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Risk factors for stress and urge urinary incontinence during pregnancy and the first year postpartum: a prospective longitudinal study


Introduction and hypothesis

We examined obstetric and maternal-newborn factors and UI history for stress urinary incontinence (UI) and urge UI during pregnancy and the first year postpartum.


This prospective cohort study included 1447 pregnant women who underwent prenatal examinations and completed an Incontinence Questionnaire-Urinary Incontinence Short Form before pregnancy, during early, mid- and late pregnancy, and at five visits during the first year postpartum. Data were analyzed using univariate/multivariate generalized estimating equation (GEE) logistic regression analyses.


The prevalence rates of stress UI during late pregnancy (42.5%) and urge UI at 3–5 days postpartum (10.4%) were the highest throughout pregnancy and the first year postpartum. After adjusting for covariates, gestational age increased the risks of stress UI (p < 0.001) and urge UI (p = 0.003); stress UI during pre-pregnancy, number of previous vaginal deliveries and concurrent high body mass index (BMI) increased stress UI (all p < 0.05); urge UI during pre-pregnancy and full-time work increased urge UI (both p < 0.05) during pregnancy. During the postpartum period, vaginal delivery increased stress UI (p < 0.001) and urge UI (p = 0.041); stress UI during pre-pregnancy and pregnancy, women aged ≥ 30 years and vacuum extraction/forceps delivery increased stress UI (all p < 0.05). Urge UI during early, mid- and late pregnancy increased stress UI (all p < 0.05).


Gestational age increased stress and urge UI, while previous vaginal deliveries and high BMI increased stress UI; full-time work increased urge UI during pregnancy. Vaginal delivery increased both UIs, and vacuum/forceps delivery and maternal age increased stress UI during postpartum.

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  1. 1.

    Rogers RG, Ninivaggio C, Gallagher K, Borders AN, Qualls C, Leeman LM. Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study. Int Urogynecol J. 2017;28(11):1701–7.

    Article  Google Scholar 

  2. 2.

    Trivino-Juarez JM, Romero-Ayuso D, Nieto-Pereda B, Forjaz MJ, Criado-Alvarez JJ, Arruti-Sevilla B, Aviles-Gamez B, Oliver-Barrecheguren C, Mellizo-Diaz S, Soto-Lucia C, Pla-Mestre R. Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth. Women Birth. 2017;30(1):29–39.

    Article  Google Scholar 

  3. 3.

    Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2013;24(9):1473–9.

    Article  Google Scholar 

  4. 4.

    Chang SR, Chen KH, Lin HH, Lin MI, Chang TC, Lin WA. Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum. Obstet Gynecol. 2014;123(3):568–77.

    Article  Google Scholar 

  5. 5.

    Wesnes SL, Hannestad Y, Rortveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand. 2017;96(10):1214–22.

    Article  Google Scholar 

  6. 6.

    Rotar M, Trsinar B, Kisner K, Barbic M, Sedlar A, Gruden J, Vodusek DB. Correlations between the ICIQ-UI short form and urodynamic diagnosis. Neurourol Urodyn. 2009;28(6):501–5.

    Article  Google Scholar 

  7. 7.

    Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21(2):193–202.

    Article  Google Scholar 

  8. 8.

    Mason L, Glenn S, Walton I, Appleton C. The experience of stress incontinence after childbirth. Birth. 1999;26(3):164–71.

    CAS  Article  Google Scholar 

  9. 9.

    Perry S, McGrother CW, Turner K. An investigation of the relationship between anxiety and depression and urge incontinence in women: development of a psychological model. Br J Health Psychol. 2006;11(Pt 3):463–82.

    Article  Google Scholar 

  10. 10.

    Ng K, Cheung RYK, Lee LL, Chung TKH, Chan SSC. An observational follow-up study on pelvic floor disorders to 3-5 years after delivery. Int Urogynecol J. 2017;28(9):1393–9.

    Article  Google Scholar 

  11. 11.

    Kok G, Seven M, Guvenc G, Akyuz A. Urinary incontinence in pregnant women: prevalence, associated factors, and its effects on health-related quality of life. J Wound Ostomy Continence Nurs. 2016;43(5):511–6.

    Article  Google Scholar 

  12. 12.

    Dinç A. Prevalence of urinary incontinence during pregnancy and associated risk factors. Lower Urinary Tract Symptoms. 2018;10(3):303–7.

    Article  Google Scholar 

  13. 13.

    Siahkal SF, Iravani M, Mohaghegh Z, Sharifipour F, Zahedian M. Maternal, obstetrical and neonatal risk factors' impact on female urinary incontinence: a systematic review. Int Urogynecol J. 2020;31(11):2205–24.

    Article  Google Scholar 

  14. 14.

    Daly D, Clarke M, Begley C. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. Int Urogynecol J. 2018;29(3):353–62.

