title: The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study.
abstract: OBJECTIVE
  To investigate the contribution of obstetric risk factors to persistent urinary incontinence (UI) between 4 and 18 months postpartum.
  
  
  METHODS
  Prospective pregnancy cohort.
  
  
  METHODS
  Six metropolitan public hospitals in Victoria, Australia.
  
  
  METHODS
  A total of 1507 nulliparous women recruited to the Maternal Health Study in early pregnancy (≤24 weeks of gestation).
  
  
  METHODS
  Data from hospital records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and at 3, 6, 9, 12 and 18 months postpartum analysed using logistic regression.
  
  
  METHODS
  Persistent UI 4-18 months postpartum in women continent before pregnancy.
  
  
  RESULTS
  Of the women who were continent before pregnancy, 44% reported UI 4-18 months postpartum, and 25% reported persistent UI (symptoms at multiple follow ups). Compared with spontaneous vaginal birth, women who had a caesarean before labour (adjusted odds ratio [aOR] 0.4, 95% confidence interval [95% CI] 0.2-0.9), in first-stage labour (aOR 0.4, 95% CI 0.2-0.6) or in second-stage labour (aOR 0.4, 95% CI 0.2-1.0) were less likely to report persistent UI 4-18 months postpartum. Prolonged second-stage labour in women who had an operative vaginal birth was associated with increased likelihood of UI (aOR 2.5, 95% CI 1.3-4.6). Compared with women who were continent in pregnancy, women reporting UI in pregnancy had a seven-fold increase in odds of persistent UI (aOR 7.4, 95% CI 5.1-10.7).
  
  
  CONCLUSIONS
  Persistent UI is common after childbirth and is more likely following prolonged labour in combination with operative vaginal birth. The majority of women reporting persistent UI at 4-18 months postpartum also experienced symptoms in pregnancy.
authors: Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
authors: D
authors: D
authors: Gartland
authors: S
authors: S
authors: Donath
authors: C
authors: C
authors: MacArthur
authors: S J
authors: SJ
authors: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D001722:Birth Order; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology*; D014739:Victoria; D055815:Young Adult