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

描述(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)的患病率很高，但这些疾病背后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，并调查这些联系背后的生物学机制。在该奖项的第一阶段，在第一次分娩后5-10年的某个时间点，阴道分娩后与剖腹产相比，盆底疾病显著增加。此外，研究发现，与剖腹产相比，阴道分娩后骨盆肌肉力量明显减弱。认识到产科事件对导致盆底疾病的生物学途径的关键影响，本建议的目标是描述盆底疾病随时间的变化，并调查分娩和盆腔肌肉无力对这些变化的影响程度。目前应用的具体目的是：目的1：探讨产科暴露对盆底疾病发生和进展的影响；目的2：探讨盆底肌肉无力对盆底疾病进展的影响。这些目标将通过对1300名临产妇女(加上每年招募的额外参与者)的既定队列进行年度监测来实现。使用有效问卷和体检的数据，将每年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、会阴切开和会阴撕裂)和骨盆肌肉力量(在第一个资助周期结束时在这个队列中使用经过验证的工具进行测量)。分析将集中于与疾病随时间进展相关的因素以及患有轻度盆底疾病的妇女的预后。这项研究的新方面包括关注随时间推移的疾病严重程度的测量，考虑效果异质性的分析方法，以及前瞻性检查骨盆肌肉无力的影响的机会。这项拟议的研究意义重大，因为它将提供有关盆底疾病自然病史的关键信息，并确定最重要的产科先兆。因此，这些发现将确定 最有可能患盆底疾病的妇女，并将作为预防试验的基础。此外，骨盆肌肉无力可能被证明是治疗干预的新靶点。最后，这些结果有望通过指导未来盆底疾病病理生理学的翻译研究来促进科学发展。鉴于盆底疾病的高患病率和这些疾病的手术治疗的高发生率，预防至关重要，以减少 美国女性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.