Breastfeeding and Postpartum Genitourinary Symptoms, a Prospective Cohort Study

Illston J D1, McMinn E K1, McIlwraith C A1, McGraw M R2, Mounir D1, Lin C P3, Richter H E1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 335
Open Discussion ePosters
Scientific Open Discussion Session 21
Thursday 30th August 2018
13:30 - 13:35 (ePoster Station 2)
Exhibition Hall
Quality of Life (QoL) Female Incontinence Prospective Study Questionnaire
1. University of Alabama at Birmingham, Department of Obstetrics and Gynecology, 2. Greenville Health System, Department of Obstetrics and Gynecology, 3. University of Alabama at Birmingham, Center for Clinical and Translational Science
Presenter
J

Jana Dopson Illston

Links

Poster

Abstract

Hypothesis / aims of study
To evaluate the impact of breastfeeding on postpartum lower urinary tract, vaginal, and sexual function symptoms.  We hypothesized that breastfeeding women would have clinically and statistically significantly worse lower urinary tract symptoms as measured by the Urinary Distress Inventory-6 (UDI-6) at 3 months postpartum than non-breastfeeding women.  Vaginal symptoms and sexual function were evaluated as secondary outcomes.
Study design, materials and methods
After Institutional Review Board approval was obtained, 361 primiparous, postpartum women with singleton deliveries ≥34 weeks were surveyed regarding breastfeeding choices (breastfeeding vs non-breastfeeding) and genitourinary symptoms in this novel prospective cohort study. Validated instruments, including Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), Most Bothersome Symptom questionnaire (MBS), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), were utilized and, apart from for the paper-based baseline collection, were performed on-line. Questionnaires were completed at baseline, 6 weeks, 3 and 6 months postpartum, except the PISQ-IR, which was included at 3 and 6 months.  The primary outcome was comparing UDI-6 scores at 3 months postpartum between subjects primarily breastfeeding vs those not breastfeeding.  Secondary outcome measures included the IIQ-7, MBS and PISQ-IR scores. Two-sample t-tests and chi-square (or Fisher’s exact) tests were used for the bivariate analysis. Multivariable linear and logistic regression models were fitted to evaluate the group differences while controlling for potential confounding variables such as age, race, BMI, diabetes status, and infant weight at delivery. 74 participants were needed in each arm to achieve 80% power to detect a minimum important difference (11.6 points) in UDI-6 using a two-tailed t-test at a type I error rate of 0.05.
Results
183 women (110 breastfeeding, 73 non-breastfeeding) met inclusion criteria. Overall the mean age of participants was 27.3±5.7, 53.6% were Caucasian, and 62.3% delivered vaginally. In bivariate analysis, UDI-6 scores at 3 months were not significantly different between the breastfeeding (5.6±11.8) and non-breastfeeding (7±12) groups, p=0.43.  Similarly, there was no difference at 6 months (5.9±9.5 breastfeeding, 8.1±13.5 non-breastfeeding, p=0.27).  IIQ-7 scores did not differ significantly between groups at 3 months (4.9±7.4 breastfeeding, 13±5 non-breastfeeding, p=0.07) or 6 months (6.9±11.6 breastfeeding, 6.7±16.1 non-breastfeeding, p=0.96). Multivariable analysis at 3 months (Table 1) revealed that breastfeeding participants who were not sexually active had significantly lower partner-related scores (β=-0.85, 95% CI=(-1.58,-0.12), p=0.024) than the non-breastfeeding group. Those in the breastfeeding group who were sexually active scored higher, however, in condition impact than those in the non-breastfeeding group (β=0.29, 95% CI=(0.11, 0.47), p=0.002). Results of the MBS revealed that breastfeeding women were almost three times more likely to experience vaginal dryness (OR=2.82, 95% CI=(1.19, 6.66), p=0.018) at 3 months.
Interpretation of results
Our primary hypothesis was that breastfeeding women would have worse lower urinary tract symptoms and impact; however, there was no difference in UDI-6 and IIQ-7 scores between women breastfeeding versus not breastfeeding at 3 and 6 months postpartum. More bothersome vaginal dryness and mixed impact on sexual function were noted in the breastfeeding group.
Concluding message
Breastfeeding impacts symptoms of vaginal dryness and sexual function but did not affect lower urinary tract symptoms at a clinically significant level.  These findings may lead to treatments impacting postpartum vaginal symptom improvement.
Figure 1
Disclosures
Funding Funding for the BABES Study was partially provided by the Higdon Family Endowment for Resident Research, Greenville Health System Department Obstetrics and Gynecology, Greenville, SC and the University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, AL. Statistical analysis of research reported in this study was partially supported by National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001417. Clinical Trial No Subjects Human Ethics Committee Institutional Review Board Helsinki Yes Informed Consent Yes
28/03/2024 07:14:30