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Sartorão Filho CI, Pinheiro FA, Takano L, Prudêncio CB, Nunes SK, Rls H, Calderon IMP, Barbosa AMP, Rudge MVC. Risk factors for postpartum urinary incontinence: The impact of early-onset and late-onset Gestational Diabetes Mellitus in a nested case-control study. Eur J Obstet Gynecol Reprod Biol 2023; 290:5-10. [PMID: 37708658 DOI: 10.1016/j.ejogrb.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 07/29/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) and many other clinical variables have been associated with postpartum urinary incontinence (UI). However, the data are still restricted, and no study explored early- or late-onset GDM as a risk factor for this condition. We aimed to identify independent risk factors for postpartum UI, focusing on GDM and its early or late onset. METHODS A nested case control derived from the Diamater cohort study included 517 pregnant women who submitted to a planned C-section and followed by 6-18 months after delivery according to the timing of GDM diagnosis: early-onset GDM (before 20 weeks) and late-onset GDM(24-28 weeks) and the occurrence of UI. RESULTS Univariate analysis showed that the risk for 6-18 months postpartum UI was 49% higher in non-Caucasian ethnicity (1.49,1.02-2.18), 3,3 times higher in previous bariatric surgery [3.37,1.36-8.21], 39% higher in GDM women (1.39,1.01-1.93), and 5% higher for each BMI score in prepregnancy (1.05, 1.03-1.08) and at the end of pregnancy (1.05,1.02-1.08). Multivariate logistic regression analysis indicates that prepregnancy BMI was the only independent factor associated with the 6-18 months postpartum UI (adj 1.05, 95 %CI 1.02-1.08, P <.001). After stratifying, a second univariate and multivariate analysis were done according to the prepregnancy BMI cutoff score of 25. Thus, a significant association between GDM and postpartum UI in prepregnancy overweight women (RR: 1.91; 95 %CI 1.25-2.90, P =.003) and no association between GDM and 6-18 months postpartum UI in normal prepregnancy BMI (RR: 0.78, 95 %CI 0.39-1.54, P =.482) were found. After multivariate regression, the early-onset-GDM remained the unique independent adjusted risk factor for 6-18 months postpartum UI analysis (adjRR 2.15, 95 %CI 1.33-3.46, P =.002). CONCLUSION After a planned C-section, we observed a 6-18 months postpartum UI higher occurrence after GDM, either in early-onset GDM or late-onset GDM. In addition, being overweight (BMI > 25) among women with early-onset GDM was associated with postpartum UI.
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Affiliation(s)
- Carlos I Sartorão Filho
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; Educational Foundation of the Municipality of Assis (FEMA), Department of Medical School, Assis, Brazil
| | - Fabiane A Pinheiro
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Luiz Takano
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; Educational Foundation of the Municipality of Assis (FEMA), Department of Medical School, Assis, Brazil
| | - Caroline B Prudêncio
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Sthefanie K Nunes
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Hallur Rls
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Iracema M P Calderon
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Angélica M P Barbosa
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; São Paulo State University (UNESP), Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, Marília, Brazil
| | - Marilza V C Rudge
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil.
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Pinheiro FA, Sartorão Filho CI, Prudencio CB, Nunes SK, Pascon T, Hallur RLS, Takano L, Enriquez EMA, Catinelli BB, Carr AM, Junginger B, Rudge MVC, Barbosa AMP. Pelvic floor muscle dysfunction at 3D transperineal ultrasound in maternal exposure to gestational diabetes mellitus: A prospective cohort study during pregnancy. Neurourol Urodyn 2022; 41:1127-1138. [PMID: 35419878 DOI: 10.1002/nau.24927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 11/12/2022]
Abstract
AIM This study aimed to assess, for the first time, the dynamic morphometry of pelvic floor muscles (PFM) using three-dimensional transperineal ultrasound (3D-TPUS) and its progression at two-time points of gestation between women with and without gestational diabetes mellitus (GDM), and whether the PFM dysfunction is connected to GDM. METHODS The study comprised 83 consecutive pregnant women with (n = 38) and without (n = 45) GDM screened at 24-30 and 38-40 weeks of gestation. 3D-TPUS and a mobility test were used to quantify PFM dynamic morphometry during maximum contraction and the Valsalva maneuver. RESULTS When compared to the control group, GDM women had no significant variations in all levator hiatal dimensions at 24-30 weeks of gestation. Meanwhile, women with GDM experienced an increase in levator hiatal area (LHa) (p < 0.000) during PFM contraction and enlargement in LHa (p < 0.001) during Valsalva maneuver (p = 0.010) at 38-40 weeks of gestation. As a result, the mobility index among GDM women had a lower value (p = 0.000). The dynamic morphometry development of PFM in GDM women at two stages during pregnancy revealed a substantial decrease (p = 0.000) in all LHa dimensions of contraction, distension, and mobility. CONCLUSIONS Using 3D-TPUS, we found that GDM women had a specific pattern of PFM functional changes in the third trimester of pregnancy. These initial findings revealed alterations in PFM functionality, such as decreased contractility, distensibility, or mobility. This dysfunctional PFM could contribute to the long-term development of pelvic floor dysfunction years after a GDM pregnancy.
