Table 2.
Descriptive data on studies included in the systematic review.
| Origin | Design | Asso- ciation | N | Data gathering | Respons-rate | Adjust. | Time point of UI | Birth-weight | Parity | Age | BMI | Delivery | Main finding | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Altaweel [21] * | Saudi Arabia | Cross-sectional | ++ | 2,180 | Quest.: UDI-6, IIQ-7 | 30 % | Yes | > 4 kg | All | 30 ± 10 | All | SVD and CS | Birthweight of baby >4 kg OR 1.7 (1.4–2). Not data on type or severity by birthweight. | |
| Arya [41] | USA | Cohort | - | 315 | Telephone interview and questionnaire. IIQ-7 | Yes | 2 weeks, 3 months, 1 year after delivery | Primiparous | 21-23 | SVD 48% | On univariate analysis, there was no association between the presences of urinary incontinence at any follow-up period after delivery infant birthweight. Hazard Ratio: 1,0 (95% CI 0,9-1,1) | |||
| Forceps 29% Vacuum 24% | ||||||||||||||
| Baracho [42] | Brazil | Cross-sectional | ++ | 192 | Delivery charts. Interview, ICIQ-SF, physical exam | Yes | 5-7 mth pp | >2.988 kg | Primiparous | 23,2 | BMI>25: 39/192 | SVD | Newborn weight (g), mean (SD) among women with UI: 3,206.4 (364.8). Among women without UI: 3,128.3 (372.8) 0.14*. Significant finding. Sign. association between SUI and weight >2.988 g | |
| Boyles [10] * | USA | Cross- sectional | ++ | 5,599 | Quest. | 39 % | Yes | 3-6 mth pp | > 8 lb. | Primiparous, continent before pregn. | 27 | 24 | CS 27%. Forceps/vacuum 13% | Increasing UI with birthweight >8 lb., but only among women delivering by vaginal delivery: adjusted OR 1.22, (1.03–1.45). OR 0.84 (0.53–1.35) among women delivering by CS. |
| Brown [22] * | Australia | Cross- sectional | ++ | 1,336 | Statewide postal survey. | 62 % | Yes | 6-7 mth pp | >4 kg | All | SVD 69%. Forceps 11%. Emergency CS 9%. Elective CS 9%. | Infants weighing ≥ 4000 g associated with higher rates of urinary incontinence (37/196 [18.9%] versus 101/1097 [9.2%], OR 2.29 [95% CI 1.5-3.5]). Associations of assisted vaginal births controlling for duration of labor, birthweight of infant and perineal trauma. Infant birthweight: <3000 g, 3000-3999 g, >4000 g: Adjusted OR for UI: 1.90 [1.2-3.1] | ||
| Burgio [43] | USA | Cohort | - | 523 | Interview day 2. and 3, week 6 and 3, 6, and 12 mth pp. | Yes | 6 weeks – 12 mth pp. | Mixed, parity 1,9 | 28,6 | Heaviest previous birthweight OR 0.999, 95% CI 0.990- 1.008. p = 793 | ||||
| Cardo [44] | Spain | Cohort | - | 272 | Interviewed at term and 4 months pp. ICQ-SF and KHQ | 4 mth pp | Mixed | 31,8 | SVD 62%. Forceps 4%. Vacuum 21%. CS 21%. |
When only vaginal delivery is analyzed, no statistical association with newborn's weight was found. | ||||
| Caseym [23] * | USA | Cohort | + | 3,887 | Interview | 37 % | Yes | 5-7 mth pp | > 4 kg | Primiparous | 22,5 | BMI 30 | Univariate analyses: Birthweight >4000 g in 279 women (7%). Among these Urge UI 14 (9%, OR 1.3 (0.7- 2.3)). Stress UI 10 (7%, OR 1.0 (0.5- 1.9)). Adjusted analyses: association between stress UI and weight >4000 g: OR 1.2: 0.6 – 2.3. | |
| Castillo [45] | Spain | Cohort | - | 243 | Quest; ICIQ-SF | 6 mth pp. | Mixed | 29,9 | BMI 26,2 | VD 66%. | No statistically significant differences were found between a worsening on quality of life and birthweight | |||
