The Epidemiologic Study Of Primipara With Urinary Incontinence In China

BACKGROUNDAs the development of society and requirement for high life quality, female urinary incontinence (UI) has become the worldwide health problem for women and affects the quality of life directly. There are three types of urinary incontinence including stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence. Stress urinary incontinence is the most common condition. Large-scale investigations have been conducted in many countries. In 2006 an multicentric epidemiologic study on urinary incontinence in Chinese adult women was done and the results showed that the prevalence rate of UI, SUI, UUI and MUI was 39.9%, 18.9%,2.6% and 9.4%, respectively. The most common type in all was SUI which was 61% in constituent ratio. Meanwhile, in the analysis of risk factors, the first correlation factor was vaginal delivery (OR=3.891). Because pregnancy and delivery is an inevitable process in majority women, the study for primipara with urinary incontinence is imperative. A few countries have conducted the study on primipara with urinary incontinence. Different studies have shown inconsistent results, mainly due to the differences of the study population (UI condition before pregnancy and age), the follow-up periods before/after delivery, the ascertainment methods and the medical conditions. Epidemiologic feature refer to many aspects such as definition, etiology, factors related to onset, distribution and detrimental effects for individual and society. Comprehension about the epidemiologic feature of primipara with urinary incontinence related to pregnancy/delivery can provide the evidence of prevention. Especially these data is limited in our country; a large-sample multi centric prospective cohort study should be conducted based on previous cross-sectional study. The data could be provided to prevent the urinary incontinence of primipara during the pregnancy and postpartum and provide epidemiological data for the further research of UI in ChinaOBJECTIVE1. To investigate the incidence rate and constituent ratio of different types of UI in Chinese primipara during pregnancy.2. To investigate the incidence rate, prevalence rate, constituent ratio and remission rate of different types of UI i n Chi nese pri mi para at 6 weeks postpartum.3. To investigate the incidence rate, prevalence rate, constituent ratio and remission rate of different types of UI i n Chi nese pri mi para at 6 months postpartum4. To investigate the epidemiologicol factors of SUI in Chi nese pri mi para at 6 weeks postpartum5. To investigate the epidemiological factors of SUI in Chinese pri mi para at 6 months postpartum6. To explore the impact of different delivery patterns for the prevalence of UI and SUI i n Chi nese pri mi para postpartum.7. To study the differences about the prevalence, incidence and remission of SUI between urban and village primipara in China.METHODFrom Sep 2007 to May 2009, in seven administrative districts and twelve urban and village points, a primipara population-based multicentric prospective study was performed. A stratified random sample of 9840 was taken according to the incidence of UI in national epidemiological result. All the subjects were interviewed with questionnaire including general characteristic and Bristol Female Lower Urinary Tract Symptoms Questionnaires (BFLUTS) for lower urinary tract symptoms. This survey was designed, guided and quality-controlled by epidemiologic professors. RESULTS1. The prevalence rate of UI, SUI, UUI and MUI during pregnancy in Chinese primipara was 26.7%,18.6%,2.0% and 4.3%, respectively. The prevalence rate of UI, SUI, UUI and MUI at 6 weeks postpartum in Chinese primipara was 9.5%,6.9%, 0.8% and 1.1%, respectively. The prevalence rate of UI, SUI, UUI and MUI at 6 months postpartum in Chinese primipara was 6.8%,5.0%,0.3% and 0.9%, respectively. The incidence of UI after pregnancy was a question that should be paid attention to.2. The major structural characteristic of UI during pregnancy and postpartum in Chinese primipara was SUI, which consisted more than a half followed by MUI and UUI. Thi s may be because the i ncrease of abdominal pressure I ed to SUI.3. The prevalence rate of UI postpartum in Chinese primipara with different delivery pattern was different:the prevalence rate of UI at 6 weeks and 6 months postpartum in primipara with vaginal delivery were higher than that of cesarean delivery with significant statistical difference.While there was no statistical difference between selective cesarean delivery and non-selective cesarean delivery.4. The incidence