懷孕期婦女膀胱過動症相關因素之探討

Abstract

研究背景及目的：膀胱過動症（Overactive Bladder, OAB）是一種症狀不是疾病，在台灣是非常普遍的症狀，此症狀不會危及生命，但卻會因症狀愈嚴重進而影響身體活動、心理健康及社交功能，顯示膀胱過動症造成女性患者生活困窘影響之重要性。目前已有許多研究針對一般婦女或40歲以上婦女進行膀胱過動症之盛行率及影響因素的調查，但針對孕期婦女的研究國外僅有少數，且國內亦缺乏相關研究，故本研究主要目的為調查懷孕初期至後期婦女膀胱過動症（OAB）、乾式膀胱過動症（OAB dry）及濕式膀胱過動症（OAB wet）之盛行率、發生率、症狀嚴重程度及困擾程度的變化，並探討懷孕期婦女膀胱過動症之影響因素。 研究方法：本研究為一縱貫性研究設計，於北部某醫學中心產科門診採方便取樣選取符合納入條件者進行收案，以問卷收集個案人口學基本資料、產科學變項、中文版膀胱過動症量表（ICIQ-OAB）評估，並分別於個案懷孕中期及後期返回產科門診產檢時進行兩階段之問卷調查，以收集個案膀胱過動症之資料。所得資料採用SPSS for Mac v25版軟體進行統計分析，採用描述性統計呈現人口學基本資料、產科學變項及膀胱過動症之盛行率、發生率、症狀嚴重程度及症狀困擾程度，其中連續性變項以平均值、標準差呈現，非連續性變項則以次數及百分比呈現。運用廣義估計方程式（Generalized estimating equation, GEE）於重複測量資料分析，推論三個孕期之盛行率、發生率、症狀嚴重程度及症狀困擾程度在三個時間點之變化。影響因素分析使用廣義估計方程式（Generalized estimating equation, GEE）中二元鏈結函數分析膀胱過動症盛行率、發生率之影響因素，並以線性鏈結函數分析膀胱過動症症狀嚴重程度、症狀困擾程度之影響因素。另以多元邏輯斯回歸（Multinomial logistic regression）分別進行三個孕期之乾式膀胱過動症及濕式膀胱過動症影響因素比較。 研究結果：研究結果顯示懷孕婦女膀胱過動症及濕式膀胱過動症的盛行率及發生率均會隨著懷孕週數增加顯著上升，乾式膀胱過動症盛行率於懷孕後期時顯著下降，發生率則是在懷孕中期時顯著上升；孕期膀胱過動症盛行率及發生率的主要影響因素為懷孕週數。懷孕婦女之膀胱過動症症狀嚴重程度及困擾程度均會隨著懷孕週數增加顯著增加，症狀嚴重程度的影響因素為懷孕週數及孕期增加BMI，困擾程度的影響因素則為懷孕週數。懷孕期濕式膀胱過動症之主要影響因素為孕期增加BMI；乾式膀胱過動症之主要影響因素則為生產次數。對於懷孕期膀胱過動症（包含乾式、濕式膀胱過動症）之盛行率、嚴重程度皆與懷孕前是否有膀胱過動症、症狀嚴重程度及困擾程度等因素顯著相關。 結論：研究發現膀胱過動症之盛行率、發生率、症狀嚴重程度及困擾程度均會隨著週數增加顯著上升，且懷孕期膀胱過動症之重要影響因素包括懷孕週數、孕期BMI變化及生產次數。本研究結果有助於醫療人員了解膀胱過動症在懷孕期間的變化及其對於懷孕婦女的之影響程度，若能及早提供護理指導或介入措施，可使婦女在懷孕過程中降低因膀胱過動症所造成生活影響的程度。

Background: Overactive Bladder (OAB) is not a disease but a non-life-threatening symptom which can importantly affect physical, psychological, and social function aspects of those who suffer from it, this is very common in Taiwan. Many studies have reported prevalence and risk factors of OAB in general women or aged ≥40, but rarely investigated during pregnancy and lack of studies in Taiwan. In present study, we evaluated the associated factors of prevalence, incidence proportion, symptom severity, and interference of OAB, OAB with urge incontinence (OAB-wet), and OAB without urge incontinence (OAB-dry) in three stage of pregnancy. Methods: In an observational longitudinal study, Patients were recruited from the obstetric department of a medical center in northern Taiwan. The data were collected using a questionnaire including demographic variables, and International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB) Taiwanese version in three stage of pregnancy. Descriptive statistics were used to evaluate demographic variables, prevalence, incidence proportion, symptom severity, and interference of OAB, OAB-wet, and OAB-dry. Generalized estimating equation (GEE) was used to evaluate the changes in prevalence, incidence proportion, symptom severity, and interference in three-stage of pregnancy. The associated factors of prevalence, incidence proportion were evaluated via GEE binary logistic and used identity link function to evaluate the associated factors of symptom severity and interference. Multinomial logistic regression was used to evaluate the associated factors of OAB-dry and OAB-wet in early, middle, and late pregnancy, respectively. Statistical analysis was performed using SPSS v25 for Mac (IBM SPSS Inc, Chicago, IL). All data are presented as mean with standard deviation for continuous variables, nominal variables presented as number and percentage. A p value of <0.05 was considered statistically significant. Results: OAB and OAB-wet were significantly increased the prevalence and incidence proportion with gestational age growth, OAB-dry was significantly decreased the prevalence rate at the late pregnancy and the incidence proportion was significantly increased at the middle pregnancy, the associated factors of prevalence and incidence proportion of OAB were gestational age. The symptom severity and interference of OAB were significantly increased following the gestational age, the associated factors of symptom severity were gestational age and increased body mass index (BMI), the associated factor of interference was gestational age. The associated factor of OAB-wet was increased BMI. The associated factor of OAB-dry was parity. The associated factors of prevalence, symptom severity, and interference in OAB including OAB-dry and OAB-wet were significantly related to the OAB that was found before the pregnancy. Conclusions: Following gestational age growth, the prevalence, incidence proportion, symptom severity, and interference were increased. Moreover, the gestational age, BMI, and parity were significant associated factors. These data are of clinical value, particularly given the patient of intervention measures and nursing education earlier, not only helping the health care worker to understand the changes of OAB but improve the quality of life of pregnant women.