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Affiliation(s)
- Fabiane A Pinheiro
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Carlos I Sartorão Filho
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Department of Medical Health, Medical School, Fundação Educacional do Município de Assis (FEMA, Assis Municipality Educational Foundation (FEMA), Assis, São Paulo State, Brazil
| | - Caroline B Prudencio
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Sthefanie K Nunes
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Tawana Pascon
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Ragavendra L S Hallur
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Center for Biotechnology, Pravara Institute of Medical Sciences (Deemed to be University), Loni, Maharashtra, India
| | - Luis Takano
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Department of Medical Health, Medical School, Fundação Educacional do Município de Assis (FEMA, Assis Municipality Educational Foundation (FEMA), Assis, São Paulo State, Brazil
| | - Eusébio M A Enriquez
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Bruna B Catinelli
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Aline M Carr
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Baerbel Junginger
- Department of Gynecology, Pelvic Floor Center Charitè, Charitè University Hospital, Berlin, Germany
| | - Marilza V C Rudge
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Angélica M P Barbosa
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo State, Brazil
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Sartorão Filho CI, Pinheiro FA, Prudencio CB, Nunes SK, Takano L, Enriquez EMA, Orlandi MIG, Junginger B, Hallur RLS, Rudge MVC, Barbosa AMP. Impact of gestational diabetes on pelvic floor: A prospective cohort study with three-dimensional ultrasound during two-time points in pregnancy. Neurourol Urodyn 2020; 39:2329-2337. [PMID: 32857893 DOI: 10.1002/nau.24491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/10/2020] [Indexed: 01/24/2023]
Abstract
AIM To evaluate the pelvic floor (PF) biometry using three-dimensional ultrasound (US) at two-time points of gestational in pregnant women with gestational diabetes mellitus (GDM). METHODS A prospective cohort study conducted at the Perinatal Diabetes Research Center including 44 pregnant women with GDM and 66 pregnant women without GDM at 24 to 28 weeks of gestation. Three-dimensional transperineal US was performed at 24 to 28 and 34 to 38 weeks of gestation in the lithotomy position at rest. The axial plane of the minimal Levator hiatal dimensions was used to determine Levator ani muscle and Hiatal area (HA) biometry at 24 to 28 and 34 to 38 weeks of gestation. RESULTS Of the 110 pregnant women, 100 (90.9%) completed the follow-up at 34 to 38 weeks of gestation. The evaluation by US showed a negative biometric change between the two-time points, during pregnancy in women with GDM; in the HA (β coefficient: estimative of effect in biometric progression according to GDM diagnosis, using the non-GDM group as reference = -6.76; P = .020), anteroposterior diameter (β = -5.07; P = .019), and Levator ani thickness (β = -12.34; P = .005). CONCLUSIONS Pregnant women with GDM had a significantly lower than expected percentage of changes in biometry of Levator ani thickness and HA from 24 to 28 to 34 to 38 weeks of gestation when compared with the group of pregnant women without GDM. GDM alters the morphology of PF structures assessed by three-dimension US. This reported complication may be implicated in adverse birth outcomes and may play a role in the development of PF dysfunction.
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Affiliation(s)
- Carlos I Sartorão Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Department of Medicine, Assis Municipality Educational Foundation (FEMA), Medical School, Fundação Educacional do Município de Assis (FEMA), Assis, São Paulo, Brazil
| | - Fabiane A Pinheiro
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Caroline B Prudencio
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Sthefanie K Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Luiz Takano
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Eusebio M A Enriquez
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Maiara I G Orlandi
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Baerbel Junginger
- Department of Gynecology, Pelvic Floor Center Charité, Charité University Hospital, Berlin, Germany
| | - Raghavendra L S Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Marilza V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Angélica M P Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo, Brazil
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Prudencio CB, Rudge MVC, Pinheiro FA, Sartorão Filho CI, Nunes SK, Pedroni CR, Junginger B, Barbosa AMP. Negative impact of gestational diabetes mellitus on progress of pelvic floor muscle electromyography activity: Cohort study. PLoS One 2019; 14:e0223261. [PMID: 31697712 PMCID: PMC6857854 DOI: 10.1371/journal.pone.0223261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background and objective Pelvic floor muscles are involved in postural stability, in maintenance
intra-abdominal pressure, and on mechanical support for pelvic organ.