rate of de novo UI at 6 weeks postpartum in Chinese primipara was 3.1%. In the UI present at 6 weeks postpartum, the constituent ratio of de novo SUI, UUI and MUI was 74.8%,9.5% and 5.1%. The incidence rate of de novo UI at 6 months postpartum in Chinese primipara was 3.5%. In the UI present at 6 months postpartum, the constituent ratio of de novo SUI, UUI and MUI was 71.3%,4.8% and 11.2%.5. The incident gestational week of UI during pregnancy in Chinese primipara ranged from 4th to 41st week and mean week was the (32nd±6) week. The incident peak was 32nd week and the constituent ratio of incident UI in late pregnancy was 88.1% (1215/1379), which was significant higher than other periods during pregnancy.6. The incidence rate of de novo UI postpartum in Chinese primipara with different delivery patterns was different:the incidence rate of de novo UI at 6 weeks and 6 months postpartum in primipara with vaginal delivery were higher than that of cesarean delivery, which had significant statistical difference; but there was no statistical difference between selective cesarean delivery and non-selective cesarean delivery.7. In Chinese primipara with UI during pregnancy, the remission rate of UI at 6 weeks postpartum was 74.7%, and the remission rate at 6 months postpartum was 83.7%, which had significant statistical difference; in Chinese primipara with UI at 6 weeks postpartum, the remission rate at 6 months postpartum was 56.3%.The remission rates of UI postpartum in Chinese primipara in different areas were different:the remission rates of UI in different postpartum period in urban primipara were higher than that in village primipara, which had significant statistical difference.The remission rate of UI postpartum in Chinese pri mi para with different delivery pattern were different:In the primipara with UI during pregnancy and at 6 weeks postpartum, the remission rate of UI in different postpartum period in Chinese primipara with vaginal delivery were lower than that of cesarean delivery, selective cesarean delivery and non-selective, which had statistical difference; There were no statistical differences between the remission rate of UI postpartum with selective cesarean delivery and non-selective cesarean delivery. 8. The risk factors of prevalence of SUI at 6 months postpartum in Chinese pri mi para included village living, more exercises, pelvic surgery history, SUI during pregnancy and SUI at 6 weeks postpartum; Minority, cesarean delivery and pelvic muscle training were protective factors.SUI during pregnancy and at 6 weeks postpartum were very strong predictors for prevalence of SUI at 6 months postpartum in Chinese primipara, and SUI at 6 weeks postpartum had a stronger relation with SUI postpartum.Pelvic muscle training was a risk factor for prevalence of SUI at 6 weeks postpartum, while a protective factor for prevalence of SUI at 6 months postpartum.CONCLUSIONS 1. The prevalence and incidence of UI during pregnancy and postpartum in Chinese primipara were both low, in which SUI was the most common condition. The prevalence and incidence rate of UI postpartum i n pri mi para wi th vaginal del i ver were higher than that of cesarean delivery; there was no statistical difference between the prevalence and incidence rate of UI postpartum with selective cesarean delivery and non-selective cesarean delivery.2. The incident period of UI during pregnancy in Chinese primipara focused on the I ate pregnancy, and the mean time was the 32nd week.3. The major structural characteristic of UI in Chinese pri mi para was SUI, consistent with the literature; the constituent ratio of SUI was the highest, and followed by MUI, UUI and other type of UI.4. Over half of UI during pregnancy and at 6 weeks postpartum in Chinese primipara could release spontaneously, which need not be intervention clinically. The remission rate of UI postpartum in urban primipara was higher than that in vill age pri mi para and the remission rate in primipara with cesarean delivery was higher.5. Cesarean delivery can reduce the prevalence risk of UI at 6 months postpartum in Chinese primipara. There was no association between the time of performing the surgery and prevalence of UI postpartum.6. SUI during pregnancy and at 6 weeks postpartum, especially at 6 weeks postpartum, can significantly increase the risk of persistent SUI postpartum in Chinese primipara These women were high risk groups for prevalence of SUI at 6 months postpartum, for whom protection and intervention measures should be conducted early.7. Pelvic muscle training after 6 weeks postpartum can reduce the prevalence of SUI postpartum.