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Natural history of urinary incontinence from first childbirth to 30-months postpartum

  • General Gynecology
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Abstract

Purpose

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.

Methods

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

Overall, 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).

Conclusion

Our findings 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.

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Data availability

The First Baby Study datasets are available from the principal investigator, Kristen Kjerulff, khk2@psu.edu.

Code availability

Not applicable.

Abbreviations

UI:

Urinary incontinence

FBS:

First Baby Study

UTI:

Urinary tract infection

OR:

Odds ratio

CI:

Confidence interval

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Funding

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, R01 HD052990.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA

    Krishna Patel, Jaime B. Long, Sarah S. Boyd & Kristen H. Kjerulff

Authors
  1. Krishna Patel
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  2. Jaime B. Long
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  3. Sarah S. Boyd
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  4. Kristen H. Kjerulff
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Contributions

KP: Manuscript writing. JL: Manuscript writing, editing. SB: Manuscript editing. KK: protocol/project development, data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Jaime B. Long.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethics approval

This study received all required approvals from the Penn State College of Medicine Institutional Review Board (IRB), as well as the IRB’s of all hospitals and organizations involved with participant recruitment.

Consent to participate

Written and signed informed consent was obtained from all individual participants included in this study.

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Not applicable.

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Appendix 1

Appendix 1

Urinary incontinence questions asked in the First Baby Study.

Asked in the baseline interview, third trimester of pregnancy

Q1. During your pregnancy, how often have you experienced any amount of accidental urine loss?

2 or more times a day

1

 =  > Q2

Once a day

2

 =  > Q2

2 or more times a week

3

 =  > Q2

Once a week

4

 =  > Q2

1–3 times per month

5

 =  > Q2

Never

6

 =  > Q3

Don’t know

8

 =  > Q3

Declined to answer

9

 =  > Q3

Q2. How much urine do you usually lose each time, drops, small splashes or more?

Drops

1

Small splashes

2

More

3

Do not know

8

Declined to answer

9

Q3. Before you became pregnant, how often did you experience any amount of accidental urine loss?

2 or more times a day

1

Once a day

2

2 or more times a week

3

Once a week

4

1–3 times per month

5

Never

6

Don't know

8

Declined to answer

9

Asked in the 1-month postpartum interview

Q1. Since your delivery, how often have you experienced any amount of accidental urine loss?

2 or more times a day

1

Once a day

2

2 or more times a week

3

Once a week

4

1–3 times per month

5

Never

6

Don't know

8

Declined to answer

9

Asked at 6, 12, 18, 24, and 30-months postpartum

Q1. In the past month, how often have you experienced any amount of accidental urine loss?

2 or more times a day

1

 =  > Q2

Once a day

2

 =  > Q2

2 or more times a week

3

 =  > Q2

Once a week

4

 =  > Q2

1–3 times per month

5

 =  > Q2

Never

6

 =  > Q3

Do not know

8

 =  > Q3

Declined to answer

9

 =  > Q3

Q2. How much urine do you usually lose each time, drops, small splashes or more?

Drops

1

Small splashes

2

More

3

Don't know

8

Declined to answer

9

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Patel, K., Long, J.B., Boyd, S.S. et al. Natural history of urinary incontinence from first childbirth to 30-months postpartum. Arch Gynecol Obstet 304, 713–724 (2021). https://doi.org/10.1007/s00404-021-06134-3

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