From the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Womens Hospital of UPMC.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute.
Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):e436-e441. doi: 10.1097/SPV.0000000000000955.
Postpartum urinary incontinence estimates range from 13% to 47%. Clinical factors associated with incontinence 1 year after first delivery are varied. We assessed the prevalence of and factors associated with urinary incontinence in primiparous women at 12 months postpartum.
Ancillary analysis of 99 nulliparous women from a prospective cohort study that assessed participants during the first and third trimesters and 12 months postpartum. Our primary outcome was urinary incontinence 12 months postpartum. Women were asked "How often do you experience urine leakage?" and considered to have urinary incontinence if a response other than "never" was reported. We collected vaginal swabs for assessment of matrix metalloproteinase-9 activity, a measure of tissue remodeling. Bivariable and logistic regression analyses were used to compare women with and without postpartum urinary incontinence.
Of 99 primiparous women, 55% (n = 54) reported urinary incontinence at 12 months postpartum. Logistic regression demonstrated that urinary incontinence during pregnancy (odds ratio, 34.3; 95% confidence interval, 7.9-149.2) and a decrease in matrix metalloproteinase 9 activity between the first and third trimesters (odds ratio, 19.34; 95% confidence interval, 3.47-107.84) were associated with postpartum urinary incontinence. The sensitivity and specificity of urinary incontinence during pregnancy for predicting postpartum urinary incontinence were 87% and 67%, respectively. The positive and negative predictive values were 76% and 81%, respectively.
Urinary incontinence affected 55% of primiparous women at 12 months postpartum. Urinary incontinence during pregnancy was strongly associated with postpartum incontinence. Importantly, vaginal tissue protease activity during pregnancy represents a possible mechanism for and biomarker of postpartum urinary incontinence.
产后尿失禁的估计范围为 13%至 47%。与首次分娩后 1 年失禁相关的临床因素各不相同。我们评估了初产妇产后 12 个月时尿失禁的患病率和相关因素。
对一项前瞻性队列研究中的 99 名初产妇进行了辅助分析，该研究在第一和第三孕期以及产后 12 个月评估了参与者。我们的主要结局是产后 12 个月时的尿失禁。询问女性“您多久会出现漏尿？”如果报告的回答不是“从不”，则认为女性患有尿失禁。我们采集阴道拭子用于评估基质金属蛋白酶-9 活性，这是组织重塑的一种衡量指标。使用双变量和逻辑回归分析比较产后尿失禁的女性和无尿失禁的女性。
在 99 名初产妇中，55%（n=54）在产后 12 个月时报告尿失禁。逻辑回归表明，妊娠期间的尿失禁（优势比，34.3；95%置信区间，7.9-149.2）和第一至第三孕期之间基质金属蛋白酶 9 活性下降（优势比，19.34；95%置信区间，3.47-107.84）与产后尿失禁相关。妊娠期间尿失禁预测产后尿失禁的敏感性和特异性分别为 87%和 67%。阳性和阴性预测值分别为 76%和 81%。
产后 12 个月时，55%的初产妇患有尿失禁。妊娠期间的尿失禁与产后尿失禁密切相关。重要的是，妊娠期间阴道组织蛋白酶活性代表了产后尿失禁的可能机制和生物标志物。
