ABSTRACT
Introduction:
Urinary incontinence (UI) is a common condition affecting women, particularly during pregnancy, due to physiological and birth-related factors. Despite its prevalence, awareness and understanding of UI among pregnant women in Jeddah, Saudi Arabia, remain limited. This cross-sectional study aims to assess the prevalence of UI and its associated risk factors at King Abdulaziz University Hospital.
Methodology:
This is a cross-sectional observational study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, assessing the prevalence of urinary incontinence and its risk factors among pregnant women using a structured questionnaire. Data were cleaned in Excel and analyzed using IBM SPSS 29.0.0.
Results:
In a study of 411 pregnant women from the Makkah region, 159 (38.7%) experienced UI during pregnancy. UI prevalence was significantly associated with being aged 25–34 years, having a university education, and being of normal weight, with all groups showing higher incidence rates (P < 0.05). A higher mean BMI was also linked to an increased likelihood of UI (P < 0.05). Notably, UI risk was higher in women in their third trimester, those experiencing their first pregnancy, and those who had never given birth before (P < 0.05). Additional risk factors included a 3–4-year interval since the last birth, episiotomy, or perineal tears during vaginal delivery and having a previously born child weighing 3.5 kg or more (P < 0.05). Employment status, income level, and smoking did not significantly affect UI prevalence.
Conclusion:
Our study highlights the significant prevalence of UI among pregnant women and its association with key demographic, obstetric, and lifestyle factors. Identifying risk factors such as gestational age, BMI, and delivery history underscores the need for early screening, education, and targeted interventions to improve maternal health and pregnancy outcomes.
Keywords: Maternal health, pregnancy, prevalence, risk factors, urinary incontinence
Introduction
Urinary incontinence (UI) represents a substantial health concern that impacts a significant proportion of women during pregnancy. It is characterized by the involuntary loss of urine and can manifest in various forms, with stress urinary incontinence (SUI) being the most prevalent among this population. The prevalence of UI during pregnancy exhibits considerable variability across different studies and demographic groups, with estimates ranging from 11.4% to a remarkable 84.5%.[1] This variability is largely attributable to differences in research methodologies, definitions of UI, and the demographic profiles of the populations under investigation.
The International Continence Society (ICS) defines urinary incontinence as “a condition where involuntary leakage of urine occurs.” UI affects around 200 million people globally, with women being more prone to experience this problem. Pregnancy and birth-related variables are among the key risk factors for developing UI.[2] Physiological alterations during pregnancy play a pivotal role in the development of UI. As gestation progresses, the enlarging uterus exerts heightened pressure on the pelvic floor musculature and the bladder, resulting in compromised pelvic support and diminished bladder control. Furthermore, hormonal fluctuations during pregnancy significantly influence the elasticity and structural integrity of pelvic tissues.[2] Consequently, numerous women experience UI for the first time during pregnancy, with research indicating that the incidence of UI escalates as gestational age advances.[1]
Numerous risk factors have been identified that are associated with an augmented likelihood of developing UI during pregnancy. Among these, advanced maternal age is frequently linked to an increased susceptibility to UI. Additionally, women who have experienced multiple pregnancies (multipara) demonstrate a higher propensity for UI compared to those who are nulliparous. A prior history of UI significantly escalates the risk during the gestational period. Furthermore, the risk of UI intensifies as pregnancy advances, particularly during the third trimester. Lifestyle factors, including constipation, obesity, and a history of urinary tract infections, have also been shown to correlate with elevated rates of UI among pregnant women.[1,2]
Despite its prevalence, little is known about pregnant women’s understanding and awareness of UI in Jeddah, Saudi Arabia. The ramifications of UI extend beyond mere physical symptoms; they can significantly affect the quality of life of pregnant women. Many report feelings of embarrassment, anxiety, and social isolation as a result of UI, which can impede daily activities and adversely impact emotional wellbeing.[3] Despite the high prevalence and potential consequences of UI, a considerable number of women do not seek medical intervention or discuss their symptoms with healthcare providers, often due to the misconception that it is a normal aspect of pregnancy that will resolve postnatally.[1]
This cross-sectional observational study sought to address the knowledge gap by examining pregnant women’s understanding and awareness of UI in Jeddah. Investigating the existing level of knowledge is critical for designing focused educational programs and preventive actions, which will ultimately contribute to enhanced pregnant women’s health and community wellbeing.
