Cesarean and vaginal birth: cohort study of the impact on pelvic floor disorders

剖腹产和阴道分娩：对盆底疾病影响的队列研究

• 批准号: 8504181
• 负责人: VICTORIA Lynn HANDA
• 金额: $ 58.79万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-13 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8504181
• 关键词: Adult; Affect; Age; Anatomy; Award; Biological; Biology; Birth; Bladder Control; Childbirth; Cohort Studies; Computer Simulation; Data; Disease; Disease Progression; Epidemiologic Studies; Epidemiology; Episiotomy; Event; Exercise; Fecal Incontinence; Female; Forcep; Foundations; Functional disorder; Funding; Future; Goals; Health; Heterogeneity; High Prevalence; Incidence; Laceration; Lead; Life; Link; Longevity; Measures; Mediating; Modeling; Muscle; Muscle Weakness; Natural History; Operative Surgical Procedures; Organ; Participant; Pathway interactions; Pelvic Floor Disorders; Pelvis; Physical Examination; Physical therapy; Play; Population; Prevention; Prevention strategy; Process; Ptosis; Public Health; Quality of life; Questionnaires; Recruitment Activity; Research; Risk; Risk Factors; Role; Science; Severities; Severity of illness; Symptoms; Testing; Therapeutic Intervention; Time; Translational Research; Urinary Incontinence; Vacuum; Vagina; Vaginal Birth after Cesarean; Vaginal delivery procedure; Woman; analytical method; base; burden of illness; cohort; common treatment; follow-up; in vivo; interest; lifetime risk; middle age; muscle strength; novel; outcome forecast; public health relevance; tool; translational study

DESCRIPTION (provided by applicant): Despite the very high prevalence of female pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse), the biological mechanisms underlying these disorders are uncertain. Epidemiologic studies suggest that childbirth plays an essential role. The long-term research goals of this team are to identify specific obstetrical events associated with pelvic floor disorders and to investigate the biologica mechanisms underlying these associations. In the first period of this award, pelvic floor disorders were shown to be significantly increased after vaginal versus cesarean birth at a single point in time, 5-10 years after first childbirth. Also, pelvic muscle strength was found to e significantly poorer after vaginal versus cesarean birth. Recognizing the critical influence of obstetrical events on the biological pathways leading to pelvic floor disorders, the goals of this proposal are to describe changes over time in pelvic floor disorders and to investigate the extent to which these changes are affected by childbirth and by pelvic muscle weakness. The specific aims of the current application are: AIM 1: to investigate the effect of obstetrical exposures on the incidence and progression of pelvic floor disorders and AIM 2: to investigate the effect of pelvic muscle weakness on the progression of pelvic floor disorders. These aims will be accomplished via annual surveillance of an established cohort of >1300 parous women (plus additional participants recruited annually). Using data from validated questionnaires and physical examinations, the severity of pelvic floor disorders will be measured annually. The exposures of interest will include obstetrical events (vaginal versus cesarean birth, forceps delivery, episiotomy and perineal laceration) and pelvic muscle strength (measured in this cohort at the end of the first funding cycle, using a validated tool). Analysis will focus on factos associated with disease progression over time as well as the prognosis for women with mild pelvic floor disorders. Novel aspects of this research include the focus on measures of disease severity over time, analytical methods that consider heterogeneity of effect, and the opportunity to prospectively examine the impact of pelvic muscle weakness. The proposed research is significant because it will provide critical information about the natural history of pelvic floor disorders and identify the most important obstetrical antecedents. Thus, the findings will identify women at greatest risk for pelvic floor disorders and will serve as a foundation for prevention trials. Also, pelvic muscle weakness may prove to be a novel target for therapeutic intervention. Finally, results are expected to advance science by guiding future translational research on pathophysiology of pelvic floor disorders. Given the high prevalence of pelvic floor disorders and the high incidence of surgical treatment for these conditions, prevention is critical to reduce the public health burden of pelvic floor disorders among U.S. women.

描述（由申请人提供）：尽管女性盆底疾病（尿失禁、大便失禁和盆腔器官脱垂）的患病率非常高，但这些疾病的生物学机制尚不清楚。流行病学研究表明，分娩起着至关重要的作用。该团队的长期研究目标是确定与盆底疾病相关的特定产科事件，并研究这些关联背后的生物学机制。在该奖项的第一期中，与剖腹产相比，在第一次分娩后 5-10 年的单一时间点，阴道分娩后盆底疾病显着增加。此外，与剖腹产相比，阴道分娩后的骨盆肌肉力量明显较差。认识到产科事件对导致盆底疾病的生物途径的关键影响，该提案的目标是描述盆底疾病随时间的变化，并调查这些变化在多大程度上受分娩和盆底肌肉无力的影响。当前申请的具体目标是：AIM 1：研究产科暴露对盆底疾病发生和进展的影响；AIM 2：研究盆底肌无力对盆底疾病进展的影响。这些目标将通过对超过 1300 名已生育妇女（加上每年招募的其他参与者）的既定队列进行年度监测来实现。使用经过验证的问卷和体检的数据，每年都会测量盆底疾病的严重程度。感兴趣的暴露将包括产科事件（阴道分娩与剖腹产、产钳分娩、会阴切开术和会阴撕裂伤）和盆腔肌肉力量（在第一个资助周期结束时使用经过验证的工具在该队列中测量）。分析将重点关注与疾病随时间进展相关的因素以及患有轻度盆底疾病的女性的预后。这项研究的新颖之处包括关注随着时间的推移测量疾病严重程度、考虑效应异质性的分析方法，以及前瞻性检查骨盆肌无力影响的机会。拟议的研究意义重大，因为它将提供有关盆底疾病自然史的关键信息，并确定最重要的产科前因。因此，研究结果将确定 盆底疾病风险最高的女性，并将作为预防试验的基础。此外，盆腔肌肉无力可能被证明是治疗干预的新目标。最后，研究结果有望通过指导盆底疾病病理生理学的未来转化研究来推动科学发展。鉴于盆底疾病的高患病率以及针对这些疾病的手术治疗的高发生率，预防对于减少盆底疾病的发生至关重要。 美国女性盆底疾病的公共卫生负担。