한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제20권4호
  • /
  • Pages.320-328
  • /
  • 2019
  • /
  • 1975-4701(pISSN)
  • /
  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
권호 표지
DOI QR코드

DOI QR Code

국내 산모의 골밀도 현황 분석 : 일개 산부인과 전문병원중심으로

Analysis of Bone Mineral Density Status in Korean Mother : In the Center of One Obstetric Hospital

  • 투고 : 2019.01.30
  • 심사 : 2019.04.05
  • 발행 : 2019.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구는 출산한 산모를 대상으로 골밀도와 골밀도에 영향을 미치는 특성을 조사하여 출산 후 골다공증 예방을 위한 기초자료를 제공하고자 한다. 최종 137명의 의무기록을 분석한 서술적 조사연구이다. 대상자의 일반적, 산과적 특성에 따른 T-score의 차이는 independent t-test와 one way ANOVA로, 사후분석은 Scheffe test로 실시하였다. 연구 대상자들의 평균 연령은 32.4세였고 T-score 평균값은 0.34였다. 출산 후 4주째 측정한 BMI에서 저체중군은 정상군과 과체중군에 비해 골밀도가 유의하게 높게 나타났고(F=11.935, p<.001). 비타민 D가 충분한 대상자는 부족한 대상자보다 부족한 대상자는 결핍인 대상자보다 골밀도가 유의하게 높은 것으로 나타났다(F=4.906, p=0.009). 유산경험이 없는 경우가 1회 이상인 경우보다 골밀도가 유의하게 높은 것으로 나타났고(t=4.264, p<.001) 자연분만을 한 경우가 제왕절개수술을 한 경우보다 골밀도가 유의하게 높은 것으로 나타났다(t=2.019, p=.046). 본 연구 결과를 바탕으로 임신과 출산과정 중 골밀도에 영향을 미치는 특성을 바탕으로 출산한 산모의 골다공증 관리 예방프로그램개발이 필요할 것이다.

This study was conducted to provide basic data for prevention of osteoporosis by examining the factors affecting bone mineral density in pregnant mothers. This investigation was a descriptive research study that analyzed a total of 137 medical records. Differences in T-score between general and obstetric characteristics were assessed by independent t-tests and one way ANOVA followed by Scheffe's post-hoc test. The mean age of the subjects was 32.4 years and the mean T-score was 0.34. The BMI measured at 4 weeks after delivery was significantly higher in the underweight group than in the normal group and the overweight group (F=11.935, p<.001). The BMD was significantly higher in subjects with sufficient vitamin D than in subjects with insufficient vitamin D, in subjects with insufficient vitamin D than in subjects with deficiency vitamin D (F=4.906, P=0.009). BMD was significantly higher in cases without experience of abortion than those with more than one experience of abortion (t=4.264, p<.001), and the normal delivery was significantly higher than that of cesarean section (t= 2.019, p=.046). Based on the results of this study, it is necessary to actively prevent the factors affecting BMD during pregnancy and delivery. The findings presented herein can be used as basic data for the management of osteoporosis.

키워드

Table 1. General and obstetric characteristics.

SHGSCZ_2019_v20n4_320_t0001.png 이미지

Table 2. Bone mineral density.

SHGSCZ_2019_v20n4_320_t0002.png 이미지

Table 3. Different in bone mineral density by general and obstetric characteristics

