Study On The Development And Validation Of The Intervention Program For Stress Urinary Incontinence During Pregnancy

BACKGROUDUrinary incontinence is one of the five chronic diseases that affect the quality of life of women,while pregnancy and childbirth are risk factors for female urinary incontinence.The exact factors that induce urinary incontinence during pregnancy remain unclear,and there is a lack of uniform conclusions.The current intervention for urinary incontinence during pregnancy is mainly from the treatment point of view,from a preventive point of view for the cause of systematic intervention is less.OBJECTIVE1.Using META analysis to screen out risk factors affecting the occurrence of urinary incontinence during pregnancy;2.Based on the results of the previous META analysis,to establish a personalized,systematic intervention program for stress urinary incontinence during pregnancy;3.Verify the effectiveness of the intervention program in the clinical application.METHODS1.META analysis.A comprehensive searching of literature about the risk factors of UI during pregnancy were performed from inception to June 2016.Sensitivity analysis and publication bias were analyzed by RevMan 5.0 software and State12.0,respectively.2.The construction of intervention program.Based on the previous studies,literature review was used to form an expert consultation questionnaire.Delphi methods was used to demonstrate the program.Twenty-one experts were invited to conduct 2 rounds of consultation.A pre-experiment was carry out to assess safety and feasibility of the intervention program.Then the final intervention program was confirmed.3.Clinical trial.Totally 60 high-risk pregnant women with SUI from an outpatient obstetrics examination at a top-three hospital in Shenzhen from September 2017 to March 2018 was selected and divided them into intervention group and control group,randomly.An individualized intervention program was performed for intervention group according.The control group received routine perinatal care.Follow-up research was performed until the third trimester（36 weeks）.The main indicators which including the incidence and severity of urinary incontinence,the indicators which including weight gaining during pregnancy,constipation,passive smoking,pelvic floor exercise compliance,etc were compared between the intervention group and control group.RESULTS1.A total of 78887 participants from 12 studies were included.Sensitivity analysis indicated that the pooled estimate was robust and stable.There was no significant publication bias suggested.The meta-analysis results showed that pregnant women aged ≥ 30 years,pre-pregnancy BMI index ≥ 30,pregnancy BMI index ≥ 25,delivery history,constipation,smoking,family UI history,preconception UI history,vaginal birth history,miscarriage history,pelvic floor strength index<30cm H₂O were associated with the prevalence of UI in pregnancy.2.The recovery rate of the two rounds of expert consultation questionnaires was 84%and 95.2%,respectively,and the average authority of the experts was 0.763,which indicated a credible result.The coordination coefficient of the two rounds of consultations was 0.342 and 0.390,respectively,which increased with the number of rounds and showed statistically significant（P<0.05）.No complications related to the intervention plan were found during the pre-examination.Finally,an intervention program for stress urinary incontinence during pregnancy was constructed,including 4 primary indicators,12 secondary indicators,and 35 tertiary indicators.3.A total of 55 pregnant women were included in the clinical trail.In terms of major indicators,the incidence and severity of urinary incontinence were significantly better than the intervention group（P<0.05）,In the secondary indicators,constipation control and passive smoking in intervention group were better than the control group（P＜0.05）.However,there was no statistical difference of weight control between this two groups（P>0.05）.CONCLUSIONIn this study,META analysis was used to screen out the risk factors of UI during pregnancy.Based on the risk factors,Delphi’s expert consultation method was used to establish the intervention program for SUI during pregnancy.Randomized controlled trials（RCT）found that the prevalence rate and the severity of SUI could be reduced among the high-risk pregnant women during the third trimester of pregnancy,which verified its effectiveness and the worthy of further promotion in clinical practice.