The impact of women's smoking, obesity and mode of delivery on urinary incontinence

Riikka Tähtinen

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Stress urinary incontinence and urgency urinary incontinence are the most burdensome and bothersome of all urinary storage symptoms in women. However, there still remains uncertainty about the impacts of smoking, obesity and mode of delivery on urinary storage symptoms. This thesis describes a series of studies to clarify and quantify the impact of these potentially modifiable risk factors for female urinary storage symptoms. In the first two studies, we used data from the FINNO Study to measure the association of smoking status and smoking intensity, overweight and obesity with urinary storage symptoms. Of the women 2 002 responded (67%). In the multivariable analyses, current smoking was associated with both urinary urgency (OR 2.7, 95% CI 1.7-4.2) and frequency (OR 3.0, 95% CI 1.8-5.0), while stress and urgency urinary incontinence were not associated with current or former smoking. Obese women (body mass index 30 or more) had approximately two-fold increase in stress urinary incontinence (OR 1.9, 95% CI 1.2-3.0) and nocturia (OR 2.4, 95% CI 1.5-3.8), and a three-fold increase in urgency urinary incontinence (OR 3.0, 95% CI 1.2-7.4), compared to normal-weight (body mass index less than 25). The third study was a systematic review and meta-analysis of the long-term impact of the delivery mode (spontaneous vaginal, assisted vaginal and cesarean) on stress and urgency urinary incontinence. Pooled estimates from 15 eligible studies demonstrated an almost two-fold increase in the risk of developing moderate to severe long-term stress urinary incontinence after vaginal delivery compared to cesarean (OR 1.85, 95% CI, 1.56–2.19, I2 = 57%), with an absolute increase of approximately 8%. A gradient that was larger in younger and smaller in older women. We found a small increased risk of moderate to severe urgency urinary incontinence (OR 1.30, 95% CI 1.02–1.65, I2 = 37%), with an absolute increase of approximately 3% in vaginal delivery versus cesarean section. In the fourth study we assessed the risk of long-term stress and urgency urinary incontinence prevalence after different types of vaginal delivery using data from the Norwegian Nord Trøndelag Health Study. Data was linked to the Medical Birth Registry of Norway. The final analysis set included 13 694 women with vaginal deliveries only. For women, aged less than 50, forceps delivery (OR 1.42, 95% CI 1.09-1.86) but not vacuum (OR 0.80, 95% CI 0.59–1.09), was associated with significant increased risk of stress urinary incontinence when compared to spontaneous vaginal delivery. The absolute increase was approximately 5%. Among younger women, forceps also had an increased risk for stress urinary incontinence (OR 1.76, 95% CI 1.20–2.60) when compared to vacuum in the direct comparison. There was no measurable impact between different vaginal delivery modes for women aged 50 or more. In conclusion, we extend previous research by providing symptom-specific associations between obesity or smoking and different urinary storage symptoms. We found a significant impact of vaginal delivery compared with cesarean delivery for younger women on stress urinary incontinence, and demonstrate for the first time the increased risks associated with forceps compared with vacuum. The association of delivery mode on urinary incontinence diminish in older age. As urinary storage symptoms are predicted to increase in prevalence as the world population ages, this work provides directions for future public health efforts.
Original languageEnglish
Supervisors/Advisors
  • Tikkinen, Kari, Supervisor
  • Cartwright, Rufus, Supervisor, External person
Award date5 Dec 2018
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4728-8
Electronic ISBNs978-951-51-4729-5
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Nocturia
  • Parity
  • Urination Disorders
  • Vacuum Extraction, Obstetrical
  • 3142 Public health care science, environmental and occupational health
  • 3123 Gynaecology and paediatrics
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this