| Chaliha [46] | UK | Cohort | + | 549 | Interview, examination | 100 % | 3 mth pp | Mean 3.37 kg ± 0.49 | Primiparous | 29 | SVD 53%. CS 24% |
Fetal weight ass with urge UI: OR 11.3 95% CI 0.4- 352.8. Stress UI: OR 2.5 95% CI 1.1- 6.1 | ||
| Chou [47] | Taiwan | Cross-sectional | - | 378 | Interview by telephone | Yes | 1 year pp | Mean 3.116 kg | Primiparous | 28,1 | BMI 27,0 | Vaginal 48%. CS 52% | Vaginal delivery: Birth body weight OR 0.999 (95% CI 0.997- 1.002, p = 0.543) for incident stress UI. When CS: Birth body weight OR 0.997 (95% CI 0.997- 1.002, p = 0.543) for incident stress UI (identical to vaginal delivery) | |
| Connolly [48] | USA | Cross-sectional | - | 3,205 | Interview. Sandvik SI score >3. | 36 % | Yes | > 4 kg | Mixed | 49,2 | Vaginal | There was an overall difference in the odds of moderate/ severe UI between the <4,000 g group, the ≥4,000 g group. | ||
| Diez-Itza [24] * | Spain | Cohort | - | 376 | Interview | Yes | 6 weeks pp | > 4 kg | Mixed | 32,4 | Vaginal | Urgency only. Birthweight > 4 kg were not associated with UUI 6 weeks postpartum (OR 0.6, 95% CI 0.05 - 3.10) | ||
| Diez-Itza [17] | Spain | Cohort | - | 272 | Interview | Yes | 2 years pp | Primiparous, continent before pregn. | 31,2 | BMI 23,4 | Vaginal 86%. CS 14%. |
Incident stress UI. No stress UI 2 years postpartum: Mean birthweight 3306. Stress UI 2 years postpartum: Mean birthweight 3281. P = 0.74. | ||
| Dimpfl [31] * | Germany | Cohort | - | 350 | Interview | No | 6 and 12 weeks pp. | 3.5 kg | Continent before pregn. | Vaginal 83%. CS 17% | Mothers, who gave birth to infants with a birthweight above 3500 g (permanent SUI: 4.7%) had no significantly higher incidence of pp UI than mothers with infants under 3500 g (7.0%). Chi’ = 0.22-n.s. | |||
| Dolan [32] * | UK | Cross- sectional | -/+ | 1,861 | Sheffield Pelvic Floor Questionnaires. | 62 % | Yes/No | 20 years after delivery | Mean 3.285 kg | Parity 1,6 | 45,7 | 24,8 | Vaginal 86%, CS 13,9 | Adjusted OR for UI 12 years after delivery in primiparous < 3000 g OR 1.32 (0.73-2.39). 3000 – 3500 g Ref. > 3500 g OR 1.05 (0.59-1.86). Adjusted OR for UI 12 years after delivery in parous: < 3000 g OR 1.25 (0.96-1.62). 3000 – 3500 g Ref. > 3500 g OR 1.21 (0.97- 1.52). |
| Eason [25] * | Canada | Cohort | - | 949 | Quest. Info collected during a RCT of perineal massage during the 3. trimester. | 79 % | Yes | 3 mth pp | 4 kg | Mixed | 28,6 | CS 18% | Baby's weight (g): <4000 N: 837 Risk: 31% OR 1.00. Baby's weight (g): ≥4000 N 112 Risk: 30% Crude OR 0.96 95% CI 0.73-1.48 | |
| Eftekhar [49] | Iran | Cohort | ++ with frequen-cy | 702 | Quest. at prenatal visit week 28-29. | 70 % | 4 mth pp | 3 kg | Primiparous continent before pregn. | Vaginal 51%. CS 49% | Stress UI. A birthweight greater than 3000 g appeared to be associated with increased frequency of SUI P = 0.000; x2 = 22.5. | |||
| Emanuela [50] | Italy | Cohort | - | 93 | Clinical examinations before delivery and at 3 and 6 months pp. | 100 % | 3 and 6 mth pp | 32,6 | Newborn weight did not show statistical differences in continent and incontinent patients | |||||
