賴美淑謝長堯臺灣大學：陳志忠Chen, Chih-ChungChih-ChungChen2007-11-282018-06-292007-11-282018-06-292006http://ntur.lib.ntu.edu.tw//handle/246246/59205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.Contents Abstract in Chinese 3 Abstract 4 Chapter 1. Background 5 Chapter 2. Literatures review 8 1. Gestational weight gain and cesarean delivery 8 2. Proportional weight gain and cesarean delivery 11 3. Pre-pregnancy body mass index and cesarean delivery 12 4. Change of body mass index during pregnancy and cesarean delivery 17 Chapter 3. Framework, hypothesis, purpose of the study 29 Chapter 4. Materials and methods 31 1. Setting 31 2. Study period 31 3. Subjects 31 4. Information source and collection 32 5. Exposure and outcome 32 6. Statistical analysis 34 Chapter 5. Results 36 1. Demographic data 36 2. Analyses of risk factors for cesarean delivery 47 a. Univariate analysis 47 b. Multivariate analysis 51 Chapter 6. Discussions 61 1. Gestational weight gain and cesarean delivery 61 2. Proportional weight gain and cesarean delivery 63 3. Pre-pregnancy body mass index and cesarean delivery 64 4. Change of body mass index during pregnancy and cesarean delivery 65 5. Limitations of the study 67 6. Strengths of the study 69 Chapter 7. Conclusion 71 References 72 Table 1 Retrospective studies of gestational weight gain and cesarean delivery 18 Table 2 Prospective study of proportional weight gain and cesarean delivery 21 Table 3 Prospective studies of pre-pregnancy body mass index and cesarean delivery 22 Table 4 Retrospective studies of pre-pregnancy body mass index and cesarean delivery 24 Table 5 Prospective study of change of body mass index during pregnancy and cesarean delivery 28 Table 6 Indications for cesarean sections of all deliveries 38 Table 7 Demographic characteristics of all deliveries 40 Table 8 BMI classification of all deliveries (IOM criteria) 41 Table 9 BMI classification of all deliveries (DOH, Taiwan criteria) 41 Table 10 Demographic characteristics of study subjects 44 Table 11 Univariate analysis of risk factors for cesarean delivery (1) 48 Table 12 Univariate analysis of risk factors for cesarean delivery (2) 50 Table 13 -2LL value of gestational weight gain model 52 Table 14 -2LL value of pre-pregnancy BMI model 54 Table 15 -2LL value of change of BMI during pregnancy model 57 Table 16 Multivariate analysis of risk factors for cesarean delivery (1) 59 Table 17 Multivariate analysis of risk factors for cesarean delivery (2) 60 Table 18 Comparison with Kabiru et al.’s study 67 Fig. 1 Framework of the study 30 Fig. 2 Flow chart of the study 36 Fig. 3 Distribution of gestational weight gain 45 Fig. 4 Distribution of pre-pregnancy BMI 45 Fig. 5 Distribution of change of BMI during pregnancy 46 Fig. 6 Distribution of proportional weight gain 46 Fig. 7 ROC curve of gestational weight gain model 53 Fig. 8 ROC curve of pre-pregnancy BMI model 56 Fig. 9 ROC curve of change of BMI during pregnancy model 58543411 bytesapplication/pdfen-US身體質量指數剖腹生產body mass indexcesarean delivery[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59205/1/ntu-95-R92846017-1.pdf