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Mixed-Methods Study of Post-Partum Urinary Incontinence in a Cohort of Women Traditionally Underrepresented in Clinical Trials
Andrea S. Kuriyama, B.S.1, Chad M. Coleman, Ph.D.1, Renee C. Noordzij, B.S.2, Yvette C. Cozier, D.Sc.1, Lois McCloskey, Dr.P.H.1, Bernard L. Harlow, Ph.D.1, Toby C. Chai, M.D.3.
1Boston University School of Public Health, Boston, MA, USA, 2Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, 3Boston Medical Center / Boston University, Boston, MA, USA.

BACKGROUND: Post-partum urinary incontinence (PPUI) can significantly decrease quality of life for individuals who are relatively young and healthy. This mixed-methods study assessed symptoms of urinary incontinence, knowledge and attitudes in a group of individuals who were at least 1 year post-partum or pregnant. The participants comprise underrepresented populations cared for at an urban safety net hospital. METHODS: This study was approved by the local IRB. English and Spanish speaking women (n=55) attending Boston Medical Center (BMC) pediatrics clinic for their birthed childs' (>12 months of age) routine well baby visit participated in the quantitative portion of this study. Pregnant women (n=7) and post-partum women (n=8) attending BMC obstetrics clinic participated in focus groups for the qualitative portion of this study. For the quantitative analysis, participants self-administered questionnaires (ICIQ, IIQ, OABSS and investigator generated questions) and the responses were quantitated and analyzed. For the quantitative study, participants were asked by an experienced facilitators (fluent in both Spanish and English) about UI, specifically where their knowledge of these conditions came from and their experiences and degree of bother with UI during pregnancy and post-partum. RESULTS: Table 1 shows the demographic details for the quantitative portion of the study where the majority (54.5%) were non-Hispanic Black and 29% were Hispanics. Table 2 and 3 shows the responses to ICIQ, IIQ, OABSS validated instruments. Of the 55 participants in the quantitative study, ~25% reported that their perception of overall bladder control was worse than prior to pregnancy. The majority of the 55 participants answered that healthcare providers did not convey information about UI or PPUI and did not provide information about UI during their pregnancy. Several themes were elicited from the qualitative study. 1. PPUI is not discussed by most providers though women hear about it in other ways. 2. PPUI is a sensitive topic of discussion. 3. PPUI disturbs daily life. 4. PPUI is not a priority relative to other pregnancy-related topics. CONCLUSIONS: Urinary incontinence during and after pregnancy is a source of physical and psychosocial morbidity resulting in substantial decrease to quality of life. However the education provided by healthcare providers to pregnant and postpartum individuals does not reflect this severity. As such, this study identifies a healthcare gap in which guidelines can be instituted which encourages healthcare providers to educate pregnant patients on UI and provide pelvic floor exercises and therapy in order to prevent it. Future PPUI prevention trials are justified in an underrepresented population.

Table 1
AgeN (%)
<255 (9.1)
25-2913 (23.6)
30-3415 (27.3)
35 or older22 (40.0)
Racial DemographicsN (%)
Hispanic16 (29.1)
Non-Hispanic White6 (10.9)
Non-Hispanic Black30 (54.5)
Other3 (5.5)

Table 2
Frequency of LeakageN (%)
None21 (38.2)
1x/wk or less13 (23.6)
2-3x/week of more21 (38.2)
Interference (1-10)N (%)
025 (45.5)
15 (9.1)
26 (10.9)
35 (9.1)
4 or more14 (25.5)

Table 3
Score (range)Mean (S.D.)
ICIQ (0-19)5.6 (6.0)
IIQ (0-21)5.4 (6.3)
OABSS (1-27)11.4 (6.5)

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