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Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study

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Introduction and hypothesis

We describe pelvic floor function in nulliparous pregnant women.

Materials and methods

Nulliparous midwifery patients completed the Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire (PFIQ-7), Wexner Fecal Incontinence Scale (W), and answered questions about sexual activity and perineal pain at baseline during the first (T1), second (T2), or third trimester (T3) and repeated in late T3. They also underwent a Pelvic Organ Prolapse Quantification (POP-Q) exam at their baseline visit. Data were compared across trimesters. Analysis of variance (ANOVA) and logistic regression accounted for repeated measures and was controlled for age and education.


We recruited 627 women. In T1, 124 women gave baseline data and completed questionnaires; in T2, 403; and in early T3, 96 (496 repeated questionnaires in later T3). Besides an increase in genital hiatus and perineal body (all adjusted p < .05), physical exam measures did not differ between trimesters. As pregnancy progressed, urinary incontinence (UI) (T1 = 33, T2 = 44, T3 = 69% women with ISI >0, all comparisons p < .02) and Incontinence Impact Questionnaire (IIQ-7) scores increased. Fecal incontinence (FI) increased (T1 = 8, T2 = 15, T3 = 16% from T2 to T3, p = .04); the Colorectal–Anal Impact Questionnaire (CRAIQ-7) scores did not. Perineal pain increased (T1 = 17, T2 = 18 and T3 = 40%, all adjusted p < .001), and sexual activity decreased (T1 = 94, T2 = 90, T3 = 77% sexually active, T1 vs T3 and T2 vs T3, p < .001) as pregnancy progressed.


During pregnancy, women experience worsening UI, FI, and perineal pain. UI symptoms are associated with a negative impact on quality of life (QoL). Sexual activity decreased and POP-Q stage did not change.

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Correspondence to Rebecca G. Rogers.

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This project was supported (in part or in full) by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), 1R01HD049819-01A2, and by the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health, grant 8 UL1TR001449.

Conflicts of interest

RG Rogers: UptoDate royalties, travel, lodging and stipends from IUGA, ABOG and ACOG. C Ninivaggio: Travel and lodging, food and beverage for AUGS Fellows’ course, travel and lodging for course sponsored by Medtronic. K Gallagher, AN Borders, C Qualls, and LM Leeman declare no conflicts of interest.

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Rogers, R.G., Ninivaggio, C., Gallagher, K. et al. Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study. Int Urogynecol J 28, 1701–1707 (2017).

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