SHGSCZ_2019_v20n4_320_t0003.png 이미지

참고문헌

  1. National Health Insurance, Quiet Thief[Osteoporosis], "1 out of 10 women in their 60s or older is sick", www.nhic.or.kr, 2016.
  2. M. H. Seong, S, H. Kwon, H. Y. Kim, J. S. Park, S. H. Lee, S. Y. choi & J. Y. Ha, "Maternal newborn nursing & women's health II", Soomoonsa, p.14, 2018.
  3. World Health Organization, "Assessment of fracture risk and its application to screening for postmenopausal osteoporosis", WHO Technical Report Series, Geneva, p.843, 1994.
  4. J. S. Moon & K. C. Won. "The diagnosis and treatment of osteoporosis", Yeungnam University, Journal of Medication, 25(1), p.19-30, 2008. https://doi.org/10.12701/yujm.2008.25.1.19
  5. Y. W. Moon, "The diagnosis of osteoporosis", Journal of the Korean Hip Society, 18(4), p.397-404, 2006.
  6. National Institutes of Health, "Consensus development panel on osteoporosis prevention, diagnosis, and therapy",The Journal American Medical Association, 94(6), p.785-795, 2001.
  7. The Korean Society of Bone Metabolism, "Physician's guide for diagnosis and treatment of osteoporosis", Seoul: Author, 2008.
  8. C. H. Yu, J. S. Lee, L. H. Lee, S. H. Kim, S. S. Lee, & I. K. Jung, "National factors related to bone mineral density in the different age groups of Korean women", The Korean Nutrition Society, 35, p.779-790, 2004.
  9. E. Y. Lee, "Lifestyle behaviors affecting bone mineral density in peri-menopausal women", Master's thesis, Ewha Womans University, Seoul, 2003.
  10. G. H. Kim, J. H. Lee & J. D. Yeo, "The bone mineral density impact factors of adult women before the menopause - based on the national health and nutrition examination survey", Journal of the Korean Society of Radiology, 9(3), p.147-168, 2015. https://doi.org/10.7742/jksr.2015.9.3.147
  11. Y. R. Kim, Y. S. Min, U. S. Jang, M. H. Nam, C. M. Chun, J. H. Chun & H. S. Sohn, "Improvements of behavior and attitude of pregnant women trained by a maternity-oriented antenatal education program : Assessment of Korean Gentle Birth (KGB) program", Journal Korean Society Maternal Child Health, 16(2), p.227-237, 2012. https://doi.org/10.21896/jksmch.2012.16.2.227
  12. HJ. Kalkwarf & BL. Specker, "Bone mineral changes during pregnancy and lactation", Endocrine, 17(1), p.49-53, 2002. DOI: http://doi.org/10.1385/ENDO:17:1:49
  13. A. J. Black, J. Topping, B. Durham, R.G. Farquharson, & W.D. Fraser, "A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy", Journal of Bone and Mineral Research, 15(3), p.557-563 2000. DOI: https://doi.org/10.1359/jbmr.2000.15.3.557
  14. Y. K. Choi, N. Y. Kim, J. M. Kim, M. S. Cho, B. S. Kang & Y. R. Kim, "Studies of nutrient composition of transitional human milk and estimated intake of nutrients by breast-fed infants in Korean mothers", Journal of Nutrition and Health, 48(6), p.476-487, 2015. DOI: http://dx.doi.org/10.4163/jnh.2015.48.6.476
  15. The Korean Society of Bone Metabolism, Committee for Practice Guidelines, "Physician's guide for diagnosis and treatment of osteoporosis", Seoul: The Korean Society of Bone Metabolism, 2010.
  16. Statistics Korea, Population Trend Survey(1993-2014). DOI: http://kostat.go.kr/wnsearch/search.jsp
  17. H. Y. Min & G. H. Jeong, "Advanced aged women's needs for pregnancy and childbirth care", Korean Journal Women Health Nursing, 21(4), p.332-341, 2015. DOI: http://dx.doi.org/10.4069/kjwhn.2015.21.4.332
  18. E. G. Kim, D. S. Hwang, J. M. Lee, C. H. Lee, J. B. Jang & K. S. Lee, "Investigation of clinical research of acupuncture treatment on hyperemesis gravidarum in medline", The Journal of Oriental Obstetrics and Gynecology, 25(4), p. 66-80, 2012. DOI: https://doi.org/10.15204/jkobgy.2012.25.4.066
  19. A. S. Laura, E. C. Mary, S. S. Kelly, P. Geraldine, F. Cynthia, B. P. Cheryl, M. Y. Stella & R. Deborah, "Prepregenancy body mass index and pregnancy weight gain: Association with preterm delivery", Obstestics & Gynecology, 96(2), p.194-200, 2000. DOI: https://doi.org/10.1016/S0029-7844(00)00883-8
  20. S. H. Kim & M. J. Park, "Management of childhood obesity", Journal of the Korean Medical Association, 60(3), p.233-241, 2017. DOI: https://doi.org/10.5124/jkma.2017.60.3.233
  21. J. S. Oh & M. S. Cho, "Comparison of eating habits based on weight gain during pregnancy: Centered on recommended standards of the institute of medicine, Journal Korean Diet Association, 17(2), p.99-117, 2011. https://doi.org/10.14373/JKDA.2011.17.2.099
  22. CM. Olson, "Achieving a healthy weight gain during pregnancy", Annual Review of Nutrition, 28, p.411-423, 2008. DOI: https://doi.org/10.1146/annurev.nutr.28.061807.155322
  23. E. Althuizen, MN. van Poppel, JC. Seidell, W, van Mechelon, "Correlates of absolute and excessive weight gain during pregnancy", Journal Womens Health, 18(10), p.1559-1566, 2009. DOI: https://doi.org/10.1089/jwh.2008.1275
