Stian Langeland Wesnes

Urinary incontinence during pregnancy

OBJECTIVE: To investigate incidence and prevalence of urinary incontinence during pregnancy and associated risk factors. METHODS: The data collection was conducted as part of the Norwegian Mother and Child Cohort Study at the Norwegian Institute of Public Health. We present questionnaire data about urinary incontinence obtained from 43,279 women (response rate 45%) by week 30. We report data on any incontinence, in addition to type, frequency, and amount of incontinence. Potential risk factors were investigated by logistic regression analyses. RESULTS: The prevalence of incontinence increased from 26% before pregnancy to 58% in week 30. The corresponding figures for nulliparous women were 15% and 48%, and for parous women 35% and 67%. The cumulative incidence was 46%. Stress urinary incontinence was the most common type of incontinence in week 30 of pregnancy, experienced by 31% of nulliparous and 42% of parous women. The majority of pregnant women had leakage less than once per week and droplets only, both before and during pregnancy. Parity was a strong and significant risk factor for incontinence in adjusted analyses both before pregnancy (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.4–2.7 for primiparous and OR 3.3, 95% CI 3.1–3.5 for multiparous women) and during pregnancy (ORs 2.0, 95% CI 1.9–2.1 and 2.1, 95% CI 2.0–2.2, respectively). Age and body mass index were weaker, but still statistically significant, risk factors. CONCLUSION: The prevalence of urinary incontinence increases substantially during pregnancy. Incontinence both before and during pregnancy seems to be associated with parity, age, and body mass index. LEVEL OF EVIDENCE: II

The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study

Objective  The objectives of this study were to investigate prevalence of urinary incontinence at 6 months postpartum and to study how continence status during pregnancy and mode of delivery influence urinary incontinence at 6 months postpartum in primiparous women.

Urinary Incontinence and Weight Change During Pregnancy and Postpartum: A Cohort Study

Weight gain during pregnancy may contribute to increased urinary incontinence (UI) during and after pregnancy, but scientific support is lacking. The effect of weight loss on UI postpartum is unclear. From 1999 to 2006, investigators in the Norwegian Mother and Child Cohort Study recruited pregnant women during pregnancy. This study was based on 12,679 primiparous women who were continent before pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and 6 months postpartum. Weight gain greater than the 50th percentile during weeks 0–15 of pregnancy was weakly associated with higher incidence of UI at week 30 compared with weight gain less than or equal to the 50th percentile. Weight gain greater than the 50th percentile during pregnancy was not associated with increased prevalence of UI 6 months postpartum. For each kilogram of weight loss from delivery to 6 months postpartum among women who were incontinent during pregnancy, the relative risk for UI decreased 2.1% (relative risk = 0.98, 95% confidence interval: 0.97, 0.99). Weight gain during pregnancy does not seem to be a risk factor for increased incidence or prevalence of UI during pregnancy or postpartum. However, weight loss postpartum may be important for avoiding incontinence and regaining continence 6 months postpartum.

Preventing urinary incontinence during pregnancy and postpartum: a review

Urinary incontinence (UI) is a common condition in association with pregnancy. Incident UI in pregnancy or postpartum are significant risk factors for UI later in life. Epidemiological studies on UI during pregnancy and postpartum list numerous variables associated with UI. For women, the main focus is on pelvic floor muscle training to prevent UI. However, several other modifiable risk factors are likely to contribute to prevention of UI during pregnancy and postpartum. This review investigated modifiable risk factors for UI during pregnancy and postpartum and also reviewed randomized controlled trials on prevention of UI in association with pregnancy. Systematic searches for publications until September 2012 on prevention of UI during pregnancy and postpartum were performed. Based on available evidence, the following recommendations to prevent UI during pregnancy and postpartum were made: women should be advised not to smoke before or during pregnancy (grade B), aim at normal weight before pregnancy (grade B), and aim at regaining prepregnancy weight postpartum (grade B). Occasional low-intensity training should be advocated (grade B), and constipation should be avoided during pregnancy (grade B) and postpartum (grade C). Women should be advised to perform pelvic floor muscle training during pregnancy and postpartum (grade A) and to use perineal warm packs during delivery (grade B). Cesarean section to prevent UI cannot be recommended (grade D). If lifestyle recommendations are addressed in association with pregnancy, incidence of UI during pregnancy and postpartum is likely to decrease.

Weight and urinary incontinence: the missing links

Excessive weight is an established and potent risk factor for urinary incontinence (UI) among women of all ages. Although few would doubt that weight plays a role in UI, there are still many uncertainties regarding weight as a risk factor. It must be clarified whether body mass index (BMI) is a better estimate than weight, waist circumference, or waist–hip ratio. It is not clear how the distribution of weight affects UI. Does being overweight due to heavy muscles, edema, or pregnancy lead to UI or only being overweight due to adiposity? It is unclear for how long a persons overweight must persist to lead to UI. We do not know whether weight is an appropriate measure of exposure or whether the association between weight and UI is confounded by socioeconomic status, diet, disease, or weight-related hormonal changes. This article summarizes knowledge gaps on the association between weight and UI.

Career choice and place of graduation among physicians in Norway

Abstract Objective. To investigate to what extent a physicians place of graduation is associated with the physician choosing a career as a general practitioner (GP), and identify factors in the curriculum that could predict a general practice career. Design. Cross-sectional study based on the membership database of the Norwegian Medical Association. Setting. Physicians working in Norway who graduated from four domestic medical schools, five other countries, and three groups of countries. Physicians were categorized according to their main professional activity as GPs, hospital physicians, and researchers. Subjects. A total of 2836 medical physicians who were working in Norway during 2010 and graduated from medical school between 2002 and 2005. Main outcome measures. Percentage and odds ratio for subjects working as a GP in Norway during 2010. Descriptive data for pre-graduate general practice education in Norwegian medical schools were also analysed. Results. Compared with the University of Oslo, there was a significantly higher proportion of GPs among physicians who had graduated from Denmark (OR 2.9, 95% CI 1.9–4.5), Poland (OR 2.0, 95% CI 1.4–2.9), Sweden (OR 1.8, 95% CI 1.0–3.1), and Trondheim (Norway) (OR 1.5, 95% CI 1.1–2.0). Across the four Norwegian medical schools, there were significant associations between choosing a general practice career and the sum of pre-graduate educational hours regarding general practice, general practice preceptorship, and the number of GP teachers. Conclusion. The physicians place of graduation appears to be associated with career choice. The universities’ total contribution in pre-graduate general practice education may be associated with future GP career choice.

Epidemiology of Urinary Incontinence in Pregnancy and Postpartum

Not many reviews have focused solely on incidence and prevalence of UI in association with pregnancy. One report gives a range of prevalence of UI in pregnancy from 32 to 64 % (Milsom et al., 2009). There are published few reviews on incident UI postpartum, most of them are based on a small number of studies. However, one systematically review (Thom & Rortveit, 2010) and several traditional reviews have been published on prevalence of UI postpartum.

General practice needs to improve recruitment and income of GP researchers.

General practitioners (GPs) lack incentives to become a PhD student. Medical PhD students have in general the lowest income of all doctors in Scandinavia. GPs lose the most money doing a PhD [1]. The result is that general practice has a low number of doctors with a PhD compared with other medical specialists.

Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study

Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.

The Effect of Urinary Incontinence Status During Pregnancy and Delivery Mode on Incontinence Postpartum. A Cohort Study

ABSTRACTUrinary incontinence starting before or during pregnancy appears to be an independent risk factor for incontinence postpartum and later in life. Studies investigating this association have had several methodological weaknesses including poor outcome measures, retrospective design, small stud