Exploration Of Risk Factors And Establishment Of A New Early Warning Model And Stategy For Stress Urinary Incontinence In Pregnancy

The incidenc of Stress Urinary incontinence,SUI,in pregnancy was 17%-67%,which is on rise year by year.This brings women a range of health problems.It happens during pregnancy and develops into postpartum and postmenopausal SUI.The occurrence of SUI during pregnancy sounded the alarm for the subsequent occurrence of SUI.It is of great significance to survey the development and outcome of SUI.SUI has become to a common disease that threatens the social and health problems of the majority of women in China.Early prevention and control to SUI have become to an important issue in the medical area.At present,the cause of SUI is not clear.we need to explore risk factors of SUI,to determine evidence-based intervention program and set up a standard evaluation program.Otherwise,it is difficult to give prevention and intervention of SUI at early time.It will bring a huge burden to the family,social and health care system.Objectives1.Analyse the risk factors of SUI during pregnancy.2.Establishment of an early warning model of SUI during pregnancy.3.Explore to a cluster intervention strategy of SUI during pregnancy.Methods and SubjectsA total of 707 women responded to a retrospective survey.All women completed a short demographic survey,a risk factor evaluated table and two international validated questionnaires:the Incontinence Impact Questionnaire(?Q)and the International Consultation on Incontinence Questionnaire Short Form(ICIQ-SF).Statistical processingSpss 20.0 statistical software was used.Numerical variables are presented as(M±SD)and M(P25-P75).The measurement data were compared with t test and t' test.Calculation data were compared by using x2 test.Data with irregular variance were compared by Wilcoxon Rank-Sum test.If the P<0.10 in univariate analysis,the factors were included in the multivariate logistic regression model.Multivariable logistic regression was used to analyze and clearify the significant indicators.The data of model were analyzed by operating characteristic(receiver operating characteristic,ROC)logistic curves and caculated area under curve as(A±SE).Early warning model of SUI in pregnancy was constructed by C5.0 decision tree method.P<0.05 was considered statisticcally difference.Results:The first partA total of 707 cases of primipara were investigated.SUI incidence rate was 28.9%.The final variables that entried into the multivariate logistic regression analysis model were:education level,abortion history,eat fruit 4-6 days a week,eat fruit 1-3 days a week,constipation,no pelvic floor muscle during pregnancy,occasional pelvic floor Muscle exercise(1-2 times per week),SUI family history,stretch marks,pre-pregnancy BMI.The second part1.According to the decision tree model extracted from the classification rules,when mothers without SUI family history,with stretch marks and with constipation,the incidence rate of SUI patients accounted for 63.2%of the node;when the mothers without SUI family history,stretch marks and pre-pregnancy BMI level>20.26,the incidence rate of SUI patients accounted for 23.2%of the node;And when the mothers without SUI family history,with stretch marks,no constipation,pre-pregnancy BMI?23.96,pelvic floor muscle exercise in pre-pregnancy(1-2 times one week),who eat fruit 1-3 days or 4-6 days a week,with abortion history,the incidence rate of SUI patients accounted for 58.8%of the node.2.The importance of risk factors were as follows:constipation,pre-pregnancy BMI level,SUI family history,weekly fruit consumption,stretch marks,abortion history,the strength of pelvic floor muscle exercise in pregnancy,the strength of physical exercise pre-pregnancy,the strength of pelvic floor muscle exercise pre-pregnancy,vomiting,education level,daily drinking.3.The accuracy of this model was 76.7%.The sensitivity of this model was 84.8%.The area under the ROC curve was 0.767±0.024(90%Cl:0.719-0.814),p=0.000.The risk of cross validation was estimated at 29.8%,P<0.001.The third partAccording to the JBI Evidence Pre-classification and Evidence Recommendation Level System(2014 version),there were seven elements:pelvic floor muscle exercise,aerobic exercise during pregnancy,lifestyle adjustment during pregnancy,dietary guidance during pregnancy,cognitive level,psychological intervention,bladder function exercise.And ultimately set up a gestational SUI cluster intervention strategy.Conclusion1.The incidence rate of SUI in pregnancy are related with the level of education,abortion history,weekly fruit consumption,constipation,pelvic floor muscle exercise during pregnancy,family history,stretch marks,pre-pregnancy BMI.Constipation is an important risk factor affecting the incidence rate of SUI during pregnancy.2.Risk factors can be analyzed by the new Early Warning Model of SUI.Its sensitivity and prediction accuracy in the local population is good.3.The proposed cluster measures of SUI prevention and control during pregnancy include:pelvic floor muscle exercise,aerobic exercise during pregnancy,pregnancy lifestyle adjustment,pregnancy diet guidance,cognitive level,psychological intervention,bladder function exercise.These measures are scientific and practical.It is highly beneficial to early prevention and control of SUI.Finally,we can further achieve to the early prevention and control by the gestational SUI cluster intervention strategies.