A comprehensive understanding of the prevalence and associated risk factors of UI during pregnancy is essential for healthcare professionals. This awareness can facilitate the development of targeted interventions and educational initiatives aimed at the prevention and management of UI, ultimately enhancing the quality of care provided to pregnant women. Increased awareness and proactive management strategies can mitigate the impact of UI, thereby improving the overall pregnancy experience for many women.
The aim of this study was to assess the prevalence of UI during pregnancy and associated risk factors at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This study is critical in providing data to guide patient-tailored, evidence-based management and the most suitable medical care procedures. It will aid in developing focused strategies for the prevention, early detection, and management of UI, thereby significantly improving pregnancy outcomes in Jeddah.
Methods
Study design, setting, and timeframe
A cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, over a period from August to November 2024.
Study participants
The study included a sample size of 411 pregnant females attending the Obstetric and Gynecological clinic who completed a predesigned international questionnaire. A subset of its questions was adapted from The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) to collect data from participants.
The inclusion criteria for the study comprised all pregnant females of any gestational age, while the exclusion criteria included those presenting with any active symptoms of acute lower urinary tract infection or those with a history of urological or gynecological surgeries.
Sampling methodology and sample size
A nonprobability convenient sampling technique was used to select 411 pregnant women who met the inclusion criteria.
Data collection procedure
Data were collected using a structured questionnaire that included five main sections. The first section contained an informed consent, ensuring that all participants voluntarily agreed to take part in the study after being informed about its purpose, and confidentiality assurances. The second section gathered patient personal data, including age, marital status, educational level, employment status, place of residence, income status, and prepregnancy weight and height for Body Mass Index (BMI) calculation. The third section focused on obstetric and gynecologic history, covering details such as gestational age, parity, previous delivery methods, time interval since the last birth, occurrence of episiotomies or perineal tears during vaginal deliveries, birth weight of the largest newborn, and any history of gynecological surgeries. The fourth section assessed personal habits that could influence UI, including smoking, caffeine intake, constipation, and a history of urinary tract infections. The final section addressed urinary complaints using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF)[4], which categorizes the severity of urinary symptoms into four levels: Slight (1–5), Moderate (6–12), Severe (13–18), and Very Severe (19–21).[5] This section also included questions about urinary frequency during pregnancy, presence and amount of UI, the extent to which it affects daily life, specific situations in which urinary leakage occurs, the number of absorbent pads changed per day due to leakage, associated concerns, history of consultation with healthcare professionals regarding urinary symptoms, and the presence of urinary symptoms before pregnancy. The structured approach ensured a comprehensive analysis of UI among pregnant women.
Ethical clearance
Ethical approval for the study was obtained from the Local Research Ethics Committee of King Abdulaziz University Hospital in Jeddah, Saudi Arabia (Reference No. 196-24).
Statistical analysis
Data were statistically analyzed using SPSS, version 26. Descriptive statistics, including frequencies and percentages for categorical variables, and mean with standard deviation for continuous variables, were computed. The Chi-squared test (χ2) was used for qualitative data, while Mann–Whitney was applied for nonparametric variables.
Multivariate logistic regression analysis was performed to assess the independent predictors of UI during pregnancy. The odds ratio (OR) was calculated with a 95% confidence interval (CI). A P value of < 0.05 was considered statistically significant.
Results
Of the studied 411 pregnant females, 159 (38.7%) had UI during pregnancy [Figure 1].