Gestational Diabetes Mellitus’ (GDM) pregnancies complicated by fetal
macrosomia, large placenta and polyhydramnios contribute for abrupt and
intense increase in maternal intra-abdominal pressure. Our objective was
analyze the impact of GDM on pelvic floor muscle (PFM) electromyography
(EMG) activity progress from 24–30 to 36–38 weeks of gestation. We conducted
a prospective cohort study. PFM EMG was performed in nulliparous or
primiparous women with one previous elective cesarean delivery and with or
not GDM diagnosed by the American Diabetes Association criteria. A careful
explanation of the muscle anatomy and functionality of the PFM was given
before EMG assessment. The outcome measures were PFM recruitment and
progress from 24–30 to 36–38 weeks of gestation analyzed by the normalized
root mean square (RMS) during rest-activity, fast and hold pelvic floor
muscle contraction. Results Fifty-two pregnant women were assigned to 2 groups: the GDM (n = 26) and
normoglycemic (NG) (n = 26). The demographic and obstetric data showed
homogeneity between the groups. PFM activity progress was decreased in
rest-activity (P = 0.042) and hold contraction (P = 0.044)
at 36–38 weeks of gestation in the GDM group relative to that in the NG
group. Conclusion GDM group showed a progressive decrease in EMG-PFM activity during
rest-activity and hold contractions from 24–30 to 36–38 weeks of
gestation.
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Affiliation(s)
- Caroline B. Prudencio
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
- * E-mail:
| | - Marilza V. C. Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Fabiane A. Pinheiro
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Carlos I. Sartorão Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Sthefanie K. Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Cristiane R. Pedroni
- Department of Physiotherapy and Occupational Therapy, School of
Philosophy and Sciences, São Paulo State University (Unesp), Universidade
Estadual Paulista (UNESP), Marilia, São Paulo, Brazil
| | | | - Angélica M. P. Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, School of
Philosophy and Sciences, São Paulo State University (Unesp), Universidade
Estadual Paulista (UNESP), Marilia, São Paulo, Brazil
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Nunes SK, Rudge CVC, Quiroz SCBV, Hallur RL, Prudencio CB, Pinheiro FA, Filho CIS, Odland J, Calderon IMP, Barbosa AMP, Rudge MVC. Impact of Gestational Diabetes Mellitus on Sexual Function: A Case-Control Study. J Womens Health (Larchmt) 2019; 29:1150-1159. [PMID: 31647360 DOI: 10.1089/jwh.2019.7794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, and this condition may be compromising female sexual function. However, there are controversial findings regarding the impact of GDM diagnosis and proposed treatments on sexual function during pregnancy. Therefore, this study seeks to elucidate the impact of GDM on sexual function in pregnant women by making a comparison between GDM and non-GDM groups using pregnancy sexual response inventory (PSRI). Materials and Methods: A case-control study involved 303 [168 women without GDM (control group) and 108 women diagnosed with GDM (case group)] Brazilian pregnant women at the Perinatal Diabetes Research Centre-Universidade Estadual Paulista, Brazil. PSRI was used to collect the data. The sexual function was scored in 10 domains as composite and specific scores by domains, categorized into quartiles (0 < 25 "very low," 25 < 50 "low," 50 < 75 "high," and 75-100 "very high"), for "before pregnancy" and "during pregnancy." The obtained data were subjected to statistical analysis using Student's t-, F-, and chi-square tests. Results: GDM women (PSRI composite score <50) are at risk of decreased sexual function during pregnancy, while non-GDM women are not at risk (PSRI composite score >50). There were no significant differences in the sexual functions between the two groups before pregnancy (p > 0.0001). After GDM diagnosis and proposed treatment, the differences were significant (p < 0.0001), notably in the frequency, arousal, orgasm, satisfaction, and dyspareunia score. Conclusions: This study showed that GDM diagnosis and proposed treatment resulted in decreased sexual functions during pregnancy.
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Affiliation(s)
- Sthefanie K Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Cibele V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Sofia C B V Quiroz
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Raghavendra L Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Caroline B Prudencio
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Fabiane A Pinheiro
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Carlos I Sartorão Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Jon Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Iracema M P Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Angélica M P Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil.,Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil
| | - Marilza V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
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