| Farrell [37] | Canada | Cohort | - | 484 | Questionnaire and hospital charts. | 83,50 % | No | 6 weeks and 6 mth pp | Mean 3.489 kg | Primiparous | 28 | CS 25%. SVD 56%. Instrumental 19%. |
Birthweight (kg) continent women: 3458 g, incontinent women: 3425 g, not significant difference. | |
| Frias [51] | Spain | Cohort | + | 89 | Sandvik questionnaire, ICIQ-SF, PISQ-12 | 2 mth | 53,7% primiparous | 31,3 | 28,3 | Eutocic 68%. Forceps 4% CS 28%. | More women with UI had babies >3000 g than women without…. 84% of women with UI had a newborn weight >3000 g compared with a rate of 60% of women without UI. No statistical differences. | |||
| Fritel [52] | France | Cohort | - | 307 | Questionnaire | 46% | No | 4 years | 4 kg | Primiparous | 29,3 | 21,3 | CS 21% Forceps 36% |
Univariate comparisons between women with current SUI and those with no SUI found no significant association between current birth weight |
| Gartland [26] * | Australia | Cohort | + | 1,283 | hospital records, quest and telephone interviews | 28–31% | No | 3, 6, 9, 12 and 18 mth pp | 4 kg | Primiparous, continent before pregnancy | 31 | SVD 31%. CS 21%. Instr 32%. |
Persistent UI 4 – 18 months postpartum. Birthweight were not significantly associated with persistent UI. Birthweight (g) <2500 OR 1.41Birthweight (g) 2500–3999 OR 1.0 (ref). Birthweight (g) ≥ 4000 OR 1.32. | |
| Glazener [38] | Aberdeen; Scotland, Birmingham; England, Dunedin, NZ | Cross-sectional | ++ for persistent UI starting in pregn. | 3,405 | Questionnaire survey in Maternity units and obstetric case note data | 70-84% | Yes | 3 mth pp | Mean 3.296 kg. Used quartiles. | Primiparous | 26,7 | SVD 58%, CS 17%, Instr 25% |
Incontinence first occurring during pregnancy and still present at 3 months was associated with heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12-2.19). Incident UI after delivery: < 3 kg Ref. 3.00–3.35 kg OR 1.26. 3.36–3.69 kg OR 1.42. ≥ 3.70 kg OR 1.33. Persistent UI starting during pregnancy: < 3 kg Ref. 3.00–3.35 kg OR 1.33. 3.36–3.69 kg OR 1.45. ≥ 3.70 OR 1.56. |
|
| Grodstein [53] | USA | Cohort(?) | - | 83,168 | Nurses’ health study | Yes | Late in life | All | 60,4 | 20 | For birthweight of the heaviest child, little association with UI. Somewhat lower risks with infant of >10.5 pounds at birth compared with <8.5 pounds. Risk for UI: <3.86 kg OR 1.00. 3.86-4.3 kg OR 1.03. 4.35-4.76 kg OR 1.05. > 4.76 kg OR 0.97. | |||
| Groutz [11] * | Israel | Cross-sectional | ++ | 300 | Interview | 100%? | 3 days p | 3.5/4 kg | 100 nulliparous. 100 primiparous. 100 ≥ para 5 | 20 - 43 | VD only | No correlation between birthweight of the first newborn and prevalence of persistent, non-pregnancy-related stress urinary incontinence. Prevalence of persistent, stress UI among grand multiparous women delivering at least one baby >4000 g was 29.4%. Prevalence of persistent stress UI among grand multiparous whose newborns did not weigh more than 4,000 g was significantly lower (16.7%, P < 0.05). | ||
| Groutz [54] | Israel | Cross-sectional | - | 363 | Interview, hospital charts | 1 year pp | mean | Primiparous continent before preg. | 28-32 | 60-63 kg | SVD and CS | Birthweight among continent women: 3240 ± 408. Birthweight among incontinent women: 3330 ± 330. No significant difference. | ||
