Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women.

INTRODUCTION AND HYPOTHESIS: Urine loss during recreational exercise is problematic. We aimed to characterize which activities are most frequently reported as causing leakage for women, adaptive management mechanisms, and awareness and interest in treatment in a cohort of physically active women. METHODS: We administered an anonymous questionnaire to 59 physically active women in Canada. Surveys were completed electronically or on paper. Demographic information was obtained. Questions about which specific activities caused leakage, adaptive behaviors to deal with urinary loss, and degree of bother were addressed, and knowledge and interest in therapies for leakage were queried. RESULTS: Activities most likely to cause leakage were skipping, trampoline, jumping jacks, and running/jogging. To decrease leakage, 93.2% voided immediately before exercise, 62.7% reported voiding breaks, and some reported fluid restriction (37.3%). Leakage impacted activity level for 50% of women. Most often, activity intensity was decreased (90.3%) or specific activities avoided (80.7%). Pad use during exercise was common (49.2%). Interest in receiving treatment for urinary incontinence (UI) was high (88.1%) despite a large proportion (35.6%) not knowing of available treatments. Interest was highest for pelvic floor physiotherapy (84.6%), although interest in both pessary and surgical management (63.5% each) was significant. CONCLUSIONS: Women experiencing UI during exercise report high-impact activities as most frequently causing loss. Adaptive behaviors are common. Physically active women are interested in treatment, and the high interest in pelvic physiotherapy presents a unique opportunity to link pelvic exercise with recreational exercise to meet both cardiovascular and continence needs in the physically active patient population.

Group prenatal care versus individual prenatal care: a systematic review and meta-analyses.

OBJECTIVE: To compare the effects of group prenatal care (GPC) and individual prenatal care (IPC) on perinatal health outcomes, including our primary outcomes of preterm birth (PTB < 37 weeks) and low birth weight (< 2500 g). DATA SOURCES: We searched Medline, Embase, CINAHL, and the references of selected articles. STUDY SELECTION: Two reviewers independently performed each step of the systematic review. Of the 4178 non-duplicate titles and abstracts identified, 77 were selected for full-text review. An additional eight full-text articles were selected from reference lists. Overall, 85 full-text articles were reviewed. Studies included assessed maternal or infant health outcomes. DATA EXTRACTION AND DATA SYNTHESIS: Two reviewers independently extracted data from eligible full-text articles. Statistical analyses were completed using Review Manager, version 5.0 (Copenhagen: The Nordic Cochrane Centre, Cochrane Collaboration, 2011), whereby dichotomous variables and continuous outcomes were analyzed using relative risk and mean difference, respectively. The random effects model was employed to pool data. Where available, adjusted data were used to assess the independent effect of GPC. Eight studies of mostly low quality (three randomized controlled trials and five cohort studies) were included, involving 3242 women, most at high risk. Women randomized to GPC had lower rates of PTB (RR 0.71; 95% CI 0.52 to 0.96), no difference in rates of LBW (RR 0.91; 95% CI 0.65 to 1.27) or IUGR (RR 0.85; 95% CI 0.61 to 1.19), fewer Caesarean sections (RR 0.80; 95% CI 0.67 to 0.93), and slightly higher rates of breastfeeding (RR 1.08; 95% CI 1.02 to 1.14). CONCLUSION: Studies comparing GPC with IPC are mostly of low quality and in high-risk groups, although two randomized studies, one a secondary analysis, showed improvement in some outcomes, including rates of PTB in women participating in GPC. In order to determine generalizability, more high-quality studies of GPC are needed.

Do psychiatric medications, especially antidepressants, adversely impact maternal metabolic outcomes?

BACKGROUND: Psychiatric illnesses, particularly depression, are some of the most common complications of pregnancy. Accordingly, pharmacologic treatment of these illnesses is prevalent and increasing. Systematic reviews on psychiatric medication use during pregnancy have shown effects on obstetrical and neonatal outcomes and non-systematic reviews of maternal outcomes suggest higher weight gain and an increased risk of gestational diabetes. However, to date there has not been a systematic review of the effects of these medications on maternal metabolic outcomes. OBJECTIVE: The objective of this study was to assess the relationship between psychiatric medication use during pregnancy and adverse maternal metabolic outcomes [gestational weight gain (GWG), gestational diabetes (GDM) and postpartum weight retention (PPWR)]. STUDY DESIGN: Systematic review and meta-analysis were used. We searched Medline, EMBASE, PsychInfo and references. Two reviewers independently performed each step of the systematic review, following the MOOSE guidelines. RESULTS: Of 3080 non-duplicate titles and abstracts, 175 articles underwent full text review. Two moderate quality cohort studies were included. No differences were found for GWG, GDM and PPWR. LIMITATIONS: There were only two studies which met our inclusion criteria, making it difficult to make any definitive conclusions regarding the effects of psychiatric medication on maternal metabolic outcomes. CONCLUSIONS: Despite the suggestions in non-systematic reviews that psychiatric medication use during pregnancy results in adverse maternal metabolic sequelae, in this systematic review, we found no evidence of an increased risk of GWG, GDM or PPWR in women with psychiatric illness who took psychiatric medications compared to non-medicated women with psychiatric illness. However, more, high quality studies are needed in this area to determine if there is an association between psychiatric medication use and maternal metabolic outcomes.

Inherited predisposition to spontaneous preterm delivery.

OBJECTIVE: To assess inherited predisposition to spontaneous preterm delivery. METHODS: In this retrospective cohort study, intergenerational data on deliveries in mother-daughter pairs were analyzed from the Aberdeen Maternity Neonatal Databank using multilevel logistic regression. The study included an exposed cohort of all women born spontaneously preterm or whose mothers had experienced at least one spontaneous preterm delivery (at 24-37 weeks of gestation). The unexposed cohort included women who were born at term (after 37 weeks of gestation) or those whose mothers had never experienced any spontaneous preterm deliveries (24-37 weeks of gestation). The primary outcome was spontaneous preterm delivery in the daughters' pregnancies. Results are shown as adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We identified 22,343 pregnancies occurring in 13,845 daughters born to 11,576 mothers. Women who were born spontaneously preterm had significantly higher odds of delivering preterm babies (OR 1.49, 95% CI 1.12-1.99). A stronger association was seen when the analysis was restricted to nulliparous women who had been born spontaneously preterm (OR 1.60, 95% CI 1.16-2.21). Other predictors of a woman having a spontaneous preterm delivery were age at delivery younger than 20 years (OR 1.67, 95% CI 1.43-1.94), lower socioeconomic status (OR 1.22, 95% CI 1.04-1.44), smoking more than 10 cigarettes per day (OR 1.47, 95% CI 1.27-1.71), body mass index 19 kg/m or less (OR 1.48, 95% CI 1.24-1.77), previous preterm delivery (OR 2.51, 95% CI 1.71-3.66). The risk of a woman delivering spontaneously preterm was increased even if her mother had a history of spontaneous preterm delivery in any other pregnancy (OR 1.35, 95% CI 1.12-1.63). The absolute risk of spontaneously delivering preterm in women who were born preterm was 9% as opposed to 6.2% in those who were born full-term. This gives an increase in risk of spontaneous preterm birth of 2.8% in women who were born spontaneously preterm. CONCLUSION: Women born spontaneously preterm or with siblings delivered in a similar manner have an increased risk of spontaneous preterm delivery in their own pregnancies. LEVEL OF EVIDENCE: II.