Tähtinen, Riikka. / The impact of women's smoking, obesity and mode of delivery on urinary incontinence. Helsinki : [R. Tähtinen], 2018. 118 p.
@phdthesis{e177819547194dbe8a3f4d47678ee85d,
title = "The impact of women's smoking, obesity and mode of delivery on urinary incontinence",
abstract = "Stress urinary incontinence and urgency urinary incontinence are the most burdensome and bothersome of all urinary storage symptoms in women. However, there still remains uncertainty about the impacts of smoking, obesity and mode of delivery on urinary storage symptoms. This thesis describes a series of studies to clarify and quantify the impact of these potentially modifiable risk factors for female urinary storage symptoms. In the first two studies, we used data from the FINNO Study to measure the association of smoking status and smoking intensity, overweight and obesity with urinary storage symptoms. Of the women 2 002 responded (67{\%}). In the multivariable analyses, current smoking was associated with both urinary urgency (OR 2.7, 95{\%} CI 1.7-4.2) and frequency (OR 3.0, 95{\%} CI 1.8-5.0), while stress and urgency urinary incontinence were not associated with current or former smoking. Obese women (body mass index 30 or more) had approximately two-fold increase in stress urinary incontinence (OR 1.9, 95{\%} CI 1.2-3.0) and nocturia (OR 2.4, 95{\%} CI 1.5-3.8), and a three-fold increase in urgency urinary incontinence (OR 3.0, 95{\%} CI 1.2-7.4), compared to normal-weight (body mass index less than 25). The third study was a systematic review and meta-analysis of the long-term impact of the delivery mode (spontaneous vaginal, assisted vaginal and cesarean) on stress and urgency urinary incontinence. Pooled estimates from 15 eligible studies demonstrated an almost two-fold increase in the risk of developing moderate to severe long-term stress urinary incontinence after vaginal delivery compared to cesarean (OR 1.85, 95{\%} CI, 1.56–2.19, I2 = 57{\%}), with an absolute increase of approximately 8{\%}. A gradient that was larger in younger and smaller in older women. We found a small increased risk of moderate to severe urgency urinary incontinence (OR 1.30, 95{\%} CI 1.02–1.65, I2 = 37{\%}), with an absolute increase of approximately 3{\%} in vaginal delivery versus cesarean section. In the fourth study we assessed the risk of long-term stress and urgency urinary incontinence prevalence after different types of vaginal delivery using data from the Norwegian Nord Tr{\o}ndelag Health Study. Data was linked to the Medical Birth Registry of Norway. The final analysis set included 13 694 women with vaginal deliveries only. For women, aged less than 50, forceps delivery (OR 1.42, 95{\%} CI 1.09-1.86) but not vacuum (OR 0.80, 95{\%} CI 0.59–1.09), was associated with significant increased risk of stress urinary incontinence when compared to spontaneous vaginal delivery. The absolute increase was approximately 5{\%}. Among younger women, forceps also had an increased risk for stress urinary incontinence (OR 1.76, 95{\%} CI 1.20–2.60) when compared to vacuum in the direct comparison. There was no measurable impact between different vaginal delivery modes for women aged 50 or more. In conclusion, we extend previous research by providing symptom-specific associations between obesity or smoking and different urinary storage symptoms. We found a significant impact of vaginal delivery compared with cesarean delivery for younger women on stress urinary incontinence, and demonstrate for the first time the increased risks associated with forceps compared with vacuum. The association of delivery mode on urinary incontinence diminish in older age. As urinary storage symptoms are predicted to increase in prevalence as the world population ages, this work provides directions for future public health efforts.",
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The impact of women's smoking, obesity and mode of delivery on urinary incontinence. / Tähtinen, Riikka.

Helsinki : [R. Tähtinen], 2018. 118 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - The impact of women's smoking, obesity and mode of delivery on urinary incontinence

AU - Tähtinen, Riikka

N1 - M1 - 118 s.

PY - 2018

Y1 - 2018

N2 - Stress urinary incontinence and urgency urinary incontinence are the most burdensome and bothersome of all urinary storage symptoms in women. However, there still remains uncertainty about the impacts of smoking, obesity and mode of delivery on urinary storage symptoms. This thesis describes a series of studies to clarify and quantify the impact of these potentially modifiable risk factors for female urinary storage symptoms. In the first two studies, we used data from the FINNO Study to measure the association of smoking status and smoking intensity, overweight and obesity with urinary storage symptoms. Of the women 2 002 responded (67%). In the multivariable analyses, current smoking was associated with both urinary urgency (OR 2.7, 95% CI 1.7-4.2) and frequency (OR 3.0, 95% CI 1.8-5.0), while stress and urgency urinary incontinence were not associated with current or former smoking. Obese women (body mass index 30 or more) had approximately two-fold increase in stress urinary incontinence (OR 1.9, 95% CI 1.2-3.0) and nocturia (OR 2.4, 95% CI 1.5-3.8), and a three-fold increase in urgency urinary incontinence (OR 3.0, 95% CI 1.2-7.4), compared to normal-weight (body mass index less than 25). The third study was a systematic review and meta-analysis of the long-term impact of the delivery mode (spontaneous vaginal, assisted vaginal and cesarean) on stress and urgency urinary incontinence. Pooled estimates from 15 eligible studies demonstrated an almost two-fold increase in the risk of developing moderate to severe long-term stress urinary incontinence after vaginal delivery compared to cesarean (OR 1.85, 95% CI, 1.56–2.19, I2 = 57%), with an absolute increase of approximately 8%. A gradient that was larger in younger and smaller in older women. We found a small increased risk of moderate to severe urgency urinary incontinence (OR 1.30, 95% CI 1.02–1.65, I2 = 37%), with an absolute increase of approximately 3% in vaginal delivery versus cesarean section. In the fourth study we assessed the risk of long-term stress and urgency urinary incontinence prevalence after different types of vaginal delivery using data from the Norwegian Nord Trøndelag Health Study. Data was linked to the Medical Birth Registry of Norway. The final analysis set included 13 694 women with vaginal deliveries only. For women, aged less than 50, forceps delivery (OR 1.42, 95% CI 1.09-1.86) but not vacuum (OR 0.80, 95% CI 0.59–1.09), was associated with significant increased risk of stress urinary incontinence when compared to spontaneous vaginal delivery. The absolute increase was approximately 5%. Among younger women, forceps also had an increased risk for stress urinary incontinence (OR 1.76, 95% CI 1.20–2.60) when compared to vacuum in the direct comparison. There was no measurable impact between different vaginal delivery modes for women aged 50 or more. In conclusion, we extend previous research by providing symptom-specific associations between obesity or smoking and different urinary storage symptoms. We found a significant impact of vaginal delivery compared with cesarean delivery for younger women on stress urinary incontinence, and demonstrate for the first time the increased risks associated with forceps compared with vacuum. The association of delivery mode on urinary incontinence diminish in older age. As urinary storage symptoms are predicted to increase in prevalence as the world population ages, this work provides directions for future public health efforts.