| Gyhagen [35] | Sweden | Cross-sectional | + | 5,236 | Questionnaire and birth registry | 65 % | Yes | 22 years pp | 4.5 kg | Primiparous | 50-53 | 26 | VD 76% CS 24%. |
Weight > 4 500 g compared to < 4 500 g among CS. OR 0.66 (95% CI 0.33–1.29). Weight > 4 500 g compared to < 4 500 g among VD 1.23 (95% CI 0.87–1.76). The risk of UI after VD vs CS increased with increasing birthweight. |
| Hatem [18] * | Canada | Cross-sectional | - | 1,291 | Questionnaire | 52 % | 6 months pp | 4 kg | Primiparous | 27,20 | 25,2 | Mix | No association between birthweight > 4000 g and UI: OR 0.63 (0.30–1.31) | |
| Hvidman [19] * | Denmark | Cross-sectional | - | 376 | Questionnaire | 1 % | Yes | Few days pp and 3 mth pp | Mixed | 29 | CS 9%. Instr. 7% |
Risk of UI first days PP and 6 mth pp OR 1.0 pr 500 g in adjusted analyses. Adjusted OR for UI first days PP 1.0. OR for UI > 4 weeks PP 1.2 (not sign). Adjusted OR for UI ≥ 12 weeks pp 1.1 (not sign). | ||
| Iwanowicz [12] * | Poland | Cross-sectional | ++ | 313 | Women treated for stress UI; medical history and urodynamic test. | 4 kg | Mixed | 50-53 | The probability of the occurrence of SUI is statistically higher after vaginal delivery of a baby with birthweight of 4000 g or more. 45% of women with UI and 34% of women without UI had babies >4000 g (sign finding). | |||||
| Kashanian [55] | Iran | Cohort | - | 1,400 | Questionnaire | 1 year pp | VD 400. ECS 600. Acute CS 400 | There was no significant difference between the women with SUI and without according to neonatal weight | ||||||
| Koveleva [9] | Russian Federation | Cohort | ++ for mixed UI | 518 | Interview | 4 mth pp | Mean | All | 30,1 | VD and CS | Mean weight of the newborn in group of patients with mixed UI was 3544 + 519 g, in the control group and 3173 + 740 g, (p < 0.01). A relative risk of occurrence mixed UI in group of women with weight of the newborn above 3544 + 519 g was higher (RR = 1,38; 95% CI - 1,02 to 1,85; p < 0,05). | |||
| Krue [13] * | Denmark | Cross-sectional | + | 119 | Questionnaire | 89 % | No | 6-30 mth pp | 4 kg | Mix | >30 | VD | Birthweight >4000 g vs <4000 g; stress UI 34% vs 31%, urge UI 6% vs 4%, mixed UI 15% vs 11%: p > 0.10. In the group whose infant birthweight was 4000 g or more the prevalence of stress incontinence 6–30 months postpartum was higher than in the <4000 g group (34.0% vs. 30.6%) (p > 0.10) | |
| Mallah [20] * | Iran | Cohort | ++ | 441 | Examination, medical records | Yes | 3 mth pp. | 4 kg | Primiparous | 28,1 | 31,5 | Mix | The incidence of UI was higher in cases of vaginal delivery and birthweight greater than 4 kg. OR 4,8 (95% CI 3,0 - 7,7) | |
|
Marsh [56] |
UK | Cross-sectional | - | 324 | Questionnaire | 3 mth pp. | Mean 3.586 kg | 82% primiparous | VD | Birthweight was not associated with increased risk of developing stress urinary incontinence | ||||
| McKinnie [57] | USA | Cross-sectional | ++ | 978 | Questionnaire | Yes | 42,7 | VD | For each additional 16 ounces of infant weight delivered vaginally, the OR for UI increased by 1.13 (1.06–1.20). | |||||
