São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; Educational Foundation of the Municipality of Assis (FEMA), Department of Medical School, Assis, Brazil.
São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2023 Nov;290:5-10. doi: 10.1016/j.ejogrb.2023.09.007. Epub 2023 Sep 11.
Gestational Diabetes Mellitus (GDM) and many other clinical variables have been associated with postpartum urinary incontinence (UI). However, the data are still restricted, and no study explored early- or late-onset GDM as a risk factor for this condition. We aimed to identify independent risk factors for postpartum UI, focusing on GDM and its early or late onset.
A nested case control derived from the Diamater cohort study included 517 pregnant women who submitted to a planned C-section and followed by 6-18 months after delivery according to the timing of GDM diagnosis: early-onset GDM (before 20 weeks) and late-onset GDM(24-28 weeks) and the occurrence of UI.
Univariate analysis showed that the risk for 6-18 months postpartum UI was 49% higher in non-Caucasian ethnicity (1.49,1.02-2.18), 3,3 times higher in previous bariatric surgery [3.37,1.36-8.21], 39% higher in GDM women (1.39,1.01-1.93), and 5% higher for each BMI score in prepregnancy (1.05, 1.03-1.08) and at the end of pregnancy (1.05,1.02-1.08). Multivariate logistic regression analysis indicates that prepregnancy BMI was the only independent factor associated with the 6-18 months postpartum UI (adj 1.05, 95 %CI 1.02-1.08, P <.001). After stratifying, a second univariate and multivariate analysis were done according to the prepregnancy BMI cutoff score of 25. Thus, a significant association between GDM and postpartum UI in prepregnancy overweight women (RR: 1.91; 95 %CI 1.25-2.90, P =.003) and no association between GDM and 6-18 months postpartum UI in normal prepregnancy BMI (RR: 0.78, 95 %CI 0.39-1.54, P =.482) were found. After multivariate regression, the early-onset-GDM remained the unique independent adjusted risk factor for 6-18 months postpartum UI analysis (adjRR 2.15, 95 %CI 1.33-3.46, P =.002).
After a planned C-section, we observed a 6-18 months postpartum UI higher occurrence after GDM, either in early-onset GDM or late-onset GDM. In addition, being overweight (BMI > 25) among women with early-onset GDM was associated with postpartum UI.
妊娠糖尿病（GDM）和许多其他临床变量与产后尿失禁（UI）有关。然而，数据仍然有限，没有研究探讨早发或晚发 GDM 是否是这种情况的危险因素。我们旨在确定产后 UI 的独立危险因素，重点关注 GDM 及其早发或晚发。
一项嵌套病例对照研究来自 Diamater 队列研究，包括 517 名接受计划剖宫产的孕妇，并在产后 6-18 个月进行随访，根据 GDM 诊断时间：早发 GDM（<20 周）和晚发 GDM（24-28 周）和 UI 的发生情况。
单因素分析显示，非白种人种族（1.49，1.02-2.18）发生 6-18 个月产后 UI 的风险增加 49%，既往减肥手术（3.37，1.36-8.21）增加 3.3 倍，GDM 女性增加 39%（1.39，1.01-1.93），孕前 BMI 每增加一个评分（1.05，1.03-1.08）和孕晚期（1.05，1.02-1.08）分别增加 5%。多因素逻辑回归分析表明，孕前 BMI 是与产后 6-18 个月 UI 相关的唯一独立因素（调整后 1.05，95%CI 1.02-1.08，P<.001）。分层后，根据孕前 BMI 截断值为 25 进行了第二次单因素和多因素分析。因此，在孕前超重的女性中，GDM 与产后 UI 之间存在显著关联（RR：1.91；95%CI 1.25-2.90，P=.003），而在正常孕前 BMI 中，GDM 与产后 6-18 个月 UI 之间无关联（RR：0.78，95%CI 0.39-1.54，P=.482）。多因素回归后，早发 GDM 仍然是产后 6-18 个月 UI 分析的唯一独立调整风险因素（调整 RR 2.15，95%CI 1.33-3.46，P=.002）。
在接受计划剖宫产的女性中，我们观察到 GDM 后，无论是早发 GDM 还是晚发 GDM，6-18 个月产后 UI 的发生率更高。此外，早发 GDM 中体重超重（BMI>25）与产后 UI 相关。
