보고서 정보
주관연구기관 |
성균관대학교 SungKyunKwan University |
연구책임자 |
한정열
|
참여연구자 |
조성일
,
양재혁
,
류현미
,
김문영
,
안현경
|
발행국가 | 대한민국 |
언어 |
한국어
|
발행년월 | 2003-01 |
주관부처 |
보건복지부 |
사업 관리 기관 |
성균관대학교 SungKyunKwan University |
등록번호 |
TRKO200300003020 |
DB 구축일자 |
2013-04-18
|
초록
▼
본 연구에서 기초하는 이론적 모형은 북미의 Teratogen information services의 working method이며, 이는 임신초기에 흡연, 음주, 약물 등의 위 험인자의 노출된 임신부에게 수동적 정보제공(Passive information)으로 관련 문헌 탐색과 생식독성 데이터베이스 (Reprotox)를 활용하여 임신부에게 직접 구두로 정보를 제공하거나 인터넷 상담의 경우 인터넷을 통한 정보를 제공한다. 또한 능동적 정보제공(Pro-active information) 으로 임신부의 인구학적 특성 및 폭로의 종류와 량
본 연구에서 기초하는 이론적 모형은 북미의 Teratogen information services의 working method이며, 이는 임신초기에 흡연, 음주, 약물 등의 위 험인자의 노출된 임신부에게 수동적 정보제공(Passive information)으로 관련 문헌 탐색과 생식독성 데이터베이스 (Reprotox)를 활용하여 임신부에게 직접 구두로 정보를 제공하거나 인터넷 상담의 경우 인터넷을 통한 정보를 제공한다. 또한 능동적 정보제공(Pro-active information) 으로 임신부의 인구학적 특성 및 폭로의 종류와 량등에 관해 데이터베이스에 입력하고 다시 출산 후 추적관찰을 통해 특정 위험 요인과 임신결과와의 연관성을 평가하고 학술지를 통한 보고와 대중들에게 계획임신과 임신 중 환경적 인자와 관련된 교육 활동을 시행한다.
따라서, 본 연구의 내용 및 범위는 임신초기 임신을 인식하지 못한 상태에서 흡연, 알코올, 약물 그리고 방사선등에 노출된 임신부에게 적절한 정보를 제공함으로써 불필요한 임신중절을 예방하고 태아기형에 대한 불안을 감소시키며, 이들 임신부들의 노출에 대한 기초 조사와 출산 후 추적관찰에 따른 각 노출과 선천성기형과의 연관성을 평가하는 것이다.
Abstract
▼
This study is a preliminary investigation for the establishment of Teratogen Information Services(TIS) in Korea. We surveyed 1,246 cases from September 1999 to October 2002. The cases were derived from the out-patient department(OPD) of Samsung Cheil hospital and the Internet counseling site for une
This study is a preliminary investigation for the establishment of Teratogen Information Services(TIS) in Korea. We surveyed 1,246 cases from September 1999 to October 2002. The cases were derived from the out-patient department(OPD) of Samsung Cheil hospital and the Internet counseling site for unexpected-pregnant women exposed to smoking, alcohol, medicinal drugs, radiation. Then, we assessed the perceptive anxiety for congenital malformations, tendency to terminate the pregnancy, and the physician's recommendation on termination of pregnancy, the rate of pregnancy termination and the association between exposure to risk factors during early pregnancy and congenital anomaly, through the prospective study.
The results show that pregnant women who smoked during early pregnancy were about 10% among the counseled. The pregnant women, on the average, smoked 7 cigarettes of tobacco a day and the last exposure time was about 7 weeks of pregnancy. Concerning alcohol, about 30% of pregnant women drank alcohol, on the average,1.8 ounces at a time and the last exposure time to alcohol was about 5 weeks of pregnancy.
About 15% of the counseled women were exposed to radiation with an average exposure dose of about 385 mrem. The most frequent causes of radiation exposure were chest and dental examinations.
