本研究主要探討妊娠糖尿病篩檢與孕婦和新生兒週產期併發症之關聯性分 析。目前國內糖尿病人口日益增加，妊娠糖尿病作為第二型糖尿病的危險因子 之外，其對於懷孕婦女在懷孕期間所衍生的併發症以及對新生兒不良妊娠照護 成果有很大的影響，其中包括母親罹患妊娠高血壓、子癲前症，新生兒不良妊 娠照護成果包括巨嬰、先天性缺陷、肩難產、第一分鐘 Apgar score 小於七分和 第五分鐘 Apgar score 小於七分等。
本研究以全民健保資料庫 2016-2019 年第一胎且為單胎懷孕婦女作為本次研 究對象，排除產前已有糖尿病的孕婦後並其中孕前沒有糖尿病母親在懷孕期間 有做妊娠糖尿病篩檢的有 378285 人，沒有做妊娠糖尿病篩檢的有 257580 人， 而其中有篩檢的母親中共有 10500 位母親有妊娠糖尿病。另外有妊娠糖尿病的 母親中在第一孕期有做妊娠糖尿病篩檢的有 4419 位，第二孕期做篩檢的有 2094 位，第三孕期做篩檢的有 3987 位，而沒有罹患妊娠糖尿病則有 625635 位。
本次研究發現孕婦年齡以及擁有肥胖、多囊性卵巢症候群、心臟疾病、腎臟 疾病會提高孕婦妊娠糖尿病篩檢意願。在控制干擾變數後，有妊娠糖尿病的母 親相對沒有妊娠糖尿病的母親其罹患妊娠高血壓(OR=6.88)和子癲前症 (OR=4.46)的風險顯著增加，並且除第五分鐘 Apgar Score 小於七分外其發生不 良妊娠照護成果的風險皆顯著增加。此外，本研究亦發現在第二孕期為參考組 的情況下，相較於低風險的妊娠糖尿病孕婦，高風險的妊娠糖尿病孕婦第一孕 期篩檢罹患子癲前症的風險會增加。
而在控制干擾變數後另外在第二孕期作為參考組的情況下，低風險的孕婦其新 生兒第一分鐘 Apgar Score 小於七分的的勝算比為(OR= 0.89)，擁有高風險因子 的妊娠糖尿病孕婦在第三孕期篩檢其新生兒第一分鐘 Apgar Score 小於七分的勝 算比為 (OR= 1.02)，顯示在第三孕期篩檢高風險組孕婦比低風險組其新生兒第一分鐘 Apgar Score 小於七分的風險會增加。但整體而言，在第三孕期被篩檢出 妊娠糖尿病孕婦其新生兒第一分鐘 Apgar Score 小於七分的風險會相對第二孕期 被篩檢出擁有妊娠糖尿病孕婦要顯著降低。
此外本研究結果發現，對比第二孕期，高風險孕婦在三孕期篩檢其新生兒有先天性缺陷的風險比低風險孕婦來得高，對於未來臨床上照護時，應建議高風險婦女應儘早接受篩檢，並在確定其罹患妊娠糖尿病後加以介入治療，將治療期拉長後或許能降低其新生兒有先天性缺陷的問題產生。因此未來探討是否該在不同時期篩檢時，本研究亦提供相關結果供未來臨床上的參考。

This study aimed to investigate the association between gestational diabetes mellitus (GDM) screening and perinatal complications in pregnant women and newborns. With the increasing prevalence of diabetes in Taiwan, GDM has become a significant risk factor for pregnant women, leading to various complications during pregnancy and adverse outcomes for newborns. These complications include maternal gestational hypertension, preeclampsia, macrosomia, congenital anomalies, shoulder dystocia, and Apgar scores below seven at one and five minutes after birth.
The study included first-time, singleton pregnant women from 2016 to 2019, excluding those with preexisting diabetes. Among the eligible subjects, 378,285 received GDM screening during pregnancy, while 257,580 did not undergo screening. Among those screened, 10,500 were diagnosed with GDM. Additionally, among women with GDM, 4,419 underwent screening in the first trimester, 2,094 in the second trimester, and 3,987 in the third trimester. The remaining 625,635 pregnant women did not have GDM. The findings revealed that maternal age, obesity, polycystic ovary syndrome, heart disease, and kidney disease increased the willingness of pregnant women to undergo GDM screening. After controlling for confounding variables, mothers with GDM had significantly higher risks of developing gestational hypertension (OR=6.88) and preeclampsia (OR=4.46) compared to those without GDM. Moreover, the risk of adverse perinatal outcomes significantly increased in mothers with GDM, except for Apgar scores below seven at five minutes after birth. Furthermore, compared to low- risk GDM pregnant women, high-risk GDM pregnant women had an increased risk of developing preeclampsia if screened in the first trimester.
In the context of controlling for confounding variables, using the second trimester as the reference, high-risk GDM pregnant women had an increased risk of having newborns with Apgar scores below seven at one minute after birth if screened in the third trimester. However, overall, the risk of Apgar scores below seven at one minute after birth was significantly lower in GDM pregnant women detected through screening in the third trimester compared to those detected in the second trimester (OR=0.67).
Furthermore, the study revealed that high-risk pregnant women were at a higher risk of having neonates with congenital defects than low-risk women when screened during the third trimester compared to the second trimester. Consequently, for future clinical care, it is recommended that high-risk pregnant women undergo early screening and receive intervention after GDM diagnosis. Prolonged intervention may reduce the incidence of congenital defects in newborns. Thus, this study provides valuable insights for future clinical considerations when determining optimal screening timing.

論文審定書.........................................................................................i
中 文 摘 要......................................................................................ii
英 文 摘 要.....................................................................................iv
目 錄..............................................................................................vi
圖 次.............................................................................................viii
表 次...............................................................................................ix
第一章 緒論....................................................................................................... 1
第一節 研究背景................................................................................................1
第二節 研究動機................................................................................................2
第三節 研究問題................................................................................................3
第二章 文 獻 探 討..............................................................................................4
第一節 糖尿病分類與診斷................................................................................4
第二節 妊娠糖尿病高危險因子.........................................................................9
第三節 妊娠糖尿病相關併發症與不良妊娠照護成果...................................13
第四節 妊娠糖尿病篩檢....................................................................................15
第五節 文獻總結...............................................................................................18
第三章 研 究 方 法.............................................................................................19
第一節 研究架構.................................................................................................19
第二節 研究假說.................................................................................................20
第三節 資料處理與研究對象篩選....................................................................22
第四節 資料來源與研究變項說明.....................................................................26
第五節 分析方法................................................................................................33
第四章 研 究 結 果..............................................................................................38
第一節 研究對象之人口學及高風險因子特徵分佈.........................................38
第二節 妊娠糖尿病篩檢因素行為分析.............................................................47
第三節 有無妊娠糖尿病母親其妊娠併發症與新生兒不良照護成果分析.....51
第四節 不同篩檢時期其妊娠併發症與新生兒不良照護成果分析.................58
第五章 討論與研究限制.....................................................................................74
第一節 研究假說結果........................................................................................74
第二節 研究結果探討........................................................................................80
第三節 研究應用................................................................................................84
第四節 研究限制.................................................................................................85
第六章 結論與建議.............................................................................................87
第一節 結論........................................................................................................87
第二節 研究貢獻.................................................................................................88
第三節 研究建議.................................................................................................89
參考文獻 ............................................................................................................ 90

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