Risk of urinary incontinence after childbirth: a 10-year prospective cohort study.

Abstract

OBJECTIVE:

To estimate prospectively the effect of first delivery on subjective bladder function and to assess the influence of subsequent deliveries and obstetric events

METHODS:

We performed a prospective, observational cohort study. During a 10-week period in 1995, 304 of 309 eligible primiparous women (98%) entered the study at the postpartum maternity ward and completed a bladder function questionnaire. The 10-year observational period was completed by 246 of 304 subjects (81%).

RESULTS:

Prevalence of moderate-severe stress urinary incontinence increased from 5 of 304 subjects (2%) at baseline to 27 of 229 (12%) at 10 years follow-up (P < .001). Prevalence of moderate-severe urinary urgency increased from 0 subjects (0%) at baseline to 31 of 229 (13%) at the 10-year follow-up (P < .001). The relative risk (RR) (adjusted for maternal age and parity) of moderate to severe urinary incontinence increased significantly 10 years after first delivery (RR 5.8, 95% confidence interval [CI] 1.2-33.7). At multivariable analysis adjusted for age and parity, stress urinary incontinence symptoms at 9 months and 5 years follow-up were independently associated with the presence of symptoms at 10 years after index delivery (RR 13.3, 95% CI 3.9-33.1 and RR 14.1, 95% CI 2.5-18.8, respectively). Number of vaginal deliveries or other obstetric covariates did not affect the risk of stress urinary incontinence or urinary urgency.

CONCLUSION:

Vaginal delivery is independently associated with a significant long-term increase in stress urinary incontinence symptoms, as well as urinary urgency, regardless of maternal age or number of deliveries.

LEVEL OF EVIDENCE:

II-2.

• Authors: Daniel Altman, Asa Ekström, Catharina Gustafsson, Annika López, Christian Falconer, Jan Zetterström
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 108 Issue 4 Pg. 873-8 (Oct 2006) ISSN: 0029-7844 [Print] United States
• PMID: 17012448 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Cohort Studies
• Delivery, Obstetric (adverse effects)
• Female
• Humans
• Multivariate Analysis
• Parity
• Pregnancy
• Regression Analysis
• Risk Factors
• Urinary Bladder (injuries)
• Urinary Incontinence, Stress (epidemiology, etiology)