directly, so it gets less attention from health providers. Researches indicate that SG can not only predict birth-related injuries indirectly but also affect women's body image and quality of life. Because current studies show that SG prevention cream and other prevention methods have limited effect, figuring out the associated factors of SG can be a better way to get rid of it. However, the associated factors of SG reported in current studies keep being contradictory, and there is no such research in Taiwan, which makes this issue worth investigating. Objectives This study aims to figure out the incidence of SG, and the relationship between SG and women's demographic characteristics, obstetric factors, and their past experiences of striae, hoping to know the associated factors of SG. Methods It was a cross-sectional study. The research participants were recruited in the outpatient and postpartum wards of a medical center in the north of Taiwan. All singleton pregnant women visiting the outpatient clinics were included. A self-reported questionnaire was used to collect relevant data. The questionnaire includes three parts: demographic characteristics, obstetrics variables, and an SG survey. The analytics of the collected data was done with the statistical software SPSS version 19.0. The different characteristics between women with and without SG were analyzed with the chi-square test and independent T-test. Plus, a review of all cases, primipara subgroup, and multipara subgroup were done respectively; the relevant factors were tested to confirm the predictive factors of SG by using logistic regression. Results The results showed 66.0% of women experienced striae gravidarum during their pregnancy. Age, weight gain during pregnancy, newborn birth weight and newborn sex are predictors to striae gravidarum. Experiencing excessive weight gain during pregnancy (OR=1.951，95% CI=1.099~3.464) and larger newborn weight (OR=1.001，95% CI=1.000~1.001) were risk factors of striae gravidarum while being older (OR=0.936，95% CI=0.894~0.979) and having male newborn (OR=0.637，95% CI=0.448~0.905) lowering the risk of striae gravidarum. However, if the history of striae gravidarum of their mothers was considered, it would be the only predictor to striae gravidarum. The risk of striae gravidarum would increase if their mothers experienced striae gravidarum before (OR=2.394，95% CI=1.516~3.780). In the primipara subgroup, their age and the weight of their newborn were predictors to striae gravidarum. Larger newborn weight (OR=1.001，95% CI=1.000~1.001) was the risk factor while being older (OR=0.909，95% CI=0.854~0.966) lowering the risk of striae gravidarum. In the multipara subgroup, previous striae gravidarum, weight gain during pregnancy, and newborn sex were predictors to striae gravidarum. Experiencing striae gravidarum in a previous pregnancy (OR=11.632，95% CI=6.045~22.384) and excessive weight gain (OR=5.856，95% CI=1.570~21.849) were risk factors of striae gravidarum while having male newborn (OR=0.381，95% CI=0.196~0.743) lowering the risk of striae gravidarum. Conclusion Striae gravidarum is a common skin change during pregnancy. Age, weight gain during pregnancy, newborn birth weight and newborn sex are predictors to striae gravidarum. In the primipara subgroup, their age and the weight of their newborn were predictors to striae gravidarum. In the multipara subgroup, previous striae gravidarum, weight gain during pregnancy, and newborn sex were predictors to striae gravidarum. We suggest healthcare professionals normalize striae gravidarum and assist women to know the possible risk factors to minimize their uncertainty. This may improve the mental health of pregnant women.