Women with gestational diabetes mellitus (GDM) are at increased risk of postpartum urinary incontinence, including stress, urge, and mixed type, say Taiwanese investigators.
And the problems may persist for at least two years after delivery, a finding that goes against the common belief that genitourinary problems subside soon after delivery.
The study also found that quality of life is often compromised in these women, Dr Chi-Mu Chuang from Taipei Veterans General Hospital and National Yang-Ming University said.
"Women with GDM should be provided with timely consultation and support once urinary incontinence occurs," Dr Chuang and colleagues advise in a report online in the British obstetrics journal BJOG.
How the study was done
They studied the impact of GDM on postpartum urinary incontinence in 6 653 pregnant women who delivered a single term infant between 2002 and 2007 at a single hospital in Taiwan. A total of 580 of the women had GDM.
At six weeks postpartum, the percentage of women with urinary incontinence was higher in the GDM group than the non-GDM group: stress urinary incontinence, 11.9% vs 5.6%; urge urinary incontinence, 4.4% vs 1.6%; mixed urinary incontinence, 2.7% vs 0.3%.
After adjusting for multiple confounding factors, GDM was a significant independent risk factor for all types of urinary incontinence, with odds ratios of 1.97 for stress urinary incontinence, 3.11 for urge incontinence and 2.73 for the mixed type.
Findings of the study
The authors say, "Compared with women without GDM, women with GDM tended to exhibit more severe symptoms of stress incontinence for up to two years postpartum, whereas for urge or mixed incontinence, more severe symptoms were found only at six months postpartum."
Quality of life was "generally poorer" among women with GDM, the researchers say. In particular, based on the Incontinence Impact Questionnaire 7, women with GDM who required insulin had a higher likelihood of functional impairment than women with GDM who required conservative treatment only or women without GDM (p<0.05, by the chi-square test for trend).
In their paper, Dr Chuang and colleagues say the "epidemiological value" of the study lies in the establishment of a positive relationship between GDM and urinary incontinence, "in addition to the established positive relationships between diabetes mellitus and urinary incontinence, and between gestation/delivery and urinary incontinence."
"This finding," they say, "suggests that diabetes and gestation/delivery may have additive or synergistic effects on postpartum urinary incontinence. However, the underlying biological pathway was not investigated in the current research, and merits further in-depth study."
(Reuters Health, August 2012)