Diabetes Subtypes and Urinary Incontinence in Pregnancy: Role of BMI & HbA1c

INTRODUCTION: Urinary incontinence (UI) is a significant health concern affecting the quality of life of many pregnant women worldwide. This study examined the relationship between diabetes mellitus and urinary incontinence during pregnancy and postpartum, focusing on metabolic factors like BMI and glycemic control.
METHODS: A prospective observational study was conducted at Başakşehir Çam and Sakura City Hospital, including 147 pregnant women in their third trimester (≥30 weeks). Participants were categorized into type 1 diabetes mellitus (n = 16), type 2 diabetes mellitus (n = 32), gestational diabetes mellitus (GDM) (n = 51), and a control group (n = 48). UI was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and metabolic parameters were retrieved from hospital records. Subgroup comparisons and ROC curve analysis determined BMI and HbA1c cut-off values for predicting postpartum UI.
RESULTS: Higher HbA1c levels were significantly associated with increased incontinence severity in GDM (p < 0.0001), but not in other diabetes subgroups. BMI effects varied: in type 1 diabetes, a higher BMI correlated with lower incontinence severity, whereas in GDM, it was linked to more severe incontinence. Postpartum UI was associated with elevated BMI in type 1 diabetes and GDM groups. ROC analysis identified optimal thresholds for predicting postpartum UI: HbA1c = 5.75% (AUC = 0.672, sensitivity = 61%, specificity = 77%) and BMI = 32.75 (AUC = 0.627, sensitivity = 65%, specificity = 61%).
DISCUSSION AND CONCLUSION: BMI and glycemic control significantly impact UI severity and postpartum persistence, particularly in GDM and type 1 diabetes. Identifying BMI and HbA1c as predictive markers underscores the need for targeted metabolic interventions.