Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort.

BACKGROUND: Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. METHODS: We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. RESULTS: UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. CONCLUSION: While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.

Body mass index, waist circumference, and urinary incontinence in midlife: A follow-up of mothers in the Danish National Birth Cohort.

BACKGROUND: Obesity is a modifiable risk factor for urinary incontinence, yet few studies have investigated how waist circumference as compared to body mass index (BMI) influences the risk of urinary incontinence. OBJECTIVE: To estimate how BMI and waist circumference associates with risk of urinary incontinence in midlife and determine which of the two is the strongest predictor of urinary incontinence. METHODS: Cohort study among mothers in the Danish National Birth Cohort. Weight and waist circumference were self-reported 7 years after cohort entry. Symptoms of urinary incontinence in midlife were self-reported using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and analyzed continuously and as presence or absence of any, stress (SUI), urgency (UUI), and mixed (MUI) urinary incontinence. Linear and log binomial regressions were used to calculate mean differences and risk ratios (RR) with 95% confidence intervals (CI). Restricted cubic splines were generated to explore nonlinear relationships. RESULTS: Among 27 254 women at a mean age of 44.2 years, any urinary incontinence was reported by 32.1%, SUI by 20.9%, UUI by 2.4%, and MUI by 8.6%. For all outcomes, increases in risk were similar with higher BMI and waist circumference. The estimates of association were strongest for MUI (RR 1.10, 95% CI 1.08;1.12 and RR 1.12, 95% CI 1.10;1.14 for half a standard deviation increase in BMI and waist circumference, respectively). While increases in risk of the other outcomes were seen across the entire range of BMI and waist circumference, the risk of SUI rose until BMI 28 kg/m2 (waist circumference 95 cm), and then fell slightly. CONCLUSIONS: Symptoms of urinary incontinence and prevalence of any urinary incontinence, SUI, UUI, and MUI increased with higher BMI and waist circumference. Self-reported BMI and waist circumference were equally predictive of urinary incontinence.