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

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确定。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，并调查这些关联的生物学机制。在该奖项的第一阶段，在第一次分娩后5-10年的单一时间点，阴道分娩与剖腹产相比，骨盆底疾病显着增加。同样，阴道分娩与剖腹产相比，骨盆肌肉力量明显变差。认识到产科事件对导致盆底疾病的生物学途径的重要影响，本提案的目标是描述盆底疾病随时间的变化，并调查这些变化受分娩和骨盆肌无力影响的程度。本申请的具体目的是：目的1：研究产科暴露对骨盆底疾病的发病率和进展的影响，目的2：研究骨盆肌无力对骨盆底疾病进展的影响。这些目标将通过每年监测一个已建立的>1300名经产妇女的队列（加上每年招募的额外参与者）来实现。使用经验证的问卷调查和体格检查的数据，每年测量盆底疾病的严重程度。关注的风险将包括产科事件（阴道分娩与剖宫产、产钳分娩、会阴切开术和会阴撕裂）和骨盆肌力（在第一个资助周期结束时，使用经验证的工具在该队列中测量）。分析将侧重于与疾病进展相关的因素，以及轻度盆底疾病妇女的预后。这项研究的新方面包括关注疾病严重程度随时间的变化，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。这项研究意义重大，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，调查结果将确定 女性患骨盆底疾病的风险最大，并将作为预防试验的基础。此外，骨盆肌无力可能被证明是一个新的治疗干预的目标。最后，研究结果有望通过指导未来盆底疾病病理生理学的转化研究来推进科学。鉴于骨盆底疾病的高患病率和这些疾病的高手术治疗率，预防对于减少 美国女性骨盆底疾病的公共卫生负担。

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.