  24. G. J. Jang & S. H. Kim, "Effects of breast-feeding education and support services on breast-feeding rates and infant's growth", Journal Korean Academy Nursing, 40(2), p.277-286, 2010. DOI: https://doi.org/10.4040/jkan.2010.40.2.277
  25. H. Y. Kim & Y. R. Heo, "Biochemical bone turnover markers, bone mineral density, and general characteristics in Korean women, Journal Korean Society Food Science Nutrition, 42(2), p.195-202, 2013. DOI: http://dx.doi.org/10.3746/jkfn.2013.42.2.195
  26. E. T. Choi & S. J. Lee, "The effect of postmenopausal program of osteoporosis protection exercise on the density of bone and the improvement of physical fitness of middle-age women", The Korean Journal of Physical Education, 42(5), p.727-734, 2003.
  27. Dargent-Molina, Poitiers, & Breart, "In elderly women weight is the best predictor of a very low bone mineral density: evidence from the EPIDOS study", Osteoporosis International, 11(10), p.881-888, 2000. https://doi.org/10.1007/s001980070048
  28. Y. H. Oh, "Association between hemoglobin level and bone mineral density in Korean adults", Master's thesis, Seoul National University College of Medicine, Seoul, 2014.
  29. S. G. Kim, D. C. Kweon & C. H. Oh, "A comparative study of Influencing BMD factors in postpartum and general women in their twenties and thirties", Journal of Radiological Science and Technology, 30(1), p.25-32, 2007.
  30. S. J. Jang, Y. M. Park, Y. E. Choi & K. H. Cho, "The correlation of bone mineral density and anemia in Korean older population", Korean Journal Clinical Geriatrics, 14(2), p.53-59, 2013.
  31. AC. Looker & ME. Mussolino, "Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults", Journal of Bone and Mineral Research, 23(1), p.143-150, 2008 DOI: http://doi.org/10.1359/JBMR.071003
  32. TL. Lash & AK. Fink, "Semi-automated sensitivity analysis to assess systematic errors in observational data", Epidemiology, 14(4), p.451-458, 2003. https://doi.org/10.1097/01.EDE.0000071419.41011.cf
  33. JP. Devogelaer, S. Goemaere, S. Boonen, JJ. Body, JM. Kaufman, JY. Reginster, S. Rozenberg & Y. Boutsen, "Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian bone club, Osteoporos Int., 17, p.8-19, 2006. DOI: https://doi.org/10.1007/s00198-005-2032-z
  34. E. J. Han, J. H. Yang, S. Y. Park, C. H. Lim, S. H. Kim, H. G. Yoon, Y. J. Han, S. W. Lee, H. M. Ryu & B. G. Park, "Vitamin D awareness and serum 25 (OH) D and serum TSH levels in pregnant women in Korea", The Korean Association of Internal Medicine, p.210, 2013.
  35. D. Liel, N. Atar & N. Ohana, "Pregnancy-associated osteoporosis: preliminary densitometric evidence of extremely rapid recovery of bone mineral density", South Med Journal, 91(1), p.33-35, 1998. https://doi.org/10.1097/00007611-199801000-00006
  36. S. Guven, C. Kart, E.H. Comert, H. Sal & E.S. Guvendag Guven, "Elective repeat caesarean delivery may affect bone mineral density compared with normal vaginal delivery", Journal of Obstetrics & Gynecology and Reproductive Biology, 219, p.131-136, 2017. DOI: https://doi.org/10.1016/j.ejoqrb.2017.10.005
  37. S. Christopher & Kovacs, "Calcium and bone metabolism in pregnancy and lactation", The Journal of Clinical Endocrinology & Metabolism, 86(6), p.2344-2348, 2001. https://doi.org/10.1210/jc.86.6.2344
  38. S. P. Jung & K. M. Lee, "Factors affecting to bone mineral density in postmenopausal women, The Yeungnam University Medication Journal, 13(2), p.261-269, 1996. https://doi.org/10.12701/yujm.1996.13.2.261
  39. H. J. Jeon, "Comparison of the nutritional status and life style by bone mineral density in postmenopausal women", Korean Society for Wellness, 9(4), p.239-250, 2014.
  40. H. J. Kang, Y. J. Kim, S. Y. Lee, J. G. Lee, Y. H. Yi, D. W. Jeong, Y. H. Cho, E. J. Choi, Y. J. Tak, H. R. Hwang, A. R. Jo, S. H. Lee, J. S. Jeon & J. H. Shin, "The association of bone mineral density and total duration of breastfeeding in postmenopausal women : The Korean National Health and Nutrition Examination Survey 2011", Korean Journal of Family Practice, 3(2), p.330-335, 2015.
  41. N. M. Chun, H. J. Chae, "Problems with bone health and the Influencing factors of bone mineral density in women across the life cycle", Korean Journal Women Health Nursing, 21(1), p.43-54, 2015. DOI: http://dx.doi.org/10.4069/kjwhn
  42. P. C. Jerilynn, A. K. Susan, J. Lawrence, K. Nancy, M. M. Timothy, A. H. David, D. A. Jonathan, M. V. Yvette, Claudie Berger, Lucie Blondeau, A. J. Stuart & Alan Tenenhouse, "Oral contraceptive use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study", Canadian Medical Association Journal, 165(8), p.1023-1029, 2001.
  43. J. O. Koo, H. S. Ahn, S. Y. Yoo, "Study of bone mineral density, body composition and dietary habits of 20-30 years women", Korean Journal Community Nutrition, 13(4), p.489-498, 2008.
  44. S. K. Kang, "Intake amount by food group and blood cadmium concentrations and bone mineral density in adults of age 30 years and above: The 5th National Health and Nutrition Survey (2010-2011)", Master's thesis, Keimoung University, Daegu, 2015.