In the light of the complex inter-relationships among diabetes mellitus, pregnancy and urinary incontinence, the hypothesis was that gestational diabetes mellitus (GDM) associated with pregnancy-specific urinary incontinence (PS-UI) will increase the occurrence and severity of UI, having a negative impact on the QoL during pregnancy and up to 12 months postpartum. The aim of this study was to investigate the severity and impact of UI on quality of life (QoL) of diabetic pregnant women over a 1-year follow-up period.

This cross-sectional study was conducted in a Perinatal Diabetes Research Center and was approved by the Research Ethics Committee of the Institution. Three hundred eighty-eight women were evaluated at five-time-points: 24-28 gestational weeks (visit 1), 34-38 gestational weeks (visit 2), 24-48 hours postpartum (visit 3), 6 weeks postpartum (visit 4) and 6-12 months postpartum (visit 5). The diagnosis of Gestational Diabetes Mellitus (GDM) was established between 24th and 28th gestational weeks, by the 75 g-OGTT test according to ADA’s criteria (1). Urinary incontinence was defined according to the International Continence Society (2) and the severity and impact on QoL were evaluated by ISI (Urinary Incontinence Severity Index) and ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form). From the data, the pregnant women were classified into two study groups: normoglycemic incontinent (NI; normal 75-g GTT; n=168) and diabetic incontinent (DI; abnormal 75-g GTT; n=220). The NI and DI groups were compared using the Chi-square test for categorical variables and Student-t test for quantitative variables. All analyses were performed using SAS software for Windows, v.9.3.

The figure 1 indicates the incontinence data and questionnaire response and the figure 2 shows the classification of UI severity and its impact on the quality of life.

The responses to the ISI and ICIQ-SF questionnaires showed greater severity combined with greater bother-score in diabetic women, with severe and very severe classification, compared to normoglycemic women in all time-points. The third item of the ICIQ-SF (Impact of UI on QoL) also demonstrated higher levels of interference on daily life in diabetic women, both during pregnancy and after delivery, except at 6 weeks postpartum (P=0.1105).

Diabetic pregnant women tended to exhibit more severe symptoms of PS-UI as well as the worse impact on QoL during pregnancy with an excessive tendency to show a similar reaction over the first year postpartum. These study not only contradicts the old concept that the effects of GDM vanish soon after delivery but also reinforce the positive interaction between pregnancy, GDM and long-term maternal outcome.

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