Arch Gynecol Obstet. 2021.doi: 10.1007/s00404-021-06134-3.
Urinary incontinence (UI) refers to the symptoms, signs, urodynamic manifestations or diagnosis of involuntary leakage of urine, which can have a serious impact on patients’ quality of life. Pregnancy, especially the first childbirth, not only has the greatest impact on the UI mechanism, but is also related to the high incidence and risk of new or long-term UI. Epidemiological studies of UI during pregnancy have shown multiple potential factors for the occurrence of postpartum UI. While certain risk factors such as age, race, fetal size/weight and diseases may not be modifiable, others such as obesity, smoking, gestational weight gain and delivery style do. By increasing understanding of UI risk factors, physicians can educate/advise patients to avoid modifiable risk factors before and during pregnancy and provide targeted interventions when necessary.
Most pregnancy-related UI studies have limited follow-up. The objectives of this study were to determine the incidence of UI in a large cohort of primiparous women before and during pregnancy and over the course of 30-months postpartum, and to identify risk factors for UI during and after pregnancy.
Nulliparous women aged 18-35 years with singleton pregnancies were interviewed in their third trimester and asked about urinary incontinence before and during pregnancy (n = 3001). After delivery these women were interviewed at 1, 6, 12, 18, 24 and 30-months postpartum and asked about urinary incontinence occurring in the month prior to each interview. Multivariable logistic regression models identified risk factors for UI during pregnancy and during the follow-up period.
Results showed that in general 4% reported having urinary incontinence before pregnancy and 36.8% during pregnancy. The strongest predictor of urinary incontinence during pregnancy was urinary incontinence before pregnancy (adjusted OR 13.11, 95% CI 7.43-23.13). Among the women with no subsequent pregnancies, the rate of urinary incontinence increased from 12.5% at 6-months postpartum to 27.4% at 30-months postpartum, 52.1% reported UI at one or more postpartum data collection stages, and the strongest predictors of postpartum UI were UI before pregnancy (adjusted OR 3.95 (95% CI 1.60-9.75) and during pregnancy (adjusted OR 4.36, 95% CI 3.24-5.87).
The findings of this study suggest that primiparous women who report UI before and during pregnancy should be monitored for the continuation or worsening of UI over the course of the first 2-3 years postpartum, and treatment options discussed.