Risk factors for urinary incontinence (UI) in primiparous women before, during and after pregnancy: early findings from the MAMMI (Maternal health And Maternal Morbidity in Ireland) study UI strand

Context and background: Urinary incontinence (UI) affects up to one in three women postpartum, but prevalence and risk factors are unknown in the Irish setting. Aim: To identify the prevalence and risk factors for UI in... [ view full abstract ]

Context and background: Urinary incontinence (UI) affects up to one in three women postpartum, but prevalence and risk factors are unknown in the Irish setting.

Aim: To identify the prevalence and risk factors for UI in primiparous women before, during and after pregnancy.

Research methodology: This UI strand is part of the MAMMI study, a multi-strand, multi-centre mixed methods study with 2800 primiparous women using self-administered surveys antenatally and at 3 and 6 months postpartum, data collection from hospital records and interviews with a sample of the women who experience UI. Ethical approval was granted by the university and site hospitals. The study began in February 2012.

Key findings: Analyses of data from 860 women who completed the antenatal survey and from 582 women who completed all 3 surveys (antenatally and at 3 and 6 months postpartum) show that prevalence of UI (i.e. leaking urine at least once per month) was 7.2% before pregnancy, 17.7% in pregnancy, 31.5% at 3, and 20.9% at 6 months postpartum.

Significant risk factors for pre-pregnancy UI were childhood enuresis or being obese (BMI ≥30kg/m2). Pregnancy risk factors were age ≥35 years or being overweight (BMI 25-29.99kg/m2).

Risk factors for reporting UI at 3 or 6 months postpartum were reporting UI during pregnancy, age 30-34 years, being underweight (BMI <18.5kg/m2) or being obese.

Women who had an operative vaginal birth, irrespective of the type, were more likely to report UI when compared with women birthing spontaneously without epidural anaesthesia. Women who had an in-labour caesarean section were less likely to report UI.

Conclusion: Routine antenatal care offers several opportunities for promoting continence in all women but particularly in those with identifiable risk factors. If enquiry about UI, and advice on preventative and curative treatments became routine, some of these women might become or stay continent.