    Article  Google Scholar 

  15. 15.

    Slavin V, Creedy DK, Gamble J. Benchmarking outcomes in maternity care: Peripartum incontinence - a framework for standardised reporting. Midwifery. 2020;83:102628.

    Article  Google Scholar 

  16. 16.

    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.

    Article  Google Scholar 

  17. 17.

    Chang SR, Chen KH, Chang TC, Lin HH. A Taiwanese version of the international consultation on incontinence questionnaire—urinary incontinence short form for pregnant women: instrument validation. J Clin Nurs. 2011;20(5-6):714–22.

    Article  Google Scholar 

  18. 18.

    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.

    Article  Google Scholar 

  19. 19.

    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    Article  Google Scholar 

  20. 20.

    Okunola TO, Olubiyi OA, Omoya S, Rosiji B, Ajenifuja KO. Prevalence and risk factors for urinary incontinence in pregnancy in Ikere-Ekiti. Nigeria Neurourol Urodyn. 2018;37(8):2710–6.

    CAS  Article  Google Scholar 

  21. 21.

    Beck RP, McCormick S, Nordstrom L. Intraurethral-intravesical cough-pressure spike differences in 267 patients surgically cured of genuine stress incontinence of urine. Obstet Gynecol. 1988;72(3 Pt 1):302–6.

    CAS  PubMed  Google Scholar 

  22. 22.

    Chapple CR, Manassero F. Pathophysiology of stress incontinence. In: Raz S, Rodríguez LV, editors. Female urology. Elsevier Saunders; 2008. p. 301–9.

  23. 23.

    Groutz A. Pregnancy, childbirth, and pelvic floor injury. In: Raz S, Rodríguez LV, editors. Female urology. Elsevier Saunders; 2008. p. 533–41.

  24. 24.

    Tahtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cardenas JL, El Dib R, Joronen KM, Al Juaid S, Kalantan S, Kochana M, Kopec M, Lopes LC, Mirza E, Oksjoki SM, Pesonen JS, Valpas A, Wang L, Zhang Y, Heels-Ansdell D, Guyatt GH, Tikkinen KAO. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol. 2016;70(1):148–58.

    Article  Google Scholar 

  25. 25.

    Arrue M, Ibanez L, Paredes J, Murgiondo A, Belar M, Sarasqueta C, Diez-Itza I. Stress urinary incontinence six months after first vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):210–4.

    Article  Google Scholar 

  26. 26.

    Tahtinen RM, Cartwright R, Vernooij RWM, Rortveit G, Hunskaar S, Guyatt GH, Tikkinen KAO. Long-term risks of stress and urgency urinary incontinence after different vaginal delivery modes. Am J Obstet Gynecol. 2019;220(2):181.e181–8.

    Article  Google Scholar 

  27. 27.

    Glazener CM, Herbison GP, MacArthur C, Lancashire R, McGee MA, Grant AM, Wilson PD. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG. 2006;113(2):208–17.

    CAS  Article  Google Scholar 

  28. 28.

    Ruiz de Vinaspre Hernandez R, Rubio Aranda E, Tomas Aznar C. Urinary incontinence and weight changes during pregnancy and post partum: a pending challenge. Midwifery. 2013;29(12):e123–9.

    Article  Google Scholar 

  29. 29.

    Wesnes SL, Hunskaar S, Bo K, Rortveit G. Urinary incontinence and weight change during pregnancy and postpartum: a cohort study. Am J Epidemiol. 2010;172(9):1034–44.

    Article  Google Scholar 

  30. 30.

    Rortveit G, Hunskaar S. Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol. 2006;195(2):433–8.

    Article  Google Scholar 

  31. 31.

    Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592–604.

    Article  Google Scholar 

  32. 32.

    Faisal I, Matinnia N, Hejar AR, Khodakarami Z. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery. 2014;30(2):227–33.

    CAS  Article  Google Scholar 

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This study was supported by a grant from the Ministry of Science and Technology of Taiwan. The authors thank MS. Yi-Wen Wang for data collection.

Author information




SR Chang: Project development, data collection and management, manuscript writing.

WA Lin: Data management and analysis.

TC Chang: Data collection and manuscript preparation.

HH Lin: Data collection and manuscript preparation.

CN Lee: Data collection and manuscript preparation.

MI Lin: Manuscript preparation.

Corresponding author

Correspondence to Shiow-Ru Chang.

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Chang, SR., Lin, WA., Chang, TC. et al. Risk factors for stress and urge urinary incontinence during pregnancy and the first year postpartum: a prospective longitudinal study. Int Urogynecol J 32, 2455–2464 (2021).

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  • Childbirth
  • Pregnancy
  • Stress UI
  • Urinary incontinence
  • Urge UI