WEIGHT GAIN DURING PREGNANCY ISASSOCIATED WITH URINARY INCONTINENCE AFTER ONE TO TWO YEARSPOSTPARTUM: A SECONDARY ANALYSIS NESTED IN A COHORT STUDY
P. S. MAGNANI 1, L.BRITO2, R. C. CAVALLI 3, A. A.MOURA-DA-SILVA 4, M. A. BARBIERI 5, H. BETTIOL5, A. A. NOGUEIRA 6;
1Ginecologiae Obstetrícia, Hosp. das Clínicas da Faculdade de Medic, RibeirãoPreto, Brazil, 2Gynecology and Obstetrics, Univ. ofCampinas, Campinas, Brazil, 3Ribeirao Preto Med. Sch.,Univ. of Sao P, Brookline, MA, 4Public Health, FederalUniv. of Maranhao, Sao Luis, Brazil, 5Pediatrics, RibeiraoPreto Med. Sch., Univ. of Sao Paulo, Ribeirao Preto, Brazil,6Ribeirao Preto Med. Scool: Univ. of, Ribeirao Preto - SP,Brazil.
Introduction: Urinaryincontinence (UI) during pregnancy and postpartum period is a commonfinding. However, most of the studies aimed to investigate UI duringpregnancy or only 12 months after delivery. Moreover, we do not knowif UI may vary according to cities with different socioeconomicsituations. Thus, it is important to emphasize that patients with UIare subject to a higher risk of permanent modifications afterdelivery.
Objective: To analyze the prevalence and thepossible risk factors for UI collected during antenatal and one totwo years postpartum period from data collected during a cohortstudy.
Methods: This secondary analysis (nested in a cohortstudy) was conducted in two Brazilian municipalities with differentsocioeconomic indicators. A total of 12,914 women were interviewed inboth cities during prenatal counseling and birth labor; 3,751 womenfrom Ribeirão Preto (RP) and 3,275 patients from São Luis (SL)returned from a total of 7,026 women during 2011/2012 to a follow-upconsultation. The presence of UI was the main outcome. A binomialregression model with univariate and multivariate estimates (onlyvariables with a p-value less than .10 were included) was adjusted toverify the association among covariables and the variable UI with thecalculation of the prevalence ratio (PR), with a significance levelof 5%.
Results: No statistically significant differenceswere seen between women who returned to consultation 1-2 yearspostpartum with the group of patients who did not. The prevalence ofUI after 12-24 months of postpartum was 16.25% in Ribeirão Preto and11.45% in São Luís (p<.001). In the former city, UI wasassociated with unemployed women (p=.006), diabetes mellitus(p=.004), gestational diabetes (p=.001), higher body mass index (BMI)(p=.011) and longer number of hours from internship to cesareansection (p=.014) were associated to UI. In São Luís, UI wasassociated with unplanned pregnancy (p=.011), higher parity (p=.038)and smaller familiar income (p=.041). A combined analysis from bothcities did not show a statistically significant association of UIwith educational level (p=.685), race (p=.070), age (p=.398),delivery hours (p=.431), birthweight (p=.867), head circumference(p=.795), being employed (p=.457), type of delivery (p=.355),episiotomy (p=.554), use of oxytocin (p=.595) and analgesia (p=.116).The following variables were statistically associated with thepresence of UI: carry weight with frequency (p=.016), tobacco use(p=.004), gravidity (p=.022), parity (p=.028), diabetes mellitus(p=.017), gestational diabetes (p<.001), higher weight gain duringpregnancy (p=.007) and higher BMI (p<0.001). Multivariate analysisshowed that only the weight gain during pregnancy remained stronglyassociated with UI in both cities (p=.018; PR 1.028 95% CI[1.005-1.051]).
Conclusions: Urinary incontinence after12-24 months postpartum presented a similar prevalence with theliterature, with a significant statistically difference betweenRibeirão Preto and São Luís. It is unknown why a moresocioeconomically developed city presented a higher UI percentage.Moreover, we showed that the weight gain during pregnancy is a strongpredictor of UI. Thus, we encourage the design of future prospectivestudies addressing this variable to strengthen the role of correctingthis variable aiming the primary prevention to UI.
References:1 - Eur Urol 2016; 70(1):148-58. 2 - BJOG 2016;123(6):1022-9. 3 -BJOG 2012;119(11):1334-43.