Figure 1.
Prevalence of urinary incontinence among pregnant women (No.: 411)
Table 1 shows that 47.4% of studied females had an age that ranged from 25 to 34 years, 67.6% had a university level of education, 55.7% were housewives, and 74% had a monthly income that was equal to expenses. Of them, 45.7% had a normal weight, and 17.3% were obese, with a mean BMI of 24.97 ± 4.95 kg/m2. It was found that the prevalence of UI during pregnancy was significantly higher among pregnant females with an age of 25–34 years, having a university education, and those having normal weight (P ≤ 0.05). At the same time, UI prevalence was significantly higher among pregnant females, with a higher mean BMI (P ≤ 0.05).
Table 1.
Relationship between the prevalence of UI during pregnancy and participants’ demographics and prepregnancy BMI (No.: 411)
| Variable | Total No. (%) | UI | χ 2 | P | |
|---|---|---|---|---|---|
|
| |||||
| Yes No. (%) | No No. (%) | ||||
| Age (years) | |||||
| 18–24 | 51 (12.4) | 15 (9.4) | 36 (14.3) | 16.69 | 0.001 |
| 25–34 | 195 (47.4) | 71 (44.7) | 124 (49.2) | ||
| 35–44 | 153 (37.2) | 62 (39) | 91 (36.1) | ||
| ≥45 | 12 (2.9) | 11 (6.9) | 1 (0.4) | ||
| Education level | |||||
| Illiterate | 6 (1.5) | 4 (2.5) | 1 (0.8) | 10.67 | 0.029 |
| Primary | 5 (1.2) | 4 (2.5) | 1 (0.4) | ||
| Secondary | 90 (21.9) | 32 (20.1) | 58 (23) | ||
| University | 278 (67.6) | 101 (63.5) | 177 (70.2) | ||
| Postgraduate | 32 (7.8) | 18 (11.3) | 14 (5.6) | ||
| Employment status | |||||
| Housewife | 229 (55.7) | 91 (57.2) | 138 (54.8) | 0.91 | 0.632 |
| Student | 38 (9.2) | 12 (7.5) | 26 (10.3) | ||
| Employee | 144 (35) | 56 (35.2) | 88 (34.9) | ||
| Income status | |||||
| Income less than expenses | 58 (14.1) | 26 (16.4) | 32 (12.7) | 3.13 | 0.209 |
| Income equal to expenses | 304 (74) | 110 (69.2) | 194 (77) | ||
| Income more than expenses | 49 (11.9) | 23 (14.5) | 26 (10.3) | ||
| Prepregnancy BMI categories | |||||
| Underweight | 25 (6.1) | 2 (1.3) | 23 (9.1) | 27.08 | <0.001 |
| Normal weight | 188 (45.7) | 59 (37.1) | 129 (51.2) | ||
| Overweight | 127 (30.9) | 57 (35.8) | 70 (27.8) | ||
| Obese | 71 (17.3) | 41 (25.8) | 30 (11.8) | ||
| Prepregnancy BMI (Mean±SD) (kg/m2) | 24.97±4.95 | 26.69±4.87 | 23.88±4.69 | 5.72* | <0.001 |
N.B.: *Mann–Whitney test
Table 2 demonstrates that 46% of studied females were in the 2nd trimester of pregnancy; for 28.2%, it was the first pregnancy; 28.2% did not give birth yet; and 44.8% of those with previous delivery had normal delivery. Of them, 29.2% had a 3–4 years interval since last birth, 30.4% had an episiotomy or tear during vaginal delivery, and 31.1% had a previously born child with 3.5 kg birth weight. It was revealed that the prevalence of UI was significantly higher among females in the 3rd trimester, in their 1st pregnancy, who did not give birth yet, and who had normal delivery at last child birth (P ≤ 0.05). At the same time, UI prevalence was significantly higher among those having 3–4 years interval since last birth, who had an episiotomy or tear during vaginal delivery, and who had a previously born child with 3.5 kg birth weight (P ≤ 0.05).
