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Erschienen in: International Urogynecology Journal 6/2022

19.02.2022 | Original Article

Development and validation of a predictive model for urinary incontinence postpartum: a prospective longitudinal study

verfasst von: Xiaojuan Wang, Ying Jin, Xuefen Xu, Hongyan Wang, Suwen Feng

Erschienen in: International Urogynecology Journal | Ausgabe 6/2022

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Abstract

Introduction and hypothesis

Urinary incontinence is a common and burdensome problem amongst women. Although it can be prevented, little progress has been made. Identifying individuals at risk remains the key to the prevention of urinary incontinence.

Methods

Eligible women were enrolled in the obstetric wards of a tertiary maternity hospital in 2020. Urinary incontinence was measured using a well-accepted questionnaire. Logistic regression with a backward stepwise process was used for predictor selection. The discrimination and calibration of the nomogram were measured using the area under the ROC curve (AUC), Hosmer–Lemeshow test and calibration curve respectively. Bootstrapping procedure with 1000 resamples was used for internal validity. A temporal split (7:3) was made and data collected from the later period were used for temporal validation.

Results

Seven predictors including birth mode, urinary incontinence before and during pregnancy, place of residence, feeding pattern, parity, and age at first birth remained in the final model. The AUC was 0.757 (95% CI: 0.72–0.80) and 0.759 (95% CI: 0.70–0.82) in the derivation and validation cohorts respectively. No significant differences were detected in the Hosmer–Lemeshow test and calibration curve in both cohorts.