Among the counseled pregnant women, about 90% were exposed to medicinal drugs. The most frequent causes for medication were common colds and skin problems. Drugs for the gastrointestinal system and analgesics were most frequently used.
The perceptive risk of major malformations on their fetus and their score on the visual analogue scale to terminate the pregnancy was 39%, about 3.5, respectively. After evidence-based teratogenic risk counseling, their perceptive risk of major malformations was decreased to about 13% and their score on the visual analogue scale to 1.2, respectively.
In the OPD counseling, about 90% were followed-up and about 60% were followed-up in the Internet counseling. Among them, about 500 pregnant women (about 50%) delivered their fetus, about 7.5 % terminated their pregnancy, about 7% aborted their fetus spontaneously and about 33% are pregnant at present. About 19% had been recommended termination of pregnancy by other medical providers.
After counseling, the frequency of actual termination of pregnancy was decreased to about 7% (P<0.05). Through OPD counseling,7.3% terminated pregnancy. Also, after Internet counseling, 8.5% terminated pregnancy. They are not significantly different in the rate of termination of pregnancy following OPD and Internet counseling(P=0.61).
Among pregnant women exposed to risk factors, the occurrence of major malformations was 19/558 (3.4%) and congenital malformations including minor anomalies was 39/558(7.0%,). Also. the occurrence of major malformations was 37/1,167 (3.2%) in unexposed pregnant women. Thus there was not a statistical difference between them in univariate analysis(p>0.05).
In multivariate logistic regression analysis considering age, past history of spontaneous abortion and occupation, there was not a statistical difference between the exposed and the unexposed group: smoking (OR=0.574, 95% CI: 0.073-4538), alcohol (OR= 1.153, 95% Cl=0.440-3023). medicinal drugs (OR = 1.130,95% Cl: 0.519-2458) and radiation (OR=1.119, 95% Cl: 0.386-3729).
In the analysis of the association between major malformations and multi-risk factors, MX(medicinal drugs+x-ray) was only marginally significant. Also, in multivariate logistic regression analysis considering age, past history of spontaneous abortion and occupation, MX was the only statistically significant variable, Adj.OR= 3.007,95% CI: 1.006-8991).
In conclusion, this study showed that the exposure to risk factors such as smoking, drinking alcohol, medicinal drugs, and radiation during early pregnancy had an effect on pregnant women to cause increased anxiety about fetal malformations and unnecessary terminations of the pregnancy. In addition, there was no significant difference in the occurrence of congenital malformations between the exposed and the non-exposed pregnant women to risk factors.
Therefore, these results are a fundamental data for the education and public information of physicians and public health providers in order to promote national health. furthermore, this study can be used for the preliminary investigation to introduce an evidence-based counseling technique for pregnant women exposed to the risk factors, to develop a Korean database for teratogenic risk counseling, and to introduce Teratology information services in Korea.
목차 Contents
- 제 1 장 서론...16
- 제 1 절 연구의 필요성...16
- 제 2 절 연구의 목표...18
- 제 3 절 연구의 내용 및 범위...20
- 제 2 장 국내외 연구의 현황...22
- 제 3 장 연구의 수행 내용 및 결과...25
- 제 1 절 연구방법...25
- 1. 연구대상...25
- 2. 연구조사방법...26
- 3. 통계적분석...30
- 제 2 절 연구결과...31
- 1. 인구학적 특성과 위험요인 노출실태 조사...31
- 2. 임신초기 위험요인 노출에 따른 자각상태 조사...42
- 3. 연구군에서 임신경과와 임신중절에 관한 상담 효과...46
- 4. 선천성기형의 평가...50
- 제 3 절 연구결과 고찰 및 정책적 제언...59
- 1. 연구의 요약 및 고찰...59
- 2. 정책건의 및 향후 연구방향...62
- 제 4 장 연구목표 달성도 및 대외 기여도...64
- 제 5 장 연구결과의 활용계획...66
- ※참고문헌...69
- 부록...72
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