Impact of physical activity on urinary continence in pregnant and postpartum women - A prospective bicentric study

Urinary incontinence (UI), defined by ICS as the involuntary loss of urine, is a common condition among women. It significantly impacts women's quality of life, and pregnancy and childbirth are key risk factors. This study aims to evaluate the impact of physical activity (PA) on UI during pregnancy and at 3 months postpartum.

This prospective bicentric study was conducted at two hospitals from September 2020 to 2023. Primiparous with singleton pregnancies were included. PA was assessed using the Ricci and Gagnon questionnaire and the Pregnancy Physical Activity Questionnaire (PPAQ). PA outside of pregnancy was categorised based on the Ricci and Gagnon score (>18: active, <18: inactive). During pregnancy, women were considered "active" if their activities, as per the PPAQ, exceeded 2hours per week. The presence and severity of UI, as well as its impact on quality of life, were evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the CONTILIFE questionnaire. UI was defined by an ICIQ-SF score>0. Assessments were conducted during the third trimester of pregnancy and at 3 months postpartum. A questionnaire on pelvic anatomy and its rehabilitation was developed to assess the women's knowledge and expectations.

Of the 287 respondents during pregnancy, 202 completed the postpartum follow-up. PA was reported at 57.9% before pregnancy and decreased by half during pregnancy (29.9%). The prevalence of UI was 9.1% before pregnancy, 39.4% in the third trimester, and 36.8% at 3 months postpartum. High BMI in the third trimester was a significant risk factor for UI during pregnancy. PA was not a risk factor for UI either before or during pregnancy. However, resuming PA after delivery was associated with a significant reduction in UI (P=0.02; IR=0.48 [IC 95%: 0.26-0.89]). Knowledge about pelvic floor rehabilitation was limited, although most women expressed a desire to learn more about this.

Physically active women do not have higher prevalence of UI during pregnancy. PA in the postpartum period significantly associated with the prevalence of UI. UI during pregnancy is a key indicator of UI postpartum. It is crucial to enhance education on PA and pelvic rehabilitation to optimise the management of UI and improve women's quality of life.