title: Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors.
abstract: OBJECTIVE
  To estimate frequency and severity and to identify risk factors of urinary incontinence (UI) and anal incontinence during pregnancy and after delivery in previously continent nulliparous women.
  
  
  METHODS
  We designed a cohort study of healthy, continent, nulliparous pregnant women attending public health care services. The field work was conducted during the control visits of the three trimesters of pregnancy, at the time of delivery, and postpartum. A self-administered questionnaire was used to assess UI (validated and adapted) and anal incontinence. Frequency of UI and anal incontinence and their confidence intervals (95% CIs) were calculated. The correlations between the severity of UI and the degree of effect on daily life were also estimated. Multivariable Cox models were applied to estimate hazard ratios for both incontinences (urinary/anal) during pregnancy and postpartum.
  
  
  RESULTS
  The cumulative incidence rate during pregnancy was 39.1% (95% CI 36.3-41.9) for UI and 10.3% (95% CI 8.3-12.3) for anal incontinence. The correlation between severity of UI and effect on daily life was moderate. Age, baseline body mass index, and family history of UI were significantly associated with the occurrence of UI during pregnancy, while age and excess weight gain during pregnancy were associated with the occurrence of anal incontinence during pregnancy. Postpartum, the identified risk factors for both incontinences were incontinence during pregnancy and vaginal delivery.
  
  
  CONCLUSIONS
  The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence. Some risk factors for both incontinences during pregnancy and postpartum are related to lifestyles and obstetric practices.
authors.affiliation: From the Catalan Agency for Health Technology Assessment and Research (AATRM); Epidemiology and Public Health Network (CIBER ESP); and Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic i Provincial, University of Barcelona, Barcelona, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Solans-Domènech
authors.forename: Emília
authors.initials: E
authors.lastname: Sánchez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Espuña-Pons
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D005242:Fecal Incontinence / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000150:complications* / Q000453:epidemiology*; D015430:Weight Gain; D055815:Young Adult