Factors Associated with Persistent Urinary Dysfunction and Leakage After Pregnancy

Objectives: Urinary dysfunction, including stress and urgency urinary incontinence (SUI and UUI), commonly occur in the postpartum population and may negatively impact quality of life. The objective of our study was to understand risk factors associated with SUI, UUI, and overall urinary dysfunction in the postpartum period.

Methods: Extending Maternal Care After Pregnancy (eMCAP) is an urban community-based program to address maternal health needs/disparities of patients in the 12-months postpartum. Health assessments include the Urinary Distress Index-6 (UDI-6) and screening for anxiety and depression with the Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS), respectively. The UDI-6 is scored 0-100 with higher scores indicating greater distress. The GAD-7 is scored 0-21, with 5-9 associated with mild anxiety, ≥10 moderate or worse anxiety. The EPDS is scored 0-30; for this study the EPDS was dichotomized with ≥10 signaling an increased likelihood of depression. Bivariate analyses were performed for at-least-somewhat bothersome (vs. not present or not-at-all bothersome) SUI and UUI and for urinary dysfunction (i.e., UDI-6 score >33.3) vs. normal function (≤33.3) using GAD-7 and EPDS results plus demographic and peri/postpartum variables as predictors.

Results: Four hundred-nineteen participants provided UDI-6 data at 9-13mo postpartum; 136 (32.5%) reported SUI, and 69 (16.5%) had UUI. Comparing SUI to no-SUI (Table 1), SUI was significantly associated with greater maternal age, higher BMI, and greater parity. There were no associations for fetal birthweight, mode of delivery, or laceration type. Of note, there was only one episiotomy and one 3^rd or 4^th degree laceration in this cohort. SUI was not linked with an increased risk of anxiety or depression. Conversely, UUI was associated with greater scores on the GAD-7 and EPDS (Table 2). UUI was also associated with BMI >30 [57 of 69 (83%) with UUI vs. 248 of 350 (71%) without UUI, p=0.048]. Considering urinary dysfunction vs. normal function, those with dysfunction had greater median (IQR) parity, GAD-7, and EPDS scores: 3(1.25-4.75) vs. 2(1-3), p=0.042; 2(0-6) vs. 0(0-2), p< 0.001; and 2(0-6) vs. 2(0-2), p< 0.001, respectively. When assessing the 34 patients (8.1% of the cohort) with GAD-7 or EPDS scores ≥10, 16 (47.1%) had a previous mental health disorder diagnosis whereas 18 (52.9%) were newly assessed in the postpartum period.

Conclusions: Approximately one year postpartum, SUI affects one-third of patients, and UUI affects one in six patients. Differing risk factors were associated with SUI than for UUI. Increasing maternal weight was linked with both types of leakage and is a modifiable risk factor. Increased scores for anxiety and depression were also associated with UUI and overall urinary dysfunction.