肥満妊婦の妊娠リスク認知と行動に関する研究  [in Japanese] A Study of Perinatal Period Risk Recognition and Behavior with Special Reference to the Over Weight in Pregnant Women  [in Japanese]

目的:妊婦の肥満は周産期リスクと強い関連がある.体重管理は日常の生活スタイルに左右されると考えられ,妊婦の認知と行動の分析が必要である.本研究は,肥満妊婦と非肥満の妊婦はリスク認知ならびに生活行動に違いがあるという仮説を検証した.方法:妊娠12週から出産前までの妊婦110名を対象とした.妊婦のリスク認知と生活行動を評価するPregnancy Behavior Scale(PBS)を用い,質問紙調査ならびに個人面接を行った.非妊娠時body mass indexと妊娠中の体重増加量をもとに,妊婦の生活行動とリスク認知の関係を分析した.結果:PBSの因子分析の結果,生活行動として,医療と連帯した生活行動,緊急時対処法の理解,妊娠考慮した日常生活の3尺度を得た.リスク認知として,楽観視・慎重視の2尺度を得た.非肥満の妊婦と比較し,肥満妊婦は妊娠リスクに楽観視を示した(p<0.001).また,妊娠中の体重増加量高群と比較し,低群は高率に保健指導を受けていた(p<0.05).体重増加量低群と比較し中群・高群は本や雑誌から情報収集している率が高かった(p<0.05).結論:本研究では,肥満妊婦と非肥満の妊婦はリスク認知や生活行動に違いがあることを明らかにした.専門家は妊婦に対し適切な情報提供を行い,生活改善のために情報を活用させる必要性が示唆された.

Background: Overweight in pregnant women is strongly associated with several perinatal risks. Health guidance focusing on weight control is of interest for reducing perinatal risks. In the present study, we hypothesized that awareness of perinatal risks and health-promoting behaviors in daily life are different between overweight and normal weight pregnant women. Method: One hundred and ten pregnant women from 12 to 40 weeks who did not show severe complications (mean age, 30.7±4.6 years) participated and completed an original questionnaire "Pregnancy Behavior Scale (PBS)" which consists of 10 items for risk recognition and 20 items for health promotion on pregnancy. Results of PBS were confirmed by a personal interview. Subcales for PBS in overweight subjects (body mass index ≧24 at baseline, n=17) or in excess weight gain subjects (increase in over 0.27kg/week, n=33) were compared with those in normal weight subjects (n=93) or in normal (0.17 to 0.27kg/week, n=47) and low (less than 0.17kg/week, n=30) weight gain subjects. Results: Factor analyses of PBS revealed that 2 subscales from risk recognition and 3 subscales from health promotion were classified. Each subscales demonstrated good internal consistency (Cronbach's alpha, from 0.54 to 0.94). A score of optimism on risk recognition in overweight subjects showed significantly higher than that in normal weight subjects (p<0.001). On the other hand, a score of adherence to health guidance on health promotion in excess weight gain subjects was significantly lower compared with that in low weight gain subjects (P<0.05). Conclusion: PBS is a valid and reliable instrument for assessing thought and behaviors in pregnant women. Overweight pregnant women are likely to neglect perinatal risks and health promotion. These results suggest that pregnant women should require health guidance focusing on weight control to reduce perinatal risks.