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Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus.

ABSTRACT: BACKGROUND:Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12?months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. METHODS:The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26?weeks, with a follow-up at 34-38?weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48?h, 6 weeks and 6 and 12?months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12?months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. DISCUSSION:To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.

SUBMITTER: Rudge MVC

PROVIDER: S-EPMC7031907 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus.

Rudge Marilza V C MVC Souza Fátima P FP Abbade Joelcio F JF Hallur Raghavendra L S RLS Marcondes João Paulo C JPC Piculo Fernanda F Marini Gabriela G Vesentini Giovana G Thabane Lehana L Witkin Steven S SS Calderon Iracema M P IMP Barbosa Angélica M P AMP Rudge M V MV Barbosa A M P AMP Calderon I M P IMP Souza F P FP Abbade J F JF Hallur L S R LSR Piculo F F Marini G G Vesentini G G Thabane L L Palma M S MS Graeff C F O CFO Arni R K RK Herculano R D RD Salvadori D F DF Mateus S S Dal Pai Silva M M Magalhães C G CG Costa R A RA Lima S A M SAM Felisbino S L SL Barbosa W W Atallah A A Girão M J B MJB Di Bella Z Z Uchoa S M SM Payão S S Hijas A A Berghman B B De Bie R R Sobrevia L L Junginger B B Alves F C B FCB Rossignoli P S PS Prudencio C B CB Orlandi M I G MIG Gonçalves M I MI Nunes S K SK Catinelli B B BB Quiroz S S Sarmento B V BV Pinheiro F A FA Sartorão C I CI Lucas R R RR Reyes D R A DRA Quiroz S B C V SBCV Enriquez E M A EMA Oliveira R G RG Floriano J F JF Marcondes J P C JPC Barneze S S Dangió T D TD Pascon T T Rossignoli P P Freitas J V JV Takano L L Reis F F Caldeirão T D TD Fernandes J N JN Carr A M AM Gaitero M V C MVC Corrente J E JE Nunes H R C HRC Candido A F AF Costa S M B SMB Dangió T D TD Pascon T T Melo J V F JVF Takano L L Reis F V D S FVDS Caldeirão T D TD Carr A M AM Garcia G A GA Rabadan G B GB Bassin H C M HCM Suyama K S KS Damasceno L N LN Takemoto M L S MLS Menezes M D MD Bussaneli D G DG Nogueira V K C VKC Lima P R PR Lourenço I O IO Marostica de Sá J J Megid R A RA Caruso I P IP Rasmussen L T LT Prata G M GM Piculo F F Vesentini G G Arantes M A MA Ferraz G A R GAR Camargo L P LP Kron M R MR Corrente J E JE Nunes H R C HRC

BMC pregnancy and childbirth 20200219 1

<h4>Background</h4>Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after t ...[more]

PMID: 32075598

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Project description:BackgroundThere is ample evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia.MethodsWe will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be "Pregnancy", "Hyperglycemia", "Diabetes Mellitus, Type 2", "Diabetes Mellitus, Type 1", "Pregnancy in Diabetics", "Diabetes, Gestational", "Urinary Incontinence", "Pelvic Floor Muscle Strength". Primary outcomes: improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as tampon test, voiding diary, urodynamic study). Secondary outcomes: improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3.DiscussionThe present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies.Trial registrationSystematic review registration: PROSPERO CRD42017065281.

Project description:Urinary incontinence has an undeniable impact on the quality of life of affected women; however, talking about incontinence is not comfortable for many women, and they often hide it and do not seek treatment. Predictors affecting women's decisions to seek treatment in communities can be different. This study was designed to identify predictors of help-seeking behaviors among Iranian women with urinary incontinence.MethodsThis cross-sectional, analytical study was conducted on 199 women with urinary incontinence who met the inclusion criteria by convenience sampling from the beginning of 2020 to the middle of 2021. The Incontinence Severity Index, Bradley's Questionnaire for Urinary Incontinence Diagnosis, Medical Embarrassment Questionnaires, Brief-Illness Perception Questionnaire, Incontinence Quality of Life Questionnaire, Barrier to Incontinence Care Seeking Questionnaire, Medical Help Seeking Scale, and Medical Outcomes Study Social Support Survey were all self-administered data collection tools used in this study. Multiple linear regression was used to investigate the relationship and prediction of help-seeking behaviors by other variables. To analyze the data, SPSS software version 20 was used.ResultsThe variables of shame, barriers to care, social support, quality of life, and age were found to be predictors of help-seeking behavior in the research population of women with urinary incontinence. Help-seeking had a direct relationship with quality of life and an inverse relationship with other factors. Among these factors, shame has the greatest impact (P = 0/001, β = - 0/37).ConclusionsThe extracted predictors, especially the variable of "shame" as the most important negative factor related to the treatment decisions of women with urinary incontinence, will help to health service providers to take into account these factors in the regular service provision programs that promote women's health, which are effective in facilitating the help-seeking of sufferers and correct guidance towards treatment or rehabilitation.

Project description:BackgroundPelvic floor muscle training is recommended as first line treatment for urinary incontinence in women based on three proposed theorized mechanisms: 'Enhanced Pelvic Floor Muscle Strength,' 'Maximized Awareness of Timing,' and 'Strengthened Core Muscles'. The purpose of this scoping review was to systematically map evidence for and against theorized mechanisms through which pelvic floor muscle training interventions work to reduce urinary incontinence in women.MethodsThe scoping review is based upon a comprehensive search of relevant literature published from 1990 to 2020 in PubMed, CINAHL, PsycINFO, ClinialTrials.gov, reference lists from review articles, and hand searches of articles by known researchers in the field. We included English-language, peer-reviewed articles on pelvic floor muscle training as an intervention for adult women if they provided empirical evidence to testing the theorized intervention mechanisms. Two independent reviewers screened articles for inclusion and extracted data to describe details of each study (author, year, country, design, sampling), measures of pelvic floor muscle strength and urinary incontinence, statistical analysis of linkage between changes in the measures, and pelvic floor muscle training regimens. Data were summarized to facilitate the integration of diverse evidence to draw conclusions on supporting or refuting the three proposed theorized mechanisms for managing urinary incontinence in women.ResultsOf the 278 articles identified with the search, 13 (4.7%) met inclusion criteria. There was weak to no evidence for the mechanism of enhanced pelvic floor muscle strength, equivocal support for maximized awareness of timing, and no evidence for strengthened core muscles.ConclusionsThis review revealed extremely limited data supporting the proposed theorized mechanisms underlying pelvic floor muscle training programs to manage urinary incontinence in women. Such evidence is needed to help women and clinicians understand how, why and when a woman benefits from pelvic floor muscle training. Future studies should specifically state and report statistical analysis that relates the theorized mechanisms to the training outcomes observed.

Project description:ObjectivesTo examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance.MethodsThis analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008.ResultsAt the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence.ConclusionsIntensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.

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Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus.

Publications

Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus.

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