AB - Stress urinary incontinence and urgency urinary incontinence are the most burdensome and bothersome of all urinary storage symptoms in women. However, there still remains uncertainty about the impacts of smoking, obesity and mode of delivery on urinary storage symptoms. This thesis describes a series of studies to clarify and quantify the impact of these potentially modifiable risk factors for female urinary storage symptoms. In the first two studies, we used data from the FINNO Study to measure the association of smoking status and smoking intensity, overweight and obesity with urinary storage symptoms. Of the women 2 002 responded (67%). In the multivariable analyses, current smoking was associated with both urinary urgency (OR 2.7, 95% CI 1.7-4.2) and frequency (OR 3.0, 95% CI 1.8-5.0), while stress and urgency urinary incontinence were not associated with current or former smoking. Obese women (body mass index 30 or more) had approximately two-fold increase in stress urinary incontinence (OR 1.9, 95% CI 1.2-3.0) and nocturia (OR 2.4, 95% CI 1.5-3.8), and a three-fold increase in urgency urinary incontinence (OR 3.0, 95% CI 1.2-7.4), compared to normal-weight (body mass index less than 25). The third study was a systematic review and meta-analysis of the long-term impact of the delivery mode (spontaneous vaginal, assisted vaginal and cesarean) on stress and urgency urinary incontinence. Pooled estimates from 15 eligible studies demonstrated an almost two-fold increase in the risk of developing moderate to severe long-term stress urinary incontinence after vaginal delivery compared to cesarean (OR 1.85, 95% CI, 1.56–2.19, I2 = 57%), with an absolute increase of approximately 8%. A gradient that was larger in younger and smaller in older women. We found a small increased risk of moderate to severe urgency urinary incontinence (OR 1.30, 95% CI 1.02–1.65, I2 = 37%), with an absolute increase of approximately 3% in vaginal delivery versus cesarean section. In the fourth study we assessed the risk of long-term stress and urgency urinary incontinence prevalence after different types of vaginal delivery using data from the Norwegian Nord Trøndelag Health Study. Data was linked to the Medical Birth Registry of Norway. The final analysis set included 13 694 women with vaginal deliveries only. For women, aged less than 50, forceps delivery (OR 1.42, 95% CI 1.09-1.86) but not vacuum (OR 0.80, 95% CI 0.59–1.09), was associated with significant increased risk of stress urinary incontinence when compared to spontaneous vaginal delivery. The absolute increase was approximately 5%. Among younger women, forceps also had an increased risk for stress urinary incontinence (OR 1.76, 95% CI 1.20–2.60) when compared to vacuum in the direct comparison. There was no measurable impact between different vaginal delivery modes for women aged 50 or more. In conclusion, we extend previous research by providing symptom-specific associations between obesity or smoking and different urinary storage symptoms. We found a significant impact of vaginal delivery compared with cesarean delivery for younger women on stress urinary incontinence, and demonstrate for the first time the increased risks associated with forceps compared with vacuum. The association of delivery mode on urinary incontinence diminish in older age. As urinary storage symptoms are predicted to increase in prevalence as the world population ages, this work provides directions for future public health efforts.

KW - Nocturia

KW - Parity

KW - Urination Disorders

KW - Vacuum Extraction, Obstetrical

KW - 3142 Public health care science, environmental and occupational health

KW - 3123 Gynaecology and paediatrics

KW - 3126 Surgery, anesthesiology, intensive care, radiology

M3 - Doctoral Thesis

SN - 978-951-51-4728-8

PB - [R. Tähtinen]

CY - Helsinki

ER -