title: Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study.
abstract: OBJECTIVE
  To investigate the extent of persistent urinary incontinence (UI) 12 years after birth, and association with delivery-mode history and other factors.
  
  
  METHODS
  Twelve-year longitudinal cohort study.
  
  
  METHODS
  Maternity units in Aberdeen, Birmingham, and Dunedin.
  
  
  METHODS
  Women who returned questionnaires 3 months and 12 years after index birth.
  
  
  METHODS
  Data on all births over a period of 12 months were obtained from the units and then women were contacted by post.
  
  
  METHODS
  Persistent UI reported at 12 years, with one or more previous contact.
  
  
  RESULTS
  Of 7879 women recruited at 3 months, 3763 (48%) responded at 12 years, with 2944 also having responded at 6 years; non-responders had similar obstetric characteristics. The prevalence of persistent UI was 37.9% (1429/3763). Among those who had reported UI at 3 months, 76.4% reported it at 12 years. Women with persistent UI had lower SF12 quality of life scores. Compared with having only spontaneous vaginal deliveries (SVDs), women who delivered exclusively by caesarean section were less likely to have persistent UI (odds ratio, OR 0.42, 95% CI 0.33-0.54). This was not the case in women who had a combination of caesarean section and SVD births (OR 1.01, 95% CI 0.78-1.30). Older age at first birth, greater parity, and overweight/obesity were associated with persistent UI. Of 54 index primiparae with UI before pregnancy, 46 (85.2%) had persistent UI.
  
  
  CONCLUSIONS
  This study, demonstrating that UI persists to 12 years in about three-quarters of women, and that risk was only reduced with caesarean section if women had no other delivery mode, has practice implications.
  
  
  CONCLUSIONS
  A longitudinal study of 3763 women showed a prevalence of persistent UI 12 years after birth of 37.9%.
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Herbison
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lancashire
authors.affiliation: NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hagen
authors.affiliation: Birmingham Women's Hospital, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Toozs-Hobson
authors.affiliation: Department of Obstetrics and Gynaecology, York Hospital, York, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dean
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: C
authors.initials: C
authors.lastname: Glazener
mesh_terms: D002585:Cesarean Section; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008423:Maternal Age; D009765:Obesity / Q000453:epidemiology; D010298:Parity; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000523:psychology
keywords: Long term; postpartum; risk factors; urinary incontinence