| Obioah [27] * | Nigeria | Cohort | ++ | 230 | Questionnaire interview | Yes | 6 weeks, 3 mth pp | 80% multipara, continent before pregn. | 31,4 | SVD 90% | Birthweight > 4 kg significantly associated with UI 3 months postpartum OR 5.60 (1.21–25.92) | |||
| Rørtveit [14] * | Norway | Cross-sectional | ++ | 11,397 | Questionnaire and birth registry | 80 % | Yes | 4 kg | VD | Significant associations between any UI and birthweight ≥ 4000 g (OR 1.1, 95% CI 1.0-1.2); moderate or severe incontinence OR 1.0 (0.9-1.2). ≥ 4000 g also associated with stress UI. | ||||
| Samuelsson [28] * | Sweden | Cross-sectional | + | 487 | Questionnaire, gyno.examin. | 76 % | Yes | Quar-tiles | Mixed | 39 | 65 kg | Mixed | There were no significant correlations with birthweights >3925 g. | |
| Schytt [16] * | Sweden | Cohort | ++ | 2,390 | Questionnaire Swedish Birth Register | 53 % | Yes/no | 1 year pp | 3.5-4 kg | 44% primiparous. Strati-fied on primiparous. | 30,5 | VD 79%. CS 13%. Instr 13%. |
Birthweight >3500 g was associated with stress UI in multiparas (RR 1.4, CI 95% 1.1–1.7). Within the vaginal group: infant birthweight >3500 g (RR 1.3; CI 95% 1.1–1.6). There was no association in multivariate analyses. Some results are adjusted. | |
| Seshan [58] | India | Cross-sectional | + | 598 | Questionnaire | Yes | Mixed | 20-60 | The weight of the largest baby delivered had the strongest impact on predicting UI symptom severity (UISS) | |||||
| Solans-Domenech [29] * | Spain | Cohort | + | 1,128 | Questionnaire | No | 7 weeks pp | > 4 kg | Continent, nulliparous women | CS 20%. VD 80%. |
UI among 12/56 women with baby >4000 g, UI among 140/832 among women with baby <4000 g. Adjusted HR for incident UI postpartum among women with baby >4000 g: 2.8 (0.9–8.4) | |||
| Thom [30] * | USA | Retro-spective cohort | ++ | 1,521 | Questionnaire, interview, abstraction of labor and delivery records. | Yes | > 4 kg | 56 | VD | Weekly UI significantly associated with weighing 4,000 g or more (OR 1.47, 95% CI 1.16–1.86). When analyzed as a continuous variable, greatest birthweight showed evidence of a threshold effect with an increase in the risk of UI associated with increasing birthweight above about 3,200 g. | ||||
| Torkestani [34] | Iran | Case-control | - | 250 | Questionnaire gyno.exam. | Yes | Mix | 33-40 | Mix | OR 0.928. 95% CI 0.43-2.00 for association with birthweight. | ||||
| Van Brummen [59] | The Netherlands | Cohort | - - | 344 | Questionnaire | 723 % | Yes | 3 and 12 mth pp | 3,418 vs 3,549 | Nulliparous | 30-31 | 21-26 | VD 83%. CS 17%. |
Infant birthweight 3,418 vs 3,549 as risk factor for urgency 1 year pp among women delivering by VD: adjusted OR 0.9 (0.98–0.99). No association was found for stress UI or urge UI. |
| Viktrup [60] | Denmark | Cohort | + | 305 | Questionnaire | 12 mth pp | Mix | VD 82%. CS 18%. |
Birthweight was increased in infants of mothers who developed stress UI after deliver, but not significantly: p = 0,07 | |||||
| Volloyhaug [61] | Norway | Cross-sectional | + | 1,641 | Questionnaire | Yes | Mean 20 years | Parous, mean 2,3 | 47 | 25,8 | VD 42% OD 42% CD 14% | Parity and the largest infant’s birthweight were additional independent risk factors for UI but did not remain significant in a multivariable logistic regression analyzes. | ||
