Hypothesis / aims of study
Pregnancy and delivery are significant risk factors for developing urinary incontinence and they are particularly associated with stress urinary incontinence (SUI) (1). A UI prevalence of 58% has been reported during the second and third trimester of pregnancy, and during the three months following childbirth the prevalence of UI is approximately 30% (2).
A Cochrane review focusing on antenatal and postnatal pelvic floor muscle training (PFMT) concludes that PFMT for continent pregnant women can prevent the onset of UI (2). In the same review, however, there was uncertainty about the treatment effect for those who were already incontinent both prenatal and postnatal.
We have developed a mobile app intended for women with SUI that contains a self-management programme based on PFMT and lifestyle advice. The PFMT programme includes different types of pelvic floor muscle contractions and instructions on how to find the right muscles. In the app the user can set reminders for training and follow training statistics. We evaluated the efficacy of the app-based programme in a randomised controlled trial (RCT) and found that women using the app experienced fewer incontinence symptoms, fewer leakage episodes and a better quality of life compared to the control group (3).
The app is now freely available on Google play and Appstore and we are interested in its use by pregnant and postnatal women since they were not included in our previous RCT. The aim of this study was to investigate the use of the app during pregnancy and the postnatal period, and the characteristics of the users.
Study design, materials and methods
This is a descriptive study of the pregnant and postnatal users of the app. We included pregnant and postnatal participants between 18 and 69 years old, who had downloaded the app and answered the inclusion questionnaire between the dates of 16 January 2018 and 15 November 2018 (10 months of inclusion).
A short questionnaire appeared when the app was downloaded with information about the study. It was optional to answer the questionnaire and the responses were sent anonymously to our research database. The information provided by the questionnaire included: age, gender, country, place of residence, education, reason for downloading the app, pregnancy, delivery during the last three months, and incontinence symptoms according to the validated questionnaire ICIQ-UI SF.
Participants were defined as incontinent if their answers to the first two questions on the ICIQ-UI SF indicated both that they experienced urinary leakage and also had some amount of leakage.
Results
This study included 10,588 participants, of which 4,729 (45%) were pregnant and 5,859 (55%) were postnatal. 66 participants answered that they were both pregnant and postnatal and they were assigned to the pregnant group. The study population constitutes 42% of the total amount of participants (n=25,276) who answered the inclusion questionnaire.
The proportion of pregnant participants that were incontinent was 47%, and 55% of the postnatal participants were incontinent. For baseline characteristics, see Table 1.
Interpretation of results
A large proportion of the total number of users of the app were either pregnant or postnatal (42%). Among the pregnant and postnatal population about half of the participants experienced incontinence. The mean ICIQ-UI SF score of those with incontinence was around 6 - 7 which is in accordance with other studies on incontinent pregnant women.
The use of the app during the period of one year corresponds to use by approximately one tenth of all pregnant women in Sweden (115,000 – 120,000 births per year) during pregnancy and/or the postpartum period.