環境事件對臺灣試管嬰兒性別之影響-以嚴重急性呼吸道症候群(SARS)事件為例

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Title:	環境事件對臺灣試管嬰兒性別之影響-以嚴重急性呼吸道症候群(SARS)事件為例 Sex ratio of in-vitro fertilization offspring following the exogenous stressors : The case of severe acute respiratory syndrome (SARS) in Taiwan
Authors:	黃惠卿 Huang, Huei-Chin
Contributors:	公共衛生學系暨研究所黃雅莉
Keywords:	試管嬰兒;單胞胎;嚴重急性呼吸道症候群;外來壓力;性別比;妊娠週數 in vitro fertilization;singletons;population distress;the Severe Acute Respiratory Syndrome;sex ratio;gestational age
Date:	2014-07-11
Issue Date:	2019-09-10 10:23:26 (UTC+8)
Abstract:	研究背景：不孕症盛行率逐年增加，使用人工協助生殖技術治療相對變多。除了治療施術過程影響胎兒出生性別外，過去文獻顯示環境事件會影響ㄧ般新生兒的出生性別比，但對於使用人工協助生殖技術治療的產婦經歷環境事件是否影響出生性別比需要進一步探討。研究目的：探討臺灣使用夫妻精卵的試管嬰兒單胞胎出生性別比是否會受到2003年3月13日嚴重急性呼吸道症候群(SARS)事件影響。研究方法：本研究屬於以一群體為基礎的研究，使用臺灣衛生福利部國民健康署人工生殖資料庫，以開始用藥日期記錄1998年至2005年週期療程資料共46846筆週期。分析方法分為兩個部份，第一部份以使用時間序列的自我迴歸整合移動平均模式探討調整時間效應後，使用夫妻精卵的試管嬰兒經歷環境2003年3月13日SARS事件，單胞胎活產出生性別之影響，第二部份以線性迴歸探討調整其他影響因子，產婦孕期經歷環境因子2003年3月13日SARS事件，對單胞胎活產出生性別比之影響。結果：產婦胚胎植入時經歷SARS事件，在第四(2003年6月5日至7月2日)、第五(2003年7月3日至7月31日)個時間分組，出生性別比顯著增加。產婦妊娠中(17-24週)和晚期(29-40週)、第三孕期經歷SARS事件出生性別比下降，但沒有統計上顯著差異。不過調整其他影響因子後，產婦第三孕期經歷SARS事件，出生性別比顯著下降。結論：產婦經歷SARS事件，可能會出現急性心理壓力，體內產生壓力賀爾蒙，這些激素對於男胎影響比較大，可能進而造成男嬰出生勝算減少，而壓力減少後，胚胎植入的男嬰出生勝算增加。但相關機制仍需進一步的探討。 BACKGROUND: Previous research suggests that human sex ratio at birth (male/female, SRB) appears to be affected when natural and man-made disasters interrupt the community regular functions in general population. However, few studies have explored the relation between the exogenous stress and SRB of in-vitro fertilization (IVF) singletons. Our study evaluates the association between the Severe Acute Respiratory Syndrome (SARS) event in 2003 and the SRB of IVF-conceived singletons in Taiwan. METHODS: Data were collected electronically by using the ART registry database of the ART procedures performed from 1998 to 2005, submitted to the Health Promotion Administration, Ministry of Health and Welfare, Executive Yuan, Taiwan. There were 46,846 ART cycles performed in our population-based study. The gestational ages were estimated by embryo implantation date for analysis. Interrupted time –series methods, which control for secular trends, seasonality and other forms of auto correlation was applied to test the SARS effect on SRB per 28-day period in gestation during, or implanted immediately after the event. Regression models were employed to measure the impact of SARS exposure on SRB during various trimester of pregnancy with adjustment of potential confounding factors. RESULTS: The SRB exhibited no secular trends, seasonality and other patterns of auto correlation over time because of the absence of Box-Jenkins parameters in the test equations. The SRB which embryos implanted in time period 4 (from 5 June 2003 to 2 July 2003) and 5(from 3 July 2003 to 31 July 2003) increased significantly after the SARS exposure. A significant decline in the SRB in the third trimester of pregnancy was detected, as potential confounding factors were adjusted. CONCLUSION: We demonstrated elevated SRB which embryos implanted in time period 4 and 5 after the SARS exposure. Those were approximated time periods that the global public health emergency caused by SARS appears close to an end. Our study suggested that the SRB of IVF-conceived singletons declined as maternal exposure to an exogenous stressor late in the pregnancy. Further studies to investigate relevant mechanisms were required.
Description:	碩士指導教授-黃雅莉委員-白其卉委員-高森永
Data Type:	thesis
Appears in Collections:	[School of Public Health] Dissertations/Theses

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