title: Reproductive history and progression of lower urinary tract symptoms in women: results from a population-based cohort study.
abstract: OBJECTIVE
  To examine whether reproductive history and related conditions are associated with the development and persistence of lower urinary tract symptoms (LUTS) other than urinary incontinence in a racially and/or ethnically diverse population-based sample of women.
  
  
  METHODS
  The Boston Area Community Health Survey enrolled 3201 women aged 30-79 years of black, Hispanic, or white race and/or ethnicity. Baseline and 5-year follow-up interviews were completed by 2534 women (conditional response rate, 83.4%). The association between reproductive history factors and population-weighted estimates of LUTS progression and persistence was tested using multivariable logistic regression models.
  
  
  RESULTS
  Between baseline and 5-year follow-up, 23.9% women had LUTS progression. In age-adjusted models, women who had delivered ≥2 childbirths had higher odds of LUTS progression, but the association was completely accounted for by vaginal child delivery (eg, 2 vaginal childbirths vs none, multivariable-adjusted odds ratio = 2.21; 95% CI, 1.46-3.35; P <.001). No increased odds of LUTS progression were found for women with only 1 vaginal delivery or who only had cesarean section(s). Uterine prolapse was associated with higher odds of LUTS progression (multivariable-adjusted odds ratio = 3.05; 95% CI, 1.43-6.50; P = .004). Gestational diabetes was associated with approximately twice the odds of LUTS progression, but only among younger women (interaction P = .003).
  
  
  CONCLUSIONS
  In this cohort study, ≥2 vaginal child deliveries, uterine prolapse, and among younger women, gestational diabetes were robust predictors of LUTS progression. Clinicians should assess the presence of bothersome urinary frequency, urgency, and voiding symptoms among women who have had multiple vaginal childbirths or gestational diabetes.
authors.affiliation: Department of Epidemiology, New England Research Institutes, Watertown, MA. Electronic address: nmaserej@post.harvard.edu.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Maserejian
authors.affiliation: Department of Epidemiology, New England Research Institutes, Watertown, MA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Curto
authors.affiliation: Department of Epidemiology, New England Research Institutes, Watertown, MA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Hall
authors.affiliation: Discipline of Medicine, Freemasons Foundation Centre for Men's Health, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
authors.affiliation: Department of Epidemiology, New England Research Institutes, Watertown, MA.
authors.forename: John B
authors.initials: JB
authors.lastname: McKinlay
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000473:pathology; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D008593:Menopause; D008875:Middle Aged; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology; D014596:Uterine Prolapse / Q000150:complications / Q000473:pathology