| Wesnes [62] * | Norway | Cohort | ++ | 5,219 | Questionnaire, birth registry | 45 % | Yes | 6 mth pp | 50/ 90 percentile. Re-analyzed on 3,5/4 kg | Primiparous continent before- and during pregn. | 27 | 23,6 | SVD only | Baby's birthweight between the 50th - 90th percentile (3541 - 4180 g) and > 90th percentile (> 4,180 g) were statistically significant risk factors for incident UI 6 months postpartum (OR 1.4; 95% CI 1.2 - 1.6 and OR 1.6; 95% CI 1.2 - 2.0, respectively) as compared to birthweight below the 50th percentile. Data reanalyzed for 3500 g and 4000 g. |
| Williams [63] | UK | Retro-spective, cross-sectional | ++(stress) -- (urge) | 482 | Questionnaire | 23 % | 12 mth pp. | Birthweight was associated with incident stress UI (spearman r coefficient r = 0,04) and protective on incident urge UI (r coefficient r= - 0,04) | ||||||
| Wu [64] | China | Cross-sectional | + + | 2,500 | Interview | 43,5 | Mix | Fetal weight was associated with stress UI only OR 1,64 (95% CI 1.27–2.13), p < 0,001 for macrocosmic infant compared with normal birthweight | ||||||
| Yang [65] | China | Cohort | - | 1,889 | Telephone interview | Yes | 6 mth pp | Primiparous | 30,6 | 72,9 kg | VD 45%. CS 55%. |
No association between neonate birthweight and SUI, UUI or MUI. | ||
| Yohay [66] | Israel | Cohort | - | 37 | Questionnaire medical records, telephone interview | 32 % | 3 mth pp | 3.344 kg | Multiparous mean 2,7 | 30,8 | SVD 73% CS 23% OD 4% |
Other obstetrical parameters including episiotomy and birthweight were not found to be significantly associated with any of the PFD items. | ||
| Yip [67] | Hong Kong | Cohort | - | 148 | Telephone interview | 4 years pp. | 3.2 kg | Nulliparous, continent before pregn. | 27-28 | VD 100% | The logistic regression analysis showed that birthweight was not significantly associated SUI 4 years after the index pregnancy- | |||
| Zanelli [68] | Italy | Cohort | ++ | 452 | Questionnaire | 3 and 12 mth pp | Statistical correlation with incontinence 3 months postpartum was found for high fetal weight | |||||||
| Zhang [69] | China | Cross-sectional | ++ | 4,684 | Questionnaire | 72 % | Yes | 1,1 | 40 | 21,9 | VD 80% CS 20%. |
A multiple logistic regression analysis showed fetal birthweight was common potential risk factors for LUTS (OR 1.40, 1.07–1.85), voiding (OR 1.42, 1.08–1.87) and storage symptoms (OR 1.63, 1.16–2.28). | ||
| Zhu [70] | China | Cross-sectional | - | 5,221 | Interview | ? | Yes | Birthweight was not identified as potential risk factors of female SUI. |
Preg = pregnancy. PP = postpartum. Quest = questionnaire. SVD = spontaneous vaginal delivery. CS = cesarean section. VD = vaginal delivery. Instr = instrumental delivery. OD = operative delivery. Adj. = adjusted analyses. OR = odds ratio. RR = relative risk. Mth = months. UI = urinary incontinence. SUI = stress urinary incontinence. UUI = urgency urinary incontinence. MUI = mixed urinary incontinence. OR = odds ratio. ++ = significant positive association between birthweight and UI. + = non-significant positive association between birthweight and UI. - = non-significant negative association between birthweight and UI. -- = significant negative association between birthweight and UI. * = studies used in meta-analysis.