(Poster 36) Lower Urinary Tract Symptoms and Pregnancy Quality of Life: A Systematic Review

Objectives: Report prevalence, severity, and quality-of-life impact of pregnancy-related lower urinary tract symptoms (LUTS), including urinary incontinence, urgency, and frequency, based on existing literature.

Methods: Systematic review performed by searching MEDLINE and PubMed for studies that: (1) utilized standardized questionnaires assessing the severity of pregnancy-related LUTS and (2) reported findings from symptom-specific quality of life (QOL) surveys or health-related quality of life (HRQOL) surveys evaluating LUTS impact during pregnancy. Article quality screened using GRADE guidelines. Averaged results are reported as mean (standard deviation).

Results: Seventeen studies (2 randomized controlled trials, 3 prospective, 12 cross-sectional) with 8,159 patients were included. All studies reported on LUTS prevalence, ranging 18.6% to 97.3%, increasing from the first trimester 20.2% (19.5) to third trimester 57.7% (27.2). Prevalence of stress (SUI), urge (UUI), and mixed (MUI) incontinence rose between trimesters, with SUI exhibiting the largest increase: 6.9% (9.6) to 32.4% (27.8).
Nine studies (52.9%) utilized standardized questionnaires to assess LUTS severity; the Urinary Distress Inventory (UDI-6) was the most common (n=8). Three studies found significant symptom severity increase from first to third trimester: two reported greater severity in UDI-6 Irritative and Stress subscales, while one observed increased UDI-6 scores across all patients with SUI, UUI, and MUI (Figure 1).
All studies used symptom-specific QOL questionnaires, with five tools employed (Table 1). Data was reported heterogeneously, however, most studies found LUTS to be associated with lower QOL scores: Two reported worsening QOL across trimesters, four showed significantly lower QOL in those with LUTS, and four demonstrated a trend toward poorer QOL. Nine studies (52.9%) used the International Consultation on Incontinence Questionnaire (ICIQ), with four reporting "moderate" impact as the most common level. Similarly, nine studies (52.9%) used the Incontinence Impact Questionnaire (IIQ): Two showed significantly worse scores across all subscales (Activity, Social, Travel and Emotional) in patients with UI versus without.
Three studies (17.6%) used HRQOL questionnaires (Table 1), all showing significantly worse outcomes for patients with UI. The two studies using SF-12 reported significantly lower Mental and Physical Component Summary scores. The study evaluating SF-36 reported significantly lower score in five of eight domains for patients with UI versus without. Between first and third trimester, patients with LUTS had worse scores on bodily pain and physical functional domains. Four studies examined help-seeking behavior among patients with LUTS and reported low rates (13.1–26.8%) of patients asking for help.

Conclusions: Limited data exists on LUTS impact on QOL during pregnancy. Our findings show increasing LUTS prevalence throughout pregnancy and that increased symptom severity is associated with poorer QOL, especially later in gestation. In addition, most patients experiencing LUTS do not seek help. Longitudinal studies with standardized questionnaires are needed for better identification and treatment of LUTS in pregnancy.