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Cited by 48Pelvic floor disorders treatmentsPregnancy-related medical researchPhysical Activity and Health

Early postpartum physical activity and pelvic floor support and symptoms 1 year postpartum

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Nygaard, Ingrid E., Wolpern, Ali, Bardsley, Tyler, Egger, Marlene J., Shaw, Janet M.·2021·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2020.08.033PMC PMC7855223
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Abstract

Background Risks of pelvic organ prolapse and urinary incontinence increase after the first vaginal delivery. During the early postpartum period, a time of active regeneration and healing of the pelvic floor, women may be particularly vulnerable to greater pelvic floor loading.Objective This prospective cohort study aimed to determine whether objectively measured moderate to vigorous physical activity in the early postpartum period predicts pelvic floor support and symptoms 1 year after the first vaginal birth.Study design We enrolled nulliparous women in the third trimester, later excluding those who had a cesarean or preterm delivery. Participants wore triaxial wrist accelerometers at 2 to 3 weeks and 5 to 6 weeks postpartum for ≥4 days. Primary outcomes, assessed 1 year postpartum, included (1) pelvic floor support on Pelvic Organ Prolapse Quantification examination, dichotomized as maximal vaginal descent of <0 cm (better support) vs ≥0 cm (worse support); and (2) pelvic floor symptom burden, considered positive with report of ≥1 bothersome symptom in ≥2 of 6 domains, assessed using the Epidemiology of Prolapse and Incontinence Questionnaire. The primary predictor was average daily moderate to vigorous physical activity. Because we could not eliminate women with pelvic floor changes before pregnancy, we modeled prevalence, rather than risk, ratios for each outcome using modified Poisson regression.Results Of 825 participants eligible after delivery, 611 completed accelerometry and 1-year follow-up; 562 completed in-person visits, and 609 completed questionnaires. The mean age was 28.9 years (standard deviation, 5.01). The mean for moderate to vigorous physical activity measured in minutes per day was 57.3 (standard deviation, 25.4) and 68.1 (standard deviation, 28.9) at 2 to 3 weeks and 5 to 6 weeks, respectively. One year postpartum, 53 of 562 participants (9.4%) demonstrated worse vaginal support and 330 of 609 participants (54.2%) met criteria for pelvic floor symptom burden. In addition, 324 (53.1%), 284 (46.6%), 144 (23.6%), and 25 (4.1%) reported secondary outcomes of stress urinary incontinence, overactive bladder, anal incontinence, and constipation, respectively, and 264 (43.4%), 250 (41.0%), and 89 (14.6%) reported no, mild, or moderate to severe urinary incontinence, respectively. The relationship between moderate to vigorous physical activity and outcomes was not linear. On the basis of plots, we grouped quintiles of moderate to vigorous physical activity into 3 categories: first and second quintiles combined, third and fourth quintiles combined, and fifth quintile. In final multivariable models, compared with women in moderate to vigorous physical activity quintiles 3 and 4, those in the lower 2 (prevalence ratio, 0.55; 95% confidence interval, 0.31-1.00) and upper quintile (prevalence ratio, 0.70; 95% confidence interval, 0.35-1.38)) trended toward lower prevalence of worse support. However, we observed the reverse for symptom burden: compared with women in quintiles 3 and 4, those in the lower 2 (prevalence ratio, 1.20; 95% confidence interval, 1.02-1.41) and upper quintile prevalence ratio 1.34 (95% confidence interval, 1.11-1.61) demonstrated higher prevalence of symptom burden. Moderate to vigorous physical activity did not predict any of the secondary outcomes. The presence of a delivery factor with potential to increase risk for levator ani muscle injury did not modify the effect of moderate to vigorous physical activity on outcomes.Conclusion Except for support, which was worse in women with moderately high levels of activity, early postpartum moderate to vigorous physical activity was either protective or had no effect on other parameters of pelvic floor health. Few women performed substantial vigorous activity, and thus, these results do not apply to women performing strenuous exercise shortly after delivery.

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  • Physical activity was reported by 3 studies, of which 1 reported a borderline significant effect of more activity to be a risk factor for primary pelvic organ prolapse.

    “Physical activity was reported by 3 studies, of which 1 reported a borderline significant effect of more activity to be a risk factor for primary POP.”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [33]

    The Results report a marginally significant association between moderate early-postpartum activity and worse vaginal support one year later (PR 1.80; p=0.052), but no significant increase in the most active group. The Study design says the authors measured prevalence rather than risk because they could not exclude pelvic-floor changes before pregnancy. The finding therefore does not establish more activity as a risk factor for new-onset primary POP. (LLM, conf=0.87)

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  • In 15 articles, the number of risk factors for analysis was limited to 10% of the number of events; in 1 article, the 10% was exceeded.

    “In 15 articles, the number of risk factors for analysis was limited to 10% of the number of events; in 1 article, the 10% was exceeded.”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [33]

    The Materials and Methods sections describe this paper’s cohort analysis and sample-size calculation, not a review of articles. Searches for the 10%-of-events rule and the counts of 15 and 1 articles found no passage addressing the claim in our copy. (LLM, conf=0.76)

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  • Pulmonary disease was reported by 2 studies and was not associated with primary pelvic organ prolapse.

    “Pulmonary disease was reported by 2 studies and was not associated with primary POP”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [33]

    The Methods (Study procedures; page unavailable) describe medical-history collection, and the Results (page unavailable) report associations between physical activity and pelvic floor outcomes. Neither reports that two studies examined pulmonary disease or that it was unassociated with primary POP. Searches for pulmonary disease, respiratory conditions, COPD, and the two-study claim found no supporting passage in our copy. (LLM, conf=0.76)

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Cites

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Research works printed but not linked: 1

  1. [42]Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013; 120(2): 152– 160. 23121158

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Authors
Nygaard, I. E., Wolpern, A., Bardsley, T., Egger, M. J., & Shaw, J. M.
Affiliations
University of Utah (US)
Corresponding author
Nygaard, Ingrid E.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2021-02
Volume
224
Issue
2
Pages
193.e1-193.e19
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2020.08.033
PMC
PMC7855223
OpenAlex
W3049736819
Cited by
48
References
112
Citations by year
2026: 4 · 2025: 9 · 2024: 15 · 2023: 11 · 2022: 6 · 2021: 3
FWCI
3.77
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (1S10OD021644-01A1, 5UL1TR001067-05, 8UL1TR000105, UL1RR025764)
  • National Center for Research Resources
  • National Center for Advancing Translational Sciences
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
postpartum exercise, moderate-to-vigorous physical activity, pelvic floor support, pelvic organ prolapse, urinary incontinence, stress urinary incontinence, pelvic floor symptoms, nulliparous women, accelerometry, overactive bladder, anal incontinence, constipation, postpartum recovery
MeSH terms
Adult, Constipation, Fecal Incontinence, Female, Humans, Prospective Studies, Urinary Incontinence, Urinary Incontinence, Stress, Cohort Studies, Exercise, Pelvic Floor, Delivery, Obstetric, Term Birth, Postpartum Period, Urinary Bladder, Overactive, Young Adult, Pelvic Organ Prolapse, Pelvic Floor Disorders, Accelerometry

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