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研究生: 林筱菁
Lin Hsiao Ching
論文名稱: 婦女懷孕前飲食營養攝取狀態與新生兒體型之相關性研究
Examination of relationships between maternal nutrition status in prepregnancy and birth outcomes
指導教授: 盧立卿
Lyu, Li-Ching
學位類別: 碩士
Master
系所名稱: 人類發展與家庭學系
Department of Human Development and Family Studies
論文出版年: 2008
畢業學年度: 96
語文別: 中文
論文頁數: 221
中文關鍵詞: 飲食頻率問卷生產後回憶各時期典型一天飲食營養素密度孕婦
英文關鍵詞: FFQ, remote diet recall, nutrient density, pregnancy
論文種類: 學術論文
相關次數: 點閱:233下載:8
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  • 本研究分析個人飲食頻率問卷和生產後回憶各時期典型一天飲食問卷來評估現今台灣婦女懷孕期前後飲食營養的攝取狀況,探討婦女懷孕期間飲食狀況與新生兒體型之間的關係,並比較婦女懷孕前及懷孕期飲食營養攝取是否有差異。合併兩個小型世代研究的受試者為分析對象,民91世代於民國91年至民國92年間,於台北市立婦幼醫院招募181名孕婦為受試者;民93世代自民國93年至95年間於台北市立婦幼醫院和臺大醫院招募150位生產後的婦女參加。以面對面或電話訪談方式收集孕婦的飲食相關資料。利用問卷調查飲食狀況、基本資料、身體測量值、新生兒健康狀況等。最後研究分析人數為306人,平均年齡30.9±4.0歲,懷孕前平均體重53.5±7.7公斤,BMI值21.0±2.9 kg/m2,懷孕期間體重平均增加14.4±4.3公斤。新生兒平均出生週數38.9±1.0週,平均出生身長49.1±2.4公分,平均出生體重3227.1±463.5公克,平均出生頭圍34.3±2.0公分。男新生兒出生體重平均比女新生兒多220公克。個人飲食頻率問卷和生產後回憶各時期典型一天飲食問卷由於需請受試者自行郵寄回本研究室,因此會有回收率較低的問題。由生產後回憶各時期典型一天飲食問卷得知,懷孕前一年孕婦平均攝取2813 kcal的熱量,懷孕前期、後期平均熱量攝取為2076 kcal和2300 kcal。由個人飲食頻率問卷發現,孕婦懷孕前一年膳食纖維、膽固醇、維生素E、維生素K、維生素B1、維生素B2、鈣、鎂、磷、鋅、葉酸、植物性蛋白質、動物性脂肪等營養素密度皆顯著低於懷孕全期;維生素A、菸鹼酸、維生素B6、維生素B12、鈉、鐵則顯著高於懷孕全期。且婦女懷孕期間比懷孕前一年攝取較多的奶類、水果、蛋類和黃豆類食物。母親懷孕週數、未懷孕BMI值、孕期總體重增加量、母親身高、新生兒性別與新生兒體型呈顯著正相關;父母教育年數、家庭社經地位與新生兒體形呈顯著負相關。在新生兒出生體重迴歸模式發現,新生兒出生體重與懷孕前葉酸、膽固醇營養素密度呈顯著正相關(p<0.05),與鈉營養素密度呈顯著負相關(p<0.05)。

    We used two dietary assessment methods including food frequency questionnaire (FFQ) and a typical day recall for postnatal women to collect dietary information during pregnancy and before pregnancy. This study analyzed the correlations and explored the possible relationships between maternal dietary status and infant outcomes including birth weight, length and head circumference. Our study subjects were from two cohort studies. First cohort were 181 pregnant women who received prenatal follow-up at Taipei Municipal Women’s and Children’s Hospital. Second cohort consists of 150 postnatal women recruited at Taipei Municipal Women’s and Children’s and National Taiwan University Hospital. Before pregnancy, the participants’ average age was 30.9years old, weight was 53.5 kg, BMI was 21.0 kg/m2, and the gestational weight gain was 14 kg. Newborn’s average gestational age was 38.9 weeks. The average birth height, weight, and head circumference of the newborns was 49.1 cm, 3227.1 g, and 34.3 cm, respectively. Regarding the FFQ and a typical day recall, because participates were asked to mail the records back to us, the response rate was much lower. By using a typical diet from postnatal women recalled, the average energy intakes before pregnancy was 2813 kcal, the first and the third trimesters were 2076 kcal, and 2300 kcal, respectively. By using the FFQ, we found that the nutrient densities of dietary fiber, cholesterol, vitamin E, vitamin B1, vitamin B2, calcium, magnesium, phosphorous, zinc, folate, plant protein, and animal fat during pregnancy were higher than pre-pregnancy, while the nutrient densities of vitamin A, niacin, vitamin B6, vitamin B12, sodium, and iron were lower than pre-pregnancy. In addition, women during pregnancy ate more milk, eggs, fruit, and soybean products than pre-pregnancy (p<0.05). We also found that maternal gestational age, BMI before pregnancy, weight gain during pregnancy, and newborn gender were positively correlated with birth outcomes, but parent’s education, and family socioeconomic status were negatively correlated with birth outcomes. The nutrient densities of folate and cholesterol before pregnancy were positively correlated with newborn weight (p<0.05), while the nutrient densities of sodiun before pregnancy was negatively correlated with newborn weight (p<0.05).

