| Abstract: | 青少女懷孕的問題已是全球各國公共衛生界所重視的議題，近年來更將觸角延伸到其所生子女的健康上。基於預防醫學的角度，為了及早發現健康的危害因子，除了重視青少女生育的結果之外，監測其小孩的生長和發育，更是今日強調的重點任務；而體位測量是監測嬰幼兒早期生長發育的重要指標。
目的：本研究欲了解青少年懷孕生產是否較易有不健康的生產結果以及是否因為母親的特質、小孩出生的結果及養育行為的不同，對6個月小孩的體重造成不同的影響。
研究設計：本研究的資料來源為「台灣出生世代研究(Taiwan Birth Cohort Study,簡稱TBCS) 」中，2005年7月1日到2006年6月30日所收集的嬰兒出生及六個月的資料。排除先天性缺陷、使用人工生殖科技及多胞胎的嬰兒，第一部份出生結果資料完整的青少女母親組（<20歲）共533位，成年組母親（20-35歲）共9347位；第二部份排除體重過重（?97百分位），最後有902位6個月體重不足(?15 百分位)，及11272位體重正常(15-97百分位) 的小孩符合收案的條件。資料以SPSS PC 15.0統計軟體進行統計，統計方法含次數、百分比、平均值±標準差進行變項之描述性統計，t檢定、X2檢定進行雙變項分析，以Z檢定及Cochran's Mantel-Haenszel進行差異檢定，並使用邏輯斯迴歸(Logistic Regression)或多層次邏輯斯迴歸(Multiple Levels Logistic Regression)，分析影響低出生體重、早產及6個月小孩體重不足的相關預測因子。
結果：青少年母親所生小孩發生低出生體重及早產的比率都顯著高於成年母親。對青少年母親而言，產前照護次數不足及懷孕期間體重增加不足，會造成低出生體重及早產發生的危險顯著增加；而懷孕期間有抽菸也會增加低出生體重發生的危險。
比較兩組母親6個月小孩體重不足的比率無顯著差異。而與6個月體重不足有顯著差異的因子包括：母親因素（母親組別、教育程度、國籍、家庭支持功能、懷孕增加體重、懷孕時是否抽菸、現在是否抽菸）、小孩因素（性別、是否早產、有無低出生體重）和養育因素（是否使用營養補充品、母親是否為白天主要照顧者、母親感受小孩健康狀況）。經調整母親、小孩及養育因素的效應，Model 顯示：外籍母親、懷孕時增加體重不足、女性小孩、低出生體重、有使用營養補充品、母親感受小孩健康狀況不良者，發生6個月體重不足的風險比較高。
進一步比較兩組母親所生小孩發生6個月體重不足的預測變項，在青少女母親中，懷孕時有抽菸的風險比顯著高於未抽菸母親所生的小孩；而成人母親中，外籍母親、懷孕期間體重增加不足、女性小孩、低出生體重、有補充副食品及感受到小孩健康狀況不佳等變項，達統計上的顯著差異。
結論：青少年懷孕有較高早產及低出生體重的發生率，經調整母親、小孩及養育因素的效應後，外籍母親、懷孕時增加體重不足、女性小孩、低出生體重、有使用營養補充品、母親感受小孩健康狀況不良者，發生6個月體重不足的風險比較高。瞭解青少女生育的結果及各種因素對6個月小孩體重的影響，能提供醫療及公共政策的參考。
Background: Adolescent pregnancy, which was the global challenges and merits the concern of public health, extended the focus to their children's health in recent years. Based on preventive medicine perspective, to detect risk factors early, besides considers the birth outcomes of teenage mothers, monitors their child's growth and development, is the key task which today emphasized. And the body-weight survey is an important target to monitor the infants’ early growth.
Objective: The purpose of this study was to explore the birth outcomes and determinants of child's body weight of 6 month old.
Methods: This study was based on questionnaire interviews as part of the Taiwan Birth Cohort Study. The sample population, Parts 1 included 533 adolescent(<20 years old) and 9347 adult(20–34 years old) mothers, and Parts 2 included 902 poor weight gain (?15 percentile) and 11272 normal weight gain (15-97 percentile) children of 6 month old. Data were analyzed with SPSS/PC for Windows v.15.0. Percentage, Mean, Standard Deviation, x2 test, Cochran's Mantel-Haenszel test, Logistic Regression and Multiple Levels Logistic Regression were used in this study.
Results: There was a significantly higher incidence of low birth weight (LBW) and premature birth in the adolescent group. For the adolescent mothers, insufficient prenatal care and poor weight gain during pregnancy are important predictors of LBW and premature birth. And have smoking during pregnant period will also to increase the risk of LBW.
When adjusted for covariates in the multiple variable models, the results showed that related to 6 months poor weight gain (1) maternal factors (ModelⅠ) were family dysfunction, poor weight gain during pregnancy; (2) maternal and infancy factors (Model Ⅱ) were family dysfunction, poor weight gain during pregnancy, female children, LBW; (3) maternal, infancy and parenting factors (Model Ⅲ) were native mother, poor weight gain during pregnancy, female children, LBW, using complementary food and perceived child had poor health.
Further compares two group of mother the predictors of 6 month old children’s poor weight gain. The results showed that (1) related to adolescent mothers were during pregnancy have smoking; (2) related to adult mothers were migrated, poor weight gain during pregnancy, female children, LBW, using complementary food and perceived child had poor health had significant difference.
Conclusion: Adolescent pregnancy exhibits a higher rate of LBW and premature birth. When adjusted for covariates in the multiple variable model, native mother, poor weight gain during pregnancy, female children, LBW, using complementary food and perceived child had poor health related to 6 months poor weight gain. In future, we may be to predict and improve those factors which are unique for parenting practices in Taiwan. |