Table 2.
Relationship between the prevalence of UI and obstetric and gynecological history (No.: 411)
| Variable | Total No. (%) | UI | χ 2 | P | |
|---|---|---|---|---|---|
|
| |||||
| Yes No. (%) | No No. (%) | ||||
| Gestational week | |||||
| First trimester | 58 (14.1) | 13 (8.5) | 45 (17.9) | 20.09 | <0.001 |
| Second trimester | 189 (46) | 62 (39) | 127 (50.4) | ||
| Third trimester | 164 (39.9) | 84 (52.8) | 80 (31.7) | ||
| Number of pregnancies | |||||
| 1 (first pregnancy) | 116 (28.2) | 20 (12.6) | 96 (38.1) | 33 | <0.001 |
| 2 | 100 (24.3) | 42 (26.4) | 58 (23) | ||
| 3 | 82 (20) | 40 (25.2) | 42 (16.7) | ||
| More than 3 (4 and above) | 113 (27.5) | 57 (35.8) | 56 (22.2) | ||
| Number of births | |||||
| Zero (Did not give birth yet) | 116 (28.2) | 20 (12.6) | 96 (38.1) | 18.45 | <0.001 |
| 1 | 111 (27) | 44 (27.7) | 67 (26.6) | ||
| 2 | 82 (20) | 39 (24.5) | 43 (17.1) | ||
| 3 | 35 (8.5) | 16 (10.1) | 19 (7.5) | ||
| More than 3 (4 and above) | 67 (16.3) | 40 (25.2) | 27 (10.7) | ||
| Previous birth method/Mode of delivery at last child birth | |||||
| Normal delivery | 184 (44.8) | 90 (56.6) | 94 (37.3) | 32.03 | <0.001 |
| Cesarean section | 109 (26.5) | 48 (30.2) | 61 (24.2) | ||
| Vacuum or Forceps Extraction | 2 (0.5) | 1 (0.6) | 1 (0.4) | ||
| Did not give birth yet (1st pregnancy) | 116 (28.2) | 20 (12.6) | 96 (38.1) | ||
| Time interval since last birth (years) | |||||
| Less than 1 year | 8 (1.9) | 6 (3.8) | 2 (0.8) | 35.07 | <0.001 |
| 1–2 years | 91 (22.1) | 46 (28.9) | 45 (17.9) | ||
| 3–4 years | 120 (29.2) | 54 (34) | 66 (26.2) | ||
| 5 or more years | 76 (18.5) | 33 (20.8) | 43 (17.1) | ||
| Did not give birth yet (1st pregnancy) | 116 (28.2) | 20 (12.6) | 96 (38.1) | ||
| Did you have an episiotomy or tear during vaginal delivery? | |||||
| I haven’t had a vaginal birth previously | 65 (15.8) | 31 (19.5) | 34 (13.5) | 40.78 | <0.001 |
| Yes | 125 (30.4) | 70 (44) | 55 (21.8) | ||
| No | 105 (25.5) | 38 (23.9) | 67 (26.6) | ||
| Did not give birth yet (1st pregnancy) | 116 (28.2) | 20 (12.6) | 96 (38.1) | ||
| What is the lowest birth weight of a previously born child (in kilograms)? | |||||
| Less than 3.5 kg | 106 (25.8) | 40 (25.2) | 66 (26.2) | 12.85 | <0.001 |
| 3.5 kg | 128 (31.1) | 55 (34.6) | 73 (29) | ||
| 4 kg | 43 (10.5) | 30 (18.9) | 13 (5.2) | ||
| 4.5 kg | 17 (4.1) | 13 (8.2) | 4 (1.6) | ||
| 5 kg or more | 1 (0.2) | 1 (0.6) | 0 (0.0) | ||
| Did not give birth yet (1st pregnancy) | 116 (28.2) | 20 (12.6) | 96 (38.1) | ||
Table 3 shows that 14.1% of studied females were smokers, 85.2% were consuming caffeinated beverage, 84.8% were complaining of constipation, and 36.6% had a previous UIT and consulted a doctor. Of them, 97.9% had a urinary leakage before pregnancy; of them, 77.8% had this complaint for 5 years or more before pregnancy. One fifth (20%) reported that they urinate during pregnancy severely. It was observed that UI prevalence was significantly higher among females who were complaining of constipation, had a previous UIT and consulted a doctor, had urinary leakage before pregnancy, had this leakage for 5 years or more before pregnancy, and who urinate during pregnancy in a severe way (P ≤ 0.05).
