Prevalence and factors associated with the occurrence of urinary incontinence during pregnancy

Santini, Ana Carolina Monteiro; Santos, Elisiane Souza; Vianna, Luana Schneider; Bernardes, João Marcos; Dias, Adriano

doi:10.1590/1806-93042019000400013

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (4) • Oct-Dec 2019 • https://doi.org/10.1590/1806-93042019000400013 copy

Prevalence and factors associated with the occurrence of urinary incontinence during pregnancy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to determine the prevalence of urinary incontinence (UI) during pregnancy, to identify and quantify the factors associated with gestational UI.

Methods:

a cross-sectional study carried out with women admitted for deliveries in all maternity wards in the city of Botucatu (São Paulo). Data were collected through a structured questionnaire, based on the literature, containing questions about the occurrence of UI, its types, risk factors and moments when urinary losses occurred. Associations between UI and the predictive variables were analyzed with logistic regression models.

Results:

950 women were interviewed, out of which 472 complained of urinary losses during pregnancy, resulting in a prevalence of 49.68% (CI95%= 46.51 - 52.86). The majority (61.8%) were classified as mixed UI. Among the covariates investigated, smoking (OR= 4.56), illicit drugs use (OR= 25.14), stimulant foods (OR= 1.84), constipation (OR=1.99), hypertensive disorders during gestation (OR= 3.23), gestational diabetes mellitus (OR= 2.89), parity (OR= 1.52) and previous caesarean sections (OR= 2.56) increased the chance of urinary losses during pregnancy.

Conclusions:

there was a high prevalence of UI during pregnancy. This condition was strongly associated with lifestyle habits and gestational morbidities. Finally, it is worth high-lighting the fact that delivery via caesarean section increased the chance of UI in subsequent pregnancies.

Key words
Pregnancy; Urinary incontinence; Epidemiology; Risk factors

	Continent (n=478) X ± D		Incontinent (n=472)		p^ * Student's t-test;*
	X̅ ± SD		X̅ ± SD		p^ * Student's t-test;*
Age (years)	25.14 ± 5.83		26.95 ± 5.81		0.433
Pre-gestational BMI (kg/m²)	26.33 ± 5.92		26.69 ± 6.41		0.565
Gestational BMI (kg/m²)	29.48 ± 6.11		29.77 ± 6.01		0.413
Pre-gestational weight (kg)	64.86 ± 13.14		65.84 ± 14.16		0.621
Final weight during pregnancy (kg)	76.34 ± 14.07		77.95 ± 15.56		0.488
Current gestation weight gain (kg)	11.69 ± 6.45		11.37 ± 6.24		0.149
	N	%	N	%	p ^ Chi-square test; BMI= body mass index.
Skin color					0.012
White	342	71.5	371	78.6
Non-white	136	28.5	101	21.4
Marital status					0.601
Has partner	402	84.1	391	82.8
No partner	76	15.9	81	17.2
Works outside the home					0.043
No	314	65.7	280	59.3
Yes	164	34.3	192	40.7
Family income (minimum wages)					<0.001
Up to 1	167	34.9	79	16.6
1-2	259	54.2	350	74.2
2-3	41	8.6	38	8.1
3 or more	11	2.3	5	1.1

	n	%	% acum
Urinary incontinence type
Urge	30	6.4	6.4
Stress	150	31.8	38.2
Mixed	292	61.8	100.0
Gestational trimester of onset of incontinence
1^st trimester	60	12.7	12.7
2^nd trimester	82	17.4	30.1
3^rd trimester	330	69.9	100.0
Loss amount
Small	175	37.1	37.1
Considerable	227	48.1	85.2
Large	70	14.8	100.0
Loss frequency
Daily	76	16.1	16.1
Once a Week	191	40.5	56.6
Several times a week	205	43.4	100.0
Loss situation ^* * Each incontinent woman may report multiple loss situations.
Laughter	288	61.0	-
Coughing	350	74.2	-
Sneezing	336	71.2	-
Carrying weights	75	15.9	-
Jumping	7	1.5	-
Small efforts	60	12.7	-
Intercourse	81	17.2	-
Sleeping	137	29.0	-
While feeling like urinating	248	52.5	-
Going to the bathroom	178	37.7	-
Upon hearing sound of water	19	4.0	-
Hand contact with water	17	3.6	-
Foot contact with water	1	0.2	-
Without noticing	194	41.1	-

	OR	CI95%	p
Age (years)	1.055	1.031 - 1.079	<0.001
Pre-pregnancy BMI (kg/m²)	1.011	0.989 - 1.031	0.364
Gestational BMI (kg/m²)	1.008	0.987 - 1.029	0.463
Pre-gestational weight (kg)	1.005	0.996 - 1.015	0.268
Final weight during pregnancy (kg)	1.007	0.999 - 1.016	0.095
Weight gain in current pregnancy (kg)	0.992	0.972 - 1.012	0.432
Skin color (non-white ref.)	0,685	0.509 - 0.921	0.012
Physical activity	0.907	0.638 - 1.289	0.586
Smoking	3.389	2.551 - 4.504	<0.001
Alcohol consumption	491	0.295 - 0.817	0.006
Use of illicit drugs	4.861	1.382 - 16.953	0.014
Stimulant food consumption	1.633	0.094 - 2.738	0.063
Intestinal constipation	1.688	1.271 - 2.242	<0.001
Previous SAH	0.218	0.133 - 1.359	0.284
GHD	2.689	1.803 - 4.009	<0.001
DM1	0.000	0.00	1.000
Previous DM2	1.695	0.403 - 7.134	0.472
GDM	2.592	1.514 - 4.441	0.001
UTI	1176	0.906 - 1.527	0.223
Previous abdominal surgery	0.000	0.00	1.000
Abortions	1.145	0.814 - 1.611	0.437
Parity	1.417	1.251 - 1.607	<0.001
Delivery method (vaginal ref.)	1.507	1.125 - 2.018	0.006
NB weight (current pregnancy)	1.252	1.093 - 1.434	0.001

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[1] Authors' contribution

Santini ACM participated in the elaboration of protocol / project, data collection and management and writing/editing of the manuscript. Santos ES e Vianna LS performed data collection and management and writing/editing of the manuscript. Bernanrdes JM worked in the data analysis and writing/editing of the manuscript. Dias A participated in the elaboration of development of protocol/project, data analysis and writing/editing of the manuscript. All authors approved the final version of the article.