基于全孕周期数据的产后压力性尿失禁危险因素分析

Analysis of risk factors for postpartum stress urinary incontinence based on full pregnancy cycle data

摘要

目的 了解产妇产后压力性尿失禁(SUI)的发病率,探索导致产后SUI发生的危险因素。方法 纳入2021年1月至2021年12月在杭州市妇产科医院产检、分娩、并于产后6~8周回院随访的1627名产妇作为研究对象,根据其有无SUI分为SUI组(n=276)和正常组(n=1351),采用调查问卷收集产妇一般临床资料、压力性尿失禁相关情况,分析导致产后SUI发病的危险因素。结果 产后SUI的发病率为16.9%,单因素分析发现产妇年龄、基础体重、基础BMI、新生儿出生体重、孕中期体重、孕中期BMI、孕中期腹围、孕中期高密度脂蛋白胆固醇水平、分娩方式与产后SUI相关(t/χ²值为3.000、2.974、2.894、2.143、2.883、3.096、2.905、3.096和11.399,P<0.05).多因素分析发现孕中期腹围(OR=1.027,95%CI:1.005~1.051)、分娩年龄(OR=1.050,95%CI:1.008~1.091)、孕中期高密度脂蛋白胆固醇(OR=0.660,95%CI:0.450~0.971)与产后SUI相关,其中孕中期腹围及分娩年龄为产后SUI发病的危险因素。结论 产妇分娩年龄、孕中期腹围是产后SUI的危险因素,孕中期高密度脂蛋白是产后SUI的保护因素.适龄妊娠分娩、定期进行盆底肌肉训练、控制孕期体重增加等可以降低SUI的发生率.

Abstract

Objective To understand the incidence of postpartum stress urinary incontinence (SUI) among postpartum women and identify the risk factors for postpartum SUI. Methods A total of 1,627 postpartum women who underwent prenatal care, delivery, and follow-up visits at 6-8 weeks postpartum at Hangzhou maternity hospital from January 2021 to December 2021 were selected as the study subjects. They were divided into two groups based on the presence or absence of SUI: the SUI group (n=276) and the normal group (n=1351). A questionnaire was used to collect general clinical data and information related to stress urinary incontinence. Risk factors for postpartum SUI were analyzed. Results The incidence of postpartum SUI was 16.9%. Univariate analysis revealed that maternal age, baseline weight, baseline BMI, neonatal birth weight, second trimester weight, second trimester BMI, second trimester abdominal circumference, second trimester HDL cholesterol levels, and mode of delivery were associated with postpartum SUI (t/χ² values were 3.000, 2.974, 2.894, 2.143, 2.883, 3.096, 2.905, 3.096 and 11.399, respectively, all P<0.05). Multivariate analysis showed that second trimester abdominal circumference (OR=1.027, 95%CI: 1.005-1.051), delivery age (OR=1.050, 95%CI: 1.008-1.091), and second trimester HDL cholesterol (OR=0.660, 95%CI: 0.450-0.971) were associated with postpartum SUI. Among them, second trimester abdominal circumference and delivery age were identified as risk factors for the development of postpartum SUI. Conclusion Maternal delivery age and second trimester abdominal circumference are risk factors for postpartum SUI, while second trimester HDL cholesterol is a protective factor. Appropriate age for pregnancy and delivery, regular pelvic floor muscle training, and controlling weight gain during pregnancy can help reduce the incidence of SUI.

关键词

尿失禁 / 产后 / 危险因素

Key words

urinary incontinence / postpartum / risk factor

参考文献

[1] Caruso F B, Schreiner L, Todescatto A D, et al. Risk factors for urinary incontinence in pregnancy: a case control study[J]. Rev Bras Ginecol Obstet, 2020, 42(12): 787-792.

[2] Imamura M, Williams K, Wells M, et al. Lifestyle interventions for the treatment of urinary incontinence in adults[J]. Cochrane Database Syst Rev, 2015, 2015(12): CD003505.