    目錄 第一章 緒論 第一節 研究動機………………………………………………… 1 第二節 研究目的………………………………………………… 2 第三節 名詞解釋………………………………………………… 3 第二章 文獻探討 第一節 懷孕前營養對於生產結果之影響………………. 6 一、葉酸…………………………………………………. 8 二、其他營養素……………………………………………. 12 第二節 懷孕前體重對於新生兒的影響….................................. 16 一、懷孕前體重對新生兒的影響………………………..….. 16 二、孕前體重對於孕期體重增加量的影響…........................ 21 第三節 孕婦營養狀況評估法………………………………… 24 一、三大飲食評估法……….……………………………... 24 二、飲食頻率問卷的信效度研究………………………. 26 三、過去時間飲食評估方法學探討…………………… 32 第四節 新生兒出生體重相關探討………………………. 38 一、台灣地區新生兒出生體重的情形………………... 38 二、不同出生體重新生兒的影響因素…....................... 41 第三章 研究方法 第一節 研究架構………………………………………………… 50 第二節 研究設計與實施程序…………………………………… 51 一、研究設計………………………………………………… 51 二、實施程序流程圖……………………………………….. 53 第三節 研究對象………………………………………………… 54 第四節 研究工具………………………………………………… 56 一、孕婦基本資料………………………………………… 56 二、飲食相關問卷………………………………………… 56 三、新生兒健康狀況問卷……………………………. 58 四、追蹤過程登記表………………………………... 58 五、問卷修改………………………………………...... 59 第五節 資料收集與訪員訓練…………………………………… 62 一、資料收集……………………………………………….... 62 二、訪員訓練……………………………………………….... 62 第六節 資料處理………………………………………………… 63 一、孕婦基本資料………………………………………… 63 二、飲食相關問卷……………………………………........ 63 三、新生兒健康狀況問卷…………………………..... 64 四、家庭社經背景歸類方法……………………........ 64 五、孕期身體活動量分類方式…………………….... 65 六、營養素完成率…………………………………….. 66 第七節 統計分析………………………………………………… 67 第四章 研究結果 第一節、孕婦基本資料分析……………………………………… 70 第二節、新生兒體型與父母基本資料分析…………………….... 77 第三節、孕婦營養素與食物種類攝取狀況分析……………….. 94 第四節、不同出生體重新生兒與孕婦飲食狀況分析………….. 114 第五節、個人飲食頻率問卷與生產後回憶各時期典型 一天飲食問卷的相對效度分析………………… 132 第六節、孕婦懷孕飲食狀況與新生兒體型之相關性分析 135 第七節、孕婦飲食狀況與新生兒體型之多元回歸分析……….. 144 第五章 討論 一、孕婦飲食狀況……………………………………… 154 二、新生兒體型影響因素……………………………… 157 三、預測新生兒體型的相關因子……………………… 162 四、飲食評估法的優缺點與相對效度………………… 164 第六章 結論……………………………………………………… 167 第七章 研究限制與建議 一、 研究對象………………………………………………. 169 二、 研究方法………………………………………………. 169 三、 研究結果 ……………………………………………... 170 參考文獻 ㄧ、中文部份……………………………………………………... 173 二、英文部份……………………………………………………… 175 附錄目錄 附錄一:懷孕前日常生活及飲食情形自填問卷…………………... 188 附錄二:研究同意書及基本資料及懷孕全期產婦問卷…………… 199 附錄三:孕婦基本資料編碼……………………………………….. 212 附錄四:家庭生活與運動編碼……………………………………. 215 圖目錄 圖3-1.1 研究架構圖……………………………………………….. 50 圖3-2.1 實施程序流程圖………………………………………….. 