Table 3.
Relationship between the prevalence of UI and participants’ personal habits and urinary complaints (No.: 411)
| Variable | Total No. (%) | UI | χ 2 | P | |
|---|---|---|---|---|---|
|
| |||||
| Yes No. (%) | No No. (%) | ||||
| Smoking (now or previously) | |||||
| No | 312 (75.9) | 121 (76.1) | 191 (75.8) | 0.005 | 0.943 |
| Yes | 99 (24.1) | 38 (23.9) | 61 (24.2) | ||
| Consumption of caffeinated beverage | |||||
| No | 61 (14.8) | 22 (13.8) | 39 (15.5) | 0.2 | 0.649 |
| Yes | 350 (85.2) | 137 (86.2) | 213 (84.5) | ||
| Complaints of constipation | |||||
| No | 168 (65.2) | 74 (46.5) | 194 (77) | 19.82 | <0.001 |
| Yes | 143 (84.8) | 85 (53.5) | 58 (23) | ||
| Previous urinary tract infections | |||||
| No | 217 (52.8) | 45 (28.3) | 172 (68.3) | 13.98 | <0.001 |
| Yes – and visited the doctor | 149 (36.3) | 84 (52.8) | 65 (25.8) | ||
| Yes – but have not visited the doctor | 45 (10.9) | 30 (18.9) | 15 (6) | ||
| Did you have urinary leakage before pregnancy? | |||||
| No | 9 (2.1) | 9 (5.7) | 0 (0.0) | 14.58 | <0.001 |
| Yes | 402 (97.9) | 150 (94.3) | 252 (100) | ||
| If your answer is “yes,” how long have you had this complaint? | |||||
| For less than one year before pregnancy | 2 (22.2) | 7 (4.4) | 0 (0.0) | 14.58 | 0.001 |
| For five years or more before pregnancy | 7 (77.8) | 2 (1.3) | 0 (0.0) | ||
| Do you frequently urinate during pregnancy? | |||||
| Never | 8 (1.9) | 0 (0.0) | 8 (2.3) | 15.66 | <0.001 |
| Mildly | 125 (30.4) | 24 (15.1) | 101 (40.1) | ||
| Moderately | 196 (47.7) | 72 (45.3) | 124 (49.2) | ||
| Severely | 82 (20) | 63 (39.6) | 19 (7.5) | ||
Multivariate logistic regression analysis was done to assess the risk factors (independent predictors) of UI during pregnancy. It was found that having a university education, having one birth, having 3–4 years interval since last birth, having a previously born child with a birth weight of 3.5 kg, and complaints of constipation or previous UTI with visiting doctors for consultation were risk factors (independent predictors) of UI during pregnancy among studied females [Table 4].
Table 4.