[3] Hu T W, Wagner T H, Bentkover J D, et al. Costs of urinary incontinence and overactive bladder in the United States: a comparative study[J]. Urology, 2004, 63(3): 461-465.

[4] Milsom I, Gyhagen M. The prevalence of urinary incontinence[J]. Climacteric, 2019, 22(3): 217-222.

[5] Wang K, Xu X, Jia G, et al. Risk factors for postpartum stress urinary incontinence: a systematic review and meta-analysis[J]. Reprod Sci, 2020, 27(12): 2129-2145.

[6] 马丹, 马巧媛. 产后尿失禁的发生现状及影响因素分析[J]. 中国临床医生杂志, 2021, 49(7): 853-856.

[7] Diez-Itza I, Zubikarai M, Galan C, et al. Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery[J]. Neurourol Urodyn, 2020, 39(6): 1849-1855.

[8] 库小霞. 产后尿失禁发生现状及影响因素的研究[D]. 锦州医科大学, 2019.

[9] Witkos' J, Hartman-Petrycka M. Will future doctors know enough about stress urinary incontinence to provide proper preventive measures and treatment? [J]. Med Educ Online, 2019, 24(1): 1685635.

[10] Rajavuori A, Repo J P, Häkkinen A, et al. Maternal risk factors of urinary incontinence during pregnancy and postpartum: a prospective cohort study[J]. Eur J Obstet Gynecol Reprod Biol X, 2022, 13: 100138.

[11] Burgio K L, Borello-France D, Richter H E, et al. Risk factors for fecal and urinary incontinence after childbirth: the childbirth and pelvic symptoms study[J]. Am J Gastroenterol, 2007, 102(9): 1998-2004.

[12] Gao J, Liu X, Zuo Y, et al. Risk factors of postpartum stress urinary incontinence in primiparas: what should we care[J]. Medicine (Baltimore), 2021, 100(20): e25796.

[13] Soto González A, Bellido D, Buño M M, et al. Predictors of the metabolic syndrome and correlation with computed axial tomography[J]. Nutrition, 2007, 23(1): 36-45.

[14] Wang Y, Simpson J A, Wluka A E, et al. Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study[J]. Arthritis Res Ther, 2009, 11(2): R31.

[15] Li Y, Zhang Z. Association between waist-to-height ratio and postpartum urinary incontinence[J]. Int Urogynecol J, 2017, 28(6): 835-843.

[16] Townsend M K, Curhan G C, Resnick N M, et al. BMI, waist circumference, and incident urinary incontinence in older women[J]. Obesity (Silver Spring), 2008, 16(4): 881-886.

[17] Noblett K L, Jensen J K, Ostergard D R. The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry[J]. Int Urogynecol J Pelvic Floor Dysfunct, 1997, 8(6): 323-326.

[18] Mack L R, Tomich P G. Gestational diabetes: diagnosis, classification, and clinical care[J]. Obstet Gynecol Clin North Am, 2017, 44(2): 207-217.

[19] Ströher R L M, Sartori M G F, Takano C C, et al. Metabolic syndrome in women with and without stress urinary incontinence[J]. Int Urogynecol J, 2020, 31(1): 173-179.

[20] Kovanecz I, Gelfand R, Sharifzad S, et al. Evaluation of the in vitro damage caused by lipid factors on stem cells from a female rat model of type 2 diabetes/obesity and stress urinary incontinence[J]. Int J Mol Sci, 2020, 21(14): 5045.

[21] 董霞. 不同分娩方式对产后尿失禁及盆底肌肉功能的影响[J]. 新疆医科大学学报, 2019, 42(7): 911-915.

[22] Hage-Fransen M A H, Wiezer M, Otto A, et al. Pregnancy-and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: a systematic review and meta-analysis[J]. Acta Obstet Gynecol Scand, 2021, 100(3): 373-382.

基金资助

国家卫生健康委员会科研基金(WKJ-ZJ-2215)