| 摘要: | 背景：人工流產與自然流產是常見的孕期經歷，且流產經驗會對後續懷孕雙親心理狀態與小孩出生結果產生不良健康影響，但目前研究在探討小孩出生結果時，較少考慮父親相關因子影響，且大多研究針對過去流產經驗對後續懷孕母親負面症狀的影響，鮮少探討過去流產經驗對父親與正向心理健康的影響，並考慮胎次的修飾作用。
研究目的：本研究以長期追蹤研究設計分析(一)探討台灣孕婦自然流產與人工流產的現況；(二)探討過去流產次數對後續懷孕新生兒出生結果的影響；(三)探討過去流產經驗對後續懷孕雙親心理健康的影響；(四)探討胎次是否為過去流產經驗與後續懷孕雙親心理健康關係間之修飾因子。
研究方法：台灣孕產期建康追蹤研究自2011年起於台北市與新北市立意選取五間教學醫院與醫學中心合作之婦產科門診進行收案，邀請母親及其伴侶一同參與研究計畫，本研究使用此計畫中1813對伴侶之資料，包含基線測量(懷孕17週以前)與懷孕中期、懷孕後期、產後一個月、產後六個月、產後一年共七次追蹤調查問卷資料。受試者於問卷中填寫母親過去流產經驗、小孩出生結果與心理健康狀況等，並使用多元邏輯斯回歸、線性回歸、線性混和模型與廣義估計方程式進行統計分析。
研究結果：研究發現過去有兩次以上自然流產經驗的母親早產的風險較高(OR=3.47,95%CI=1.25–9.61)；在心理健康方面，過去有人工流產經驗的母親，孕產期憂鬱的風險較低(OR=0.66,95%CI=0.49–0.89)，在胎次分層下，伴侶懷第二胎以上的父親，若伴侶過去有自然流產經驗，孕產期憂鬱風險(OR=1.60,95%CI=1.13–2.27)與焦慮分數(β=1.83,95%CI=0.21–3.46)較高、幸福感分數(β=-1.09,95%CI=-1.99–-0.19)較低，若伴侶過去有人工流產經驗，父親孕產期憂鬱風險較高(OR=1.54,95%CI=1.02–2.33)。
結論：過去流產經驗會影響伴侶後續懷孕心理健康與新生兒出生結果，建議宣導流產風險相關資訊，並在衛教時同時納入雙親進行心理衛生宣導，並建議家人及親友不論孕期或產後給予有反覆自然流產經驗的母親與父親更多的關心與陪伴，並提供各方面的支持降低雙親對於不良出生結果的恐懼與害怕，在正向心理健康促進方面，可以提供相關書籍、文章、課程與宣導影片，讓孕產期雙親學習保持正向的技巧。未來研究建議可以針對正向心理健康與父親角色做進一步探討，並更詳盡收集流產相關資訊進行分析，也可以探討有哪些中介因子，未來可以針對其擬定介入與預防政策。
Background: Termination of pregnancy (abortion) and miscarriage are common in pregnant women to possibly yield negative impact on parental mental health and child birth outcomes in subsequent pregnancy. Most studies have focused on examining effects of previous fetal loss experiences on maternal negative mental status, while few studies on birth outcomes have considered the effects from paternal factors. Furthermore, few studies assessed the effects on paternal and positive mental health with simultaneous consideration of potential modifying effects of parity.
Objectives: This longitudinal study aimed at examining (1) current picture of termination of pregnancy and miscarriage during pregnancy in Taiwan; (2) the effects of previous fetal loss experiences on birth outcomes; (3) the effects of previous fetal loss experiences on parental prenatal and postpartum mental health (both positive and negative); and (4) the potential modifying effects of parity and infant’s sex on the association between fetal loss experiences and parental prenatal and postpartum mental health.
Methods: This study utilized the data from Longitudinal Examination across Prenatal and Postpartum Health in Taiwan (LEAPP-HIT), which invited pregnant women and their partners to participate if they receive early prenatal care (<17 gestational weeks) at five selected hospitals in Taipei and New Taipei City. In this study, 1813 couples completed the survey including questions on maternal fetal loss experiences, child birth outcomes, and parental mental health in early pregnancy, mid pregnancy, late pregnancy, 1-month postpartum, 6-months postpartum, and 1-year postpartum. We used the multiple logistic regression, multiple linear regression, mixed effects model, and generalized estimating equations for analyses.
Results: We found that after considering important covariates, the risks of preterm delivery were significantly higher among women with more than two previous miscarriages, compared with those without fetal loss experiences (adjusted odds ratio [AOR]=3.47; 95% confidence interval [CI]=1.25~9.61). For mothers, compared with women without fetal loss history, those with history of termination were less likely to experience higher prenatal and postnatal depression (adjusted odds ratio [AOR]=0.66; 95% confidence interval [CI]=0.49~0.89). For fathers, compared with men whose partner had no fetal loss history, those of partners with history of termination were more likely to experience higher prenatal and postnatal depression (adjusted odds ratio [AOR]=1.60; 95% confidence interval [CI]=1.13~2.27), as well as increased levels of perinatal and prenatal anxiety (adjusted β=1.83, 95% confidence interval [CI]=0.21 – 3.46) and decreased levels of eudaimonia (adjusted β=-1.09, 95% confidence interval [CI]=-1.99 – -0.19), specifically among partners of multiparous women.
Conclusion: This study found that fetal loss experiences may impact negatively on child birth outcomes and parental mental health in subsequent pregnancy. We suggested to disseminate the information of risks on birth outcomes and parental mental health after fetal loss experiences to parents in health education. In addition, more resources, caring, accompany, and support should be provided to both mothers and their partners with recurrent miscarriage experiences to reduce their emotional disturbances (e.g., fear, anxiety, depression) in prenatal and postpartum periods. For positive mental health promotion, books, articles, classes, and video should be provided for improving skills for positive mental health practice. Future study should collect more information on fetal experience and assess the potential mediated factor for intervention and preventive policies planning and implementation. |