Multivariate logistic regression analysis of risk factors of UI during pregnancy among studied pregnant females
| Variable | B | Wald | P | Odds Ratio (CI: 95%) |
|---|---|---|---|---|
| Age (years) | 0.18 | 0.61 | 0.432 | 1.2 (0.76–1.89) |
| Educational level | 0.47 | 4.98 | 0.026 | 1.62 (1.4–2.94) |
| BMI | 0.06 | 0.8 | 0.369 | 0.93 (0.8–1.08) |
| BMI categories | 0.17 | 0.16 | 0.683 | 1.18 (0.52–2.69) |
| Gestational week | 0.34 | 3.25 | 0.071 | 0.7 (0.48–1.03) |
| Number of pregnancies | 0.35 | 1.46 | 0.226 | 1.42 (0.8–2.5) |
| Number of births | 0.54 | 6.46 | 0.011 | 1.58 (1.48–3.88) |
| Previous birth method/Mode of delivery at last child birth | 0.24 | 1.08 | 0.308 | 0.27 (0.79–1.05) |
| Time interval since last birth (years) | 0.4 | 4.78 | 0.029 | 1.49 (1.04–2.14) |
| Did you have an episiotomy or tear during vaginal delivery? | 0.35 | 2.26 | 0.133 | 1.42 (0.89–2.24) |
| What is the lowest birth weight of a previously born child (in kilograms)? | 0.43 | 6.88 | 0.009 | 1.64 (1.47–3.89) |
| Complaints of constipation | 0.8 | 9.61 | 0.002 | 1.44 (1.27–2.74) |
| Previous Urinary Tract Infections | 0.98 | 4.75 | 0.029 | 2.68 (1.1–6.51) |
| Did you have urinary leakage before pregnancy? | 0.79 | 0.01 | 0.089 | 0.23 (0.34–1.08) |
| Duration of urinary leakage before pregnancy | 0.11 | 0.67 | 0.081 | 0.33 (0.51–1.67) |
| Do you frequently urinate during pregnancy? | 0.74 | 11.75 | 0.001 | 1.47 (1.31–3.72) |
For women with UI (No.: 159), Figure 2 illustrates that the most common situations they experience urinary leakage were when coughing or sneezing (67.9%), before reaching the toilet (47.1%), when physically active or exercising (23.8%), and after finishing urinating and dressing (20.1%).
Figure 2.
Percentage distribution of situations in women with UI who experience urinary leakage (No.: 159)
Table 5 shows that for women with UI (No.: 159), 32.7% do not use pads, 66.1% started urinary leakage during the 2nd trimester, and for 46.1%, the major concern was being worried UI will continue after childbirth. Only 47.7% consulted a healthcare facility due to urinary leakage, and 85.6% for those with no consultation thought that UI is a normal condition.
Table 5.
Amount and types of leakage in women with UI (No.: 159)
| Variable | No. (%) |
|---|---|
| How many pads do you use due to urinary leakage? | |
| I don’t use pads | 52 (32.7) |
| 2 per day | 57 (36) |
| More than 3 per day | 33 (20.7) |
| 1–2 per week | 17 (10.6) |
| When did urinary leakage start during pregnancy? | |
| First trimester | 11 (6.9) |
| Second trimester | 105 (66.1) |
| Third trimester | 43 (27) |
| What concerns you about urinary leakage? | |
| I’m worried about the urine smell | 48 (30.1) |
| I’m worried about urine leaking from my pad | 28 (17.6) |
| I’m worried it will continue after childbirth | 73 (46.1) |
| Other (Worried about cleanliness, urine leaking on underwear, needing to change clothes outside the home) | 3 (1.8) |
| No worry | 7 (4.4) |
| Have you consulted any healthcare facility due to urinary leakage? | |
| No | 83 (52.3) |
| Yes | 76 (47.7) |
| If your answer is no, why not? (No.: 83) | |
| I think this is a normal condition | 71 (85.6) |
| Fear of examination | 12 (14.4) |
The mean score was 4 ± 6.17. Figure 3 demonstrates that for women with UI, 19.4% and 14.4% had severe and very severe UI, respectively, based on the ICIQ-UI SF score classification.
Figure 3.
