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已发表论文
自然绝经前后女性阴道分娩次数与尿失禁之间的关联：一项横断面研究
Authors Bai X, Li G, Yang D, Ma H, Zhao H, Yang X
Received 1 May 2025
Accepted for publication 9 September 2025
Published 26 September 2025 Volume 2025:17 Pages 3315—3330
DOI https://doi.org/10.2147/IJWH.S537859
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Everett Magann
Xuejiao Bai,1 Guanghui Li,1 Dongxia Yang,2 Hongli Ma,3 Hongxia Zhao,4 Xinming Yang3
1Department of First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 2Department of Gynecology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 3Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 4Institute of Basic Theory of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
Correspondence: Xinming Yang, Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 heping Road, Xiangfang District, Harbin, Heilongjiang, 150040, People’s Republic of China, Tel +8613654540399, Email yangxinming12305@163.com; 420873126@qq.com
Purpose: Urinary Incontinence (UI) associates with menopausal status and vaginal delivery (VD). Existing literature has not confirmed a cumulative effect of an increasing number of VDs on UI incidence, while hormonal changes following natural menopause modulate the risk of UI. This study investigate the association between the number of VDs and UI by stratifying women based on menopausal status.
Patients and Methods: This study examined the relationship between the number of VDs and categories of UI, including Stress Urinary Incontinence (SUI), Urge Urinary Incontinence (UUI), and Mixed Urinary Incontinence (MUI) in pre- and postmenopausal women, utilizing publically accessible data from the National Health and Nutrition Examination Survey (NHANES, 2007– 2018). Weighted multivariable logistic regression, restricted cubic splines (RCS), and subgroup analyses with interaction tests were used to examine their association.
Results: This study comprised 4,046 premenopausal and 2,698 postmenopausal women. Adjusted multivariable regression analysis (Model 2) revealed that compared to nulliparous women, the risk of SUI significantly increased with ≥ 1 VDs in premenopausal women (1 VD: OR=2.53; 2 VDs: OR=3.73; ≥ 3 VDs: OR=2.94; all P< 0.001) and with ≥ 2 VDs in postmenopausal women (2 VDs: OR=1.52; ≥ 3 VDs: OR=1.62, all P< 0.05). MUI risk was elevated at 2 VD in both premenopausal (OR=1.78, P=0.012) and postmenopausal women (OR=1.57, P=0.049). No significant association was detected between the number of VDs and UUI in either group. RCS modeling revealed inverse U-shaped relationships between the number of VDs and SUI risk and L-shaped relationships with MUI risk across both groups (nonlinear P < 0.001).
Conclusion: The number of VDs exhibits positive associations with incident SUI and MUI, while no significant association was detected with UUI. Notably, the additional risk for SUI and MUI associated with the number of VDs was attenuated in postmenopausal women compared to premenopausal women. Prospective studies are warranted to validate the robustness of these associations.
Keywords: Stress Urinary Incontinence, Urge Urinary Incontinence, Mixed Urinary Incontinence, vaginal delivery, natural menopause, NHANES
1Department of First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 2Department of Gynecology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 3Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 4Institute of Basic Theory of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
Correspondence: Xinming Yang, Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 heping Road, Xiangfang District, Harbin, Heilongjiang, 150040, People’s Republic of China, Tel +8613654540399, Email yangxinming12305@163.com; 420873126@qq.com
Purpose: Urinary Incontinence (UI) associates with menopausal status and vaginal delivery (VD). Existing literature has not confirmed a cumulative effect of an increasing number of VDs on UI incidence, while hormonal changes following natural menopause modulate the risk of UI. This study investigate the association between the number of VDs and UI by stratifying women based on menopausal status.
Patients and Methods: This study examined the relationship between the number of VDs and categories of UI, including Stress Urinary Incontinence (SUI), Urge Urinary Incontinence (UUI), and Mixed Urinary Incontinence (MUI) in pre- and postmenopausal women, utilizing publically accessible data from the National Health and Nutrition Examination Survey (NHANES, 2007– 2018). Weighted multivariable logistic regression, restricted cubic splines (RCS), and subgroup analyses with interaction tests were used to examine their association.
Results: This study comprised 4,046 premenopausal and 2,698 postmenopausal women. Adjusted multivariable regression analysis (Model 2) revealed that compared to nulliparous women, the risk of SUI significantly increased with ≥ 1 VDs in premenopausal women (1 VD: OR=2.53; 2 VDs: OR=3.73; ≥ 3 VDs: OR=2.94; all P< 0.001) and with ≥ 2 VDs in postmenopausal women (2 VDs: OR=1.52; ≥ 3 VDs: OR=1.62, all P< 0.05). MUI risk was elevated at 2 VD in both premenopausal (OR=1.78, P=0.012) and postmenopausal women (OR=1.57, P=0.049). No significant association was detected between the number of VDs and UUI in either group. RCS modeling revealed inverse U-shaped relationships between the number of VDs and SUI risk and L-shaped relationships with MUI risk across both groups (nonlinear P < 0.001).
Conclusion: The number of VDs exhibits positive associations with incident SUI and MUI, while no significant association was detected with UUI. Notably, the additional risk for SUI and MUI associated with the number of VDs was attenuated in postmenopausal women compared to premenopausal women. Prospective studies are warranted to validate the robustness of these associations.
Keywords: Stress Urinary Incontinence, Urge Urinary Incontinence, Mixed Urinary Incontinence, vaginal delivery, natural menopause, NHANES