Risk and protective factors for pregnancy-related urinary incontinence until 1 year postpartum: A cohort study using patient-reported outcome measures in Italy

ObjectiveTo investigate the epidemiology of pregnancy-related urinary incontinence (UI) and the related risk factors, focusing also on women's characteristics related to maternity pathway utilization. MethodsIn this prospective cohort study, we used patient-reported data obtained from the systematic survey on the maternity pathway that all pregnant women in Tuscany, Italy, can join. We selected 8410 women who completed-between March 2019 and November 2022-all five follow-up questionnaires from the first trimester until 12 months postpartum, each including a UI-specific patient-reported outcome measure. We performed panel regression models to explore the related risk factors. ResultsPrevalence of UI was 4.4% at the first trimester, 23.7% at the third trimester, and 15.6%, 12.6%, and 12.4% at 3, 6, and 12 months postpartum. UI occurrence and severity were higher in older, overweight/obese, and unemployed women. High-risk pregnancy and discomfort during pregnancy were risk factors. Receiving a cesarean section reduced the risk, while spontaneous tears, episiotomy, and high birth weight increased it. Women who experienced delays in pregnancy examinations because of long waiting times and women who had planned pregnancy had a higher risk, while performing during-pregnancy pelvic-floor-muscle training was protective. ConclusionBesides confirming the classic risk and protective factors for UI, we also found novel determinants related to the proper maternity pathway utilization.

Automated summary

This prospective cohort study aimed to investigate the epidemiology of pregnancy-related urinary incontinence (UI) and its related risk factors, with a focus on women's characteristics related to maternity pathway utilization. The study utilized patient-reported data obtained from a systematic survey conducted in Tuscany, Italy. The results showed that the prevalence of UI ranged from 4.4% in the first trimester to 23.7% in the third trimester. Older, overweight/obese, and unemployed women had a higher occurrence and severity of UI. Factors such as high-risk pregnancy, discomfort during pregnancy, mode of delivery, and pregnancy examinations were found to be associated with the risk of UI. Performing pelvic-floor-muscle training during pregnancy was found to be protective against UI.