Conclusions

The nomogram proved to be a convenient and reliable tool in the clinical setting for risk assessment of postpartum incontinence, which can be applied during pregnancy and the postnatal period for individual risk estimates of postpartum incontinence.
Literatur
1.
Zurück zum Zitat Wood LN, Anger JT. Urinary incontinence in women. BMJ. 2014;349:g4531.CrossRef Wood LN, Anger JT. Urinary incontinence in women. BMJ. 2014;349:g4531.CrossRef
2.
Zurück zum Zitat Milsom I, Altman D, Cartwright R, Lapitan M, Nelson R, Sjöström S. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP), and anal incontinence (AI). In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 4–142. Milsom I, Altman D, Cartwright R, Lapitan M, Nelson R, Sjöström S. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP), and anal incontinence (AI). In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 4–142.
3.
Zurück zum Zitat Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015;27(5):380–4.CrossRef Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015;27(5):380–4.CrossRef
4.
Zurück zum Zitat Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5(5):CD007471.PubMed Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5(5):CD007471.PubMed
5.
Zurück zum Zitat Palmer MH, Athanasopoulos A, Lee KS, Takeda M, Wyndaele JJ. Sociocultural and environmental influences on bladder health. Int J Clin Pract. 2012;66(12):1132–8.CrossRef Palmer MH, Athanasopoulos A, Lee KS, Takeda M, Wyndaele JJ. Sociocultural and environmental influences on bladder health. Int J Clin Pract. 2012;66(12):1132–8.CrossRef
6.
Zurück zum Zitat Minassian VA, Bazi T, Stewart WF. Clinical epidemiological insights into urinary incontinence. Int Urogynecol J. 2017;28(5):687–96.CrossRef Minassian VA, Bazi T, Stewart WF. Clinical epidemiological insights into urinary incontinence. Int Urogynecol J. 2017;28(5):687–96.CrossRef
7.
Zurück zum Zitat Sampselle CM, Palmer MH, Boyington AR, O'Dell KK, Wooldridge L. Prevention of urinary incontinence in adults: population-based strategies. Nurs Res. 2004;53:S61–7.CrossRef Sampselle CM, Palmer MH, Boyington AR, O'Dell KK, Wooldridge L. Prevention of urinary incontinence in adults: population-based strategies. Nurs Res. 2004;53:S61–7.CrossRef
8.
Zurück zum Zitat Zhu L, Lang J, Liu C, Han S, Huang J, Li X. The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China. Menopause. 2009;16(4):831–6.CrossRef Zhu L, Lang J, Liu C, Han S, Huang J, Li X. The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China. Menopause. 2009;16(4):831–6.CrossRef
9.
Zurück zum Zitat Morkved S, Bo K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014;48(4):299–310.CrossRef Morkved S, Bo K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014;48(4):299–310.CrossRef
10.
Zurück zum Zitat Rantell A, Veit-Rubin N, Giarenis I, Khullar V, Abrams P, Cardozo L. Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth international consultation on incontinence—research society 2018. Neurourol Urodyn. 2019;38(Suppl 5):S104–10.PubMed Rantell A, Veit-Rubin N, Giarenis I, Khullar V, Abrams P, Cardozo L. Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth international consultation on incontinence—research society 2018. Neurourol Urodyn. 2019;38(Suppl 5):S104–10.PubMed
11.
Zurück zum Zitat Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89(12):1511–22.CrossRef Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89(12):1511–22.CrossRef
12.
Zurück zum Zitat Schytt E, Lindmark G, Waldenstrom U. Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample. Acta Obstet Gynecol Scand. 2004;83(10):928–36.CrossRef Schytt E, Lindmark G, Waldenstrom U. Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample. Acta Obstet Gynecol Scand. 2004;83(10):928–36.CrossRef
13.
Zurück zum Zitat Viktrup L, Rortveit G, Lose G. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol. 2006;108(2):248–54.CrossRef Viktrup L, Rortveit G, Lose G. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol. 2006;108(2):248–54.CrossRef
14.
Zurück zum Zitat Li H, Long TF, Li DY, et al. The process of postpartum pelvic rehabilitation part 3: measures and implementation protocol for postpartum pelvic rehabilitation. Zhongguo Shi Yong Fu Ke Yu Chan Ke Za Zhi. 2015;31(6):522–9. Li H, Long TF, Li DY, et al. The process of postpartum pelvic rehabilitation part 3: measures and implementation protocol for postpartum pelvic rehabilitation. Zhongguo Shi Yong Fu Ke Yu Chan Ke Za Zhi. 2015;31(6):522–9.
15.
Zurück zum Zitat Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. 2015;350:g7594.CrossRef Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. 2015;350:g7594.CrossRef
16.
Zurück zum Zitat Kattan MW, O'Rourke C, Yu C, Chagin K. The wisdom of crowds of doctors: their average predictions outperform their individual ones. Med Decis Making. 2016;36(4):536–40.CrossRef Kattan MW, O'Rourke C, Yu C, Chagin K. The wisdom of crowds of doctors: their average predictions outperform their individual ones. Med Decis Making. 2016;36(4):536–40.CrossRef
17.
Zurück zum Zitat Jelovsek JE, Chagin K, Gyhagen M, et al. Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol. 2018;218(2):222.e1–19.CrossRef Jelovsek JE, Chagin K, Gyhagen M, et al. Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol. 2018;218(2):222.e1–19.CrossRef
18.
Zurück zum Zitat Jelovsek JE, Piccorelli A, Barber MD, Tunitsky-Bitton E, Kattan MW. Prediction models for postpartum urinary and fecal incontinence in primiparous women. Female Pelvic Med Reconstr Surg. 2013;19(2):110–8.CrossRef Jelovsek JE, Piccorelli A, Barber MD, Tunitsky-Bitton E, Kattan MW. Prediction models for postpartum urinary and fecal incontinence in primiparous women. Female Pelvic Med Reconstr Surg. 2013;19(2):110–8.CrossRef
19.
Zurück zum Zitat Chen L, Luo D, Chen X, Jin M, Yu X, Cai W. Development of predictive risk models of postpartum stress urinary incontinence for primiparous and multiparous women. Urol Int. 2020;104(9–10):824–32.CrossRef Chen L, Luo D, Chen X, Jin M, Yu X, Cai W. Development of predictive risk models of postpartum stress urinary incontinence for primiparous and multiparous women. Urol Int. 2020;104(9–10):824–32.CrossRef
20.
Zurück zum Zitat Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.CrossRef Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.CrossRef
21.
Zurück zum Zitat Huang L, Zhang SW, Wu SL, Ma L, Deng XH. The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence. Neurourol Urodyn. 2008;27(6):522–4.CrossRef Huang L, Zhang SW, Wu SL, Ma L, Deng XH. The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence. Neurourol Urodyn. 2008;27(6):522–4.CrossRef
22.
Zurück zum Zitat Riley RD, Ensor J, Snell KIE, et al. Calculating the sample size required for developing a clinical prediction model. BMJ. 2020;368:m441.CrossRef Riley RD, Ensor J, Snell KIE, et al. Calculating the sample size required for developing a clinical prediction model. BMJ. 2020;368:m441.CrossRef
23.
Zurück zum Zitat Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2013;24(9):1473–9.CrossRef Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2013;24(9):1473–9.CrossRef
24.
Zurück zum Zitat Wilson D, Dornan J, Milsom I, Freeman R. UR-CHOICE: can we provide mothers-to be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J. 2014;25(11):1449–52.CrossRef Wilson D, Dornan J, Milsom I, Freeman R. UR-CHOICE: can we provide mothers-to be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J. 2014;25(11):1449–52.CrossRef
25.
Zurück zum Zitat Wesnes SL, Hunskaar S, Bo K, Rortveit G. The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG. 2009;116(5):700–7.CrossRef Wesnes SL, Hunskaar S, Bo K, Rortveit G. The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG. 2009;116(5):700–7.CrossRef
26.
Zurück zum Zitat Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. JAMA. 2018;320(23):2438–47.CrossRef Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. JAMA. 2018;320(23):2438–47.CrossRef
27.
Zurück zum Zitat Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):144–51.CrossRef Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):144–51.CrossRef
28.
Zurück zum Zitat Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494.CrossRef Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494.CrossRef
29.
Zurück zum Zitat Zhu L, Li L, Lang JH, Xu T. Prevalence and risk factors for peri- and postpartum urinary incontinence in primiparous women in China: a prospective longitudinal study. Int Urogynecol J. 2012;23(5):563–72.CrossRef Zhu L, Li L, Lang JH, Xu T. Prevalence and risk factors for peri- and postpartum urinary incontinence in primiparous women in China: a prospective longitudinal study. Int Urogynecol J. 2012;23(5):563–72.CrossRef
30.
Zurück zum Zitat Lovejoy DA, Roem JL, Blomquist JL, Pandya PR, Handa VL. Breastfeeding and pelvic floor disorders one to two decades after vaginal delivery. Am J Obstet Gynecol. 2019;221(4):333.e1–8.CrossRef Lovejoy DA, Roem JL, Blomquist JL, Pandya PR, Handa VL. Breastfeeding and pelvic floor disorders one to two decades after vaginal delivery. Am J Obstet Gynecol. 2019;221(4):333.e1–8.CrossRef
Metadaten
Titel
Development and validation of a predictive model for urinary incontinence postpartum: a prospective longitudinal study
verfasst von
Xiaojuan Wang
Ying Jin
Xuefen Xu
Hongyan Wang
Suwen Feng
Publikationsdatum
19.02.2022
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal / Ausgabe 6/2022
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-022-05105-9

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