Defectos del suelo pélvico posparto en función del índice de masa corporal pregestacional y ganancia ponderal de la mujer durante el embarazo

Objective: To determine if there is a causal association between the pre-pregnancy maternal body mass index or weight gain, and the presence of postpartum pelvic floor dysfunctions, such as urinary and fecal incontinence and sexual dysfunction. Methods: We carried out a prospective observational cohort study with 500 pregnant women controlled at HUV Macarena (Seville)from january to april of 2012. Patients were categorized according to their pregestational BMI and the weight gain during pregnancy.We analyzed the causes of the presence of urinary and fecal incontinence and sexual dysfunction at 6,12 months and 7 years after delivery. Results: Overweight was observed in 26 %, obesity in 16,6 % and excessive weight gain in 46,7 %. Fetal macrosomia was associated with urinary incontinence and sexual dysfunction in all three periods and with fecal incontinence at 7 years. Statistically significant associations were observed between urinary incontinence at 7 year and obesity, OR 2,737 IC 96 % (1,262-5,938) and between sexual dysfunction at 1 year and at 7 years with obesity, OR 7,321 IC 95 % (1,307-41,006) and with weight gain, OR 8,427 IC 95 % (1,026-69,225). Conclusions: Pregnancy and childbirth are risk factors for pelvic floor dysfunctions, since fetal macrosomia, pre-pregnancy obesity and excessive weight gain have been associated with their development. It is important to advise patients on weight control before and during pregnancy. Keywords: Obesity, Gestational weight gain, Body mass index, Pregnancy, Pelvic floor disorders.