Severity of UI based on the ICIQ-UI SF score classification among women with UI (No.: 159)
Discussion
UI is the involuntary leakage of urine, affecting approximately 421 million people worldwide (8.7%), with women being more susceptible.[5] Pregnancy-related factors such as obesity, increased intra-abdominal pressure, hormonal changes, and multiparity affect pelvic floor muscle function, contributing to UI.[6] However, awareness among pregnant women in Jeddah, Saudi Arabia, remains limited. This cross-sectional study aimed to assess the prevalence of UI and its associated risk factors at King Abdulaziz University Hospital. Understanding current knowledge levels is essential for developing educational programs, preventive strategies, and evidence-based management approaches to improve pregnancy outcomes. The findings will guide tailored interventions for early detection and effective management of UI in pregnant women.
Notably, our findings reveal that 38.7% of pregnant women experience UI, with significant associations observed with age, education level, BMI, gestational trimester, obstetric history, constipation, and previous urinary tract infections (UTIs). These findings align with previous research, which has reported UI as a common and embarrassing complaint among pregnant women,[7] although variations exist in prevalence rates. Mohseni et al.[8] reported that the prevalence of UI was 29.7% among pregnant women, with 26.4% experiencing mild leakage, while 3.3% had moderate to severe leakage.[9] Tesemma et al.[1] found that the prevalence of UI was 18.6%, with stress UI being the most common type (9.3%). Similarly, a Saudi Arabian study by Al-Almutairi et al.[9] found that 41.7% of pregnant women reported UI, further reinforcing our results. Variations in UI prevalence can be attributed to differences in study populations, assessment methods, and cultural perceptions regarding UI reporting. Moreover, Yang et al.[10] found that the impact of UI on daily life was significantly greater in postpartum women compared to pregnant women, particularly in terms of social embarrassment.
Additionally, our study found that UI was significantly more prevalent among women aged 25–34 years and those with a university education. This aligns with findings from previous literature, which observed that women in their late twenties and early thirties were at higher risk due to the cumulative impact of pregnancy-related physiological changes. Xue et al.[11] found that UI prevalence in young women (aged 18–40) ranged from 2.6% to 30%. In contrast, some studies have reported higher UI prevalence among older pregnant women (>35 years) due to decreased pelvic floor muscle strength. Melville et al.[12] reported that UI prevalence increased with age as 28% of women aged 30–39 experienced UI, compared to 55% of women aged 80–90.[13] The association with education level may be linked to increased awareness and reporting among university-educated women, contrasting with other studies where lower education levels were linked to a higher risk of UI, making less-educated women more prone to experiencing UI issues.[14]
Prepregnancy BMI was significantly associated with UI, with obese women exhibiting a higher prevalence (P < 0.05). Our study reported a mean BMI of 24.97 ± 4.95 kg/m2, with UI prevalence increasing in overweight and obese individuals. These results align with those of Alsannan et al.,[13] who identified obesity as a major risk factor due to increased intra-abdominal pressure, which exacerbates stress incontinence. Similarly, Liang et al.[15] found that maternal BMI ≥25 increased the risk of UI during pregnancy, with an odds ratio of 1.35.
UI prevalence was the highest among women in their third trimester (P < 0.001), supporting findings from previous literature. Similarly, Ferrari et al.[16] reported that UI prevalence was 4.4% in the first trimester, peaking at 23.7% in the third trimester, with varying rates in between. The growing uterus exerts increased pressure on the bladder, reducing its capacity and leading to more frequent leakage episodes. Additionally, our study found a significant association between UI and first-time pregnancy (P < 0.001). However, Wuytack et al.[17] found that multiparity was associated with a 2.09-fold increase in the likelihood of UI in pregnancy compared to nulliparity.