53 表目錄 表 4-1.1 孕婦基本資料…………………………………………… 71 表 4-1.2 兩世代家庭基本資料分佈與比較……………………… 73 表 4-1.3 懷孕前一年吃素習慣與出生體型之關係……………… 74 表 4-1.4 懷孕期間抽菸習慣與出生體型之關係………………… 75 表 4-1.5 懷孕期間飲酒習慣與出生體型之關係………………… 75 表 4-1.6 懷孕期間吃素習慣與出生體型之關係………………… 76 表 4-1.7 孕期身體活動量與出生體型之關係…………………… 76 表 4-2.1 所有新生兒及分性別新生兒體型與父母基本資料…… 78 表 4-2.2 不同性別新生兒出生體重與父母基本資料…………… 81 表 4-2.2 (1)不同性別新生兒出生體重與父母基本資料………… 82 表4-2.3 不同新生兒出生體重與父母基本資料…………………… 84 表4-2.3 (1) 不同新生兒出生體重與父母基本資料…………………85 表4-2.4 父母不同基本資料與新生兒體型之關係………………… 89 表4-2.5 孕婦基本資料與新生兒出生體型之相關性……………… 93 表4-3.1 方法學研究不同時期回憶懷孕前一年的營養素攝取…… 97 表4-3.2 方法學研究不同時期回憶懷孕前一年的營養素密度…… 98 表4-3.3 方法學研究不同時期回憶懷孕前一年的營養素攝取的 相關性…………………………………………………… 99 表4-3.4 由個人飲食頻率問卷計算所得懷孕前一年和懷孕全期熱量及三大營養素佔熱量百分比……………………………… 96 表4-3.5利用個人飲食頻率問卷評估孕婦懷孕前一年和全期的營養素攝取量…………………………………………………… … 100 表 4-3.6 利用個人飲食頻率問卷評估孕婦懷孕前一年和懷孕全期的 營養素密度…………………………………………………101 表 4-3.7 利用個人飲食頻率問卷評估懷孕全期及懷孕前一年的營養素攝取量………………………………………………………103 表4-3.8 利用個人飲食頻率問卷評估懷孕期及懷孕前一年的營養素密度……………………………………………………………104 表4-3.9 孕婦懷孕前一年和懷孕全期的食物重量百分比…………105 表 4-3.10 利用典型24小時飲食回憶評估懷孕前一年及懷孕前期及後期的營養素攝取量…………………………………………106 表 4-3.11 利用典型24小時飲食回憶評估懷孕前一年及懷孕前期及後期的營養素攝取量(GEE)…………………………………. 110 表4-3.12 本研究懷孕前一年與懷孕前期、懷孕後期三期營養素攝取量與DRIs之對照………………………………………………112 表4-4.1 懷孕前個人飲食頻率分組結果-依出生體重分佈10與90百分比相互比較……………………………………………… 115 表4-4.2 懷孕前個人飲食頻率分組-依出生體重分佈10與90百分比相互比較營養素密度……………………………………… 118 表4-4.3 懷孕前個人飲食頻率分組-依出生體重分佈25與75百分比相互比較……………………………………………………… 123 表 4-4.4 懷孕前個人飲食頻率分組-依出生體重分佈25與75百分比相互比較營養素密度……………………………………… 125 表4-4.5 懷孕前個人飲食頻率分組-依三分位分組出生體重分佈相互比較………………………………………………………… 127 表4-4.6 懷孕前個人飲食頻率分組-依三分位分組出生體重分佈相互比較營養素密度…………………………………………… 129 表4-4.7 利用24小時飲食回憶評估懷孕前一年營養素攝取量… 131 表4-5.1 懷孕前一年24hr recall比較CFFQ營養素Kappa值與相關係數…………………………………………………………… 134 表 4- 6.1 懷孕前一年營養素密度(每1000大卡)與食物重量對新生兒出生體型之淨相關………………………………………… 136 表 4- 6.2 懷孕全期營養素密度(每1000大卡) 與食物重量對新生兒出生體型之淨相關……………………………………………141 表4-7.1 新生兒出生體重與孕婦懷孕前飲食狀況之多元回歸模式(β值) ……………………………………………………………….146 表 4-7.2 新生兒出生體重與孕婦懷孕前飲食狀況知多元回歸模式(B值)………………………………………………………….. 147 表4-7.3 新生兒出生體重與孕婦懷孕全期飲食狀況之多元回歸模式 (β值) …………………………………………………….. . ..150 表4-7.4 新生兒出生體重與孕婦懷孕全期飲食狀況之多元回歸模式 (B值)………………………………………………………… 151 表4-7.5 新生兒出生身長與孕婦懷孕期飲食狀況之多元回歸模式…153 表 5-1.1 非懷孕、非哺乳期婦女和懷孕婦女的飲食建議攝取量整理與本研究相比…………………………………………………..156

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    林綽娟、郭憲文(民82)。某教學醫院新生兒出生體重與頭圍之相關因素之探討。公共衛生,20(1),58-69。
    陳保中、何啟功、張蓓貞、王榮德(2000)。母親危險因子對低出生體重嬰兒、早產兒、及生長遲滯嬰兒之影響-前瞻性懷孕世代研究。中華公共衛生雜誌,19(3),191-202。
    廖宗志、林俊龍、詹婉瑜、宋鴻樟、廖建彰(2006)。外籍新娘與本地婦女的低出生體重嬰兒比較。臺灣家庭醫學雜誌,16(4),226-236。
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    林綽娟、郭憲文(民82)。某教學醫院新生兒出生體重與頭圍之相關因素之探討。公共衛生,20(1),58-69。
    藍守仁、嚴雅音、李建宏、邱正芬、張宜娟、謝淑芬(民80)。懷孕週數與出生體重及體重/身長比之研究。高雄醫學科學雜誌,7,168-172。

    二、英文部分

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