從孕期到童年：母胎風險因子對兒童健康的長期影響探討

Abstract

背景 懷孕與出生後初期是決定兒童長期健康結果的關鍵時期。母體與胎兒的風險因子，例如高齡產婦、早產、小於胎齡兒、妊娠期體重增加及出生序等，皆可能深刻影響兒童的發育、疾病風險與死亡率。雖然相關議題在部分高收入國家已有廣泛探討，但在東亞族群中，這些因子累積性的影響與具體機制仍有待釐清。 方法 本論文整合五項以台灣全國性人口資料庫為基礎的世代研究，研究主題涵蓋：(1) 早產與小於胎齡兒的成長軌跡與幼年肥胖風險；(2) 早產與小於胎齡兒對異位性疾病（氣喘、異位性皮膚炎、過敏性鼻炎）風險的影響；(3) 母親年齡對出生預後、兒童死亡率、神經發展遲緩與過敏疾病的影響；(4) 兄弟姊妹的存在與出生序對注意力不足過動症與自閉症風險的影響；以及 (5) 妊娠期體重增加對新生兒不良預後的關聯性，並探討母親身體質量指數是否調節此關聯。我們運用多元邏輯斯迴歸與Cox比例風險模型，調整社經地位、都市化程度與妊娠相關因子進行分析。 結果 早產與小於胎齡兒在學齡前呈現出異於常態的生長曲線，並具有較高的肥胖風險。早產與氣喘及過敏性鼻炎風險上升相關，卻與異位性皮膚炎風險下降有關；小於胎齡兒則在足月兒中與異位性疾病風險無明顯關聯。母親年齡過低或過高皆與不良出生結果、兒童死亡率與神經發展異常風險上升有關。兄弟姊妹的存在與較低的注意力不足過動症與自閉症風險相關，但獨生子女與長子女的神經發展風險較高。過低或過高的妊娠期體重增加會增加新生兒不良預後風險，尤其在身體質量指數偏高或偏低的母親中影響更顯著。 結論 本論文結果強調孕期與新生兒期風險因子對兒童健康的長期影響，凸顯早期辨識與個別化照護的重要性。本研究有助於發展具地區適應性的公共衛生政策、妊娠與育兒指引，並可用以促進兒童健康平等與預防長期疾病負擔。

Background The prenatal and early postnatal periods represent critical windows during which maternal and fetal risk factors can shape lifelong health trajectories. Factors such as advanced maternal age, preterm birth, small-for-gestational-age (SGA) status, gestational weight gain (GWG), and birth order are increasingly recognized for their influence on child development, morbidity, and mortality. Despite growing global attention to these risks, their cumulative effects and population-specific implications remain underexplored in East Asian contexts. Methods This dissertation integrates findings from five nationwide, population-based cohort studies. We examined: (1) the longitudinal growth trajectories and early childhood obesity risk among preterm and SGA infants; (2) associations between prematurity/SGA and pediatric atopic diseases; (3) the effects of maternal age on birth outcomes, child mortality, neurodevelopmental delay, and allergic diseases; (4) the influence of sibling presence and birth order on the risk of neurodevelopmental disorders; and (5) the relationship between maternal gestational weight gain and neonatal outcomes stratified by maternal body mass index (BMI). Statistical analyses included multivariate logistic regression and Cox proportional hazards modeling, with adjustment for socioeconomic, urbanization, and obstetric confounders. Results Preterm and SGA infants showed distinct growth patterns and elevated obesity risk by early childhood. Prematurity was associated with higher risks of asthma and allergic rhinitis but a lower risk of atopic dermatitis. Both younger and advanced maternal age were linked to adverse birth outcomes and increased risks of mortality, developmental delay, and allergic diseases in children. Sibling presence was protective against attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), while only children and firstborns exhibited elevated neurodevelopmental risks. Inadequate or excessive gestational weight gain was associated with increased risks of adverse neonatal outcomes, particularly among mothers at the extremes of the BMI spectrum. Conclusion These findings underscore the long-term health implications of maternal, fetal, and familial factors during pregnancy and early infancy. The evidence highlights the importance of precision-based prenatal care, informed reproductive counseling, and targeted pediatric surveillance. Results may inform clinical guidelines and public health strategies aimed at reducing disparities in child health rooted in early life exposures.