Our findings demonstrate that UI was significantly more prevalent among women who had undergone normal vaginal deliveries compared to cesarean sections (P < 0.001). This result is consistent with previous research, which shows that vaginal delivery significantly increases the risk of UI due to trauma to the pelvic floor and sphincter muscles. Similarly, Wesnes et al.[18] found that forceps deliveries (Relative Risk 4.0), spontaneous vaginal deliveries (Relative Risk 3.2), and vacuum deliveries (Relative Risk 3.2) were the strongest risk factors for de novo UI compared to elective cesarean section, with similar findings reported in another study by Novo et al.[19] Furthermore, we found that a 3–4-year birth interval, history of episiotomy or perineal tears, and a previously born child with a birth weight of 3.5 kg or more were independent predictors of UI, corroborating previous studies.[20,21] Maroyi et al.[22] reported associations between UI and pregnancy-related factors such as macrosomia history and prior episiotomy. These factors contribute to sustained pelvic muscle stretching and increased intra-abdominal pressure, predisposing women to UI.
Constipation, previous UTIs requiring medical consultation, and a history of urinary leakage before pregnancy were strongly associated with UI (P < 0.05). These findings align with previous research indicating that chronic constipation increases intra-abdominal pressure and weakens pelvic floor muscles.[23] Similarly, Dinç et al.[2] found that significant risk factors included previous UTI, constipation, and gestational age.
Additionally, frequent urination during pregnancy was significantly correlated with UI (P < 0.001). Women with severe UI often experienced leakage when coughing, sneezing, or exercising (67.9%), aligning with studies that categorize UI in pregnancy as predominantly SUI.[8]
A concerning finding in our study was that 52.3% of women did not seek medical consultation for UI, with 85.6% believing it to be a normal condition. This reluctance to seek medical advice has been reported in other studies, including one by Soltani et al.,[24] where embarrassment, cultural stigma, and lack of awareness were cited as major barriers to healthcare access for UI management. This highlights the need for targeted health education campaigns to improve UI awareness and encourage women to seek timely medical advice.
Limitations
There are several limitations to our study. The cross-sectional design limits the ability to establish causality, and reliance on self-reported data may introduce recall bias. Since the study was conducted at a single hospital, the findings may lack generalizability. Uncontrolled confounding factors such as hydration, diet, and physical activity could influence the results. The absence of postpartum follow-up prevents understanding of UI persistence, and the lack of intervention assessment limits practical applications. Despite these limitations, the study underscores key risk factors and the need for educational programs and early interventions to improve maternal health.
Future directions and implications
There is a need for early screening, education, and preventive strategies in prenatal care. Many women view UI as normal, underscoring the importance of awareness programs and routine screening by healthcare professionals. Future research should focus on longitudinal and multicenter studies, intervention-based approaches, and psychosocial impacts to improve clinical guidelines and maternal healthcare strategies, ultimately enhancing UI prevention, management, and overall maternal wellbeing.
Conclusion
Our study reveals a significant prevalence of UI among pregnant women and its association with various demographic, obstetric, and lifestyle factors. It underscores the importance of early screening and education to improve awareness and management. Identifying modifiable risk factors, such as obesity and constipation, can aid in developing preventive strategies. Additionally, many women perceive UI as a normal condition, leading to underreporting and a lack of medical consultation. Enhancing antenatal care programs with UI screening and counseling can improve pregnancy outcomes. Future research should explore longitudinal assessments and intervention-based approaches for effective management and prevention.
Ethical considerations
Privacy and confidentiality were obtained throughout the study and the data was only accessed by the authors. The study was conducted in accordance with the ethical principles mentioned in the Declarations of Helsinki (2013). Ethical approval was obtained from our center’s Research Biomedical Ethics Committee (reference number 164-24).
Conflicts of interest
There are no conflicts of interest.
Abbreviations
UI – Urinary Incontinence
SUI – Stress Urinary Incontinence
ICS – International Continence Society
ICIQ-UI-SF – International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form
KAUH – King Abdulaziz University Hospital
BMI – Body Mass Index
SPSS – Statistical Package for the Social Sciences
OR – Odds Ratio
CI – Confidence Interval
UTI – Urinary Tract Infection
RR – Relative Risk
Funding Statement
Nil.
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