Landmark New Study on Maternal Health Launched

Posted on: 03 March 2015

A first of its kind study to research and track the health and health problems of first-time mothers in Ireland has been launched today by researchers from the School of Nursing and Midwifery in Trinity College Dublin.

The MAMMI study (Maternal health And Maternal Morbidity in Ireland) is a longitudinal study funded by the Health Research Board (HRB) which will follow more than 2600 women through their pregnancy and for one year after the birth of their first baby, gathering information and experiences on a range of important health issues including urinary incontinence; mental health issues such as anxiety, stress and depression; pelvic girdle pain; sexual health; domestic violence; c-sections; and diet and activity during pregnancy. The study group represents almost 10% of all first-time mothers giving birth in Ireland in a given year.

The researchers say that the study is being done because a lack of information on the health of women after a baby’s birth prevents health care professionals from understanding what causes common problems for women in Ireland such as pain, urinary and bowel problems, changes affecting sexual health and emotional health and difficulties in intimate partner relationships.

Speaking about the importance of this study, MAMMI’s Principal Investigator and Chair of Nursing and Midwifery in Trinity, Professor Cecily Begley said: “Many women experience motherhood in excellent physical health, while others experience health problems, which may occur during pregnancy or result from an event that happens during or after the baby’s birth. The MAMMI study will look at a wide range of problems that can have a huge impact on a mother’s quality of life. Because of a lack of information on the prevalence, causes and interconnections between these issues for women in Ireland, women’s health problems remain invisible, not talked about and very often untreated. This is despite interventions being available, which could prevent some of the problems occurring in the first place.”

Speaking about the information gaps that currently exist in this area Professor Begley continued: “Maternity care and information gathering is focused on the pregnancy and birth period. Women have a final check-up 6 weeks after the birth, usually with their GP, when it is ‘assumed’ that her body has returned to ‘normal’.  This is the case for a lot of women who stay healthy and well but is not the case for a considerable proportion of women. This information was, and is not collected in our maternity services.”

“There is also no connection between the woman’s record held in the maternity hospital and any records kept on her if she has to attend a general hospital with a health problem resulting from pregnancy or childbirth. This means that clinicians in the maternity services never receive feedback on how women who have been in their care for pregnancy and childbirth return to normal health and well-being. We hope that this study will bridge that gap and not only make these issues visible, but also, and crucially, provide the information that will help guide, inform and improve practice and care for mothers in the future.”

According to Dr Graham Love, Chief Executive at the Health Research Board: “The MAMMI study shows how health research is providing practical solutions to real patient issues at the time when it matters most. It is important that these findings are widely disseminated so that as many women as possible can benefit from this research.”

Urinary Incontinence or ‘Leaking Urine’

The MAMMI study has today released the first set of early findings on urinary incontinence (leaking urine) in women, before, during and after the birth of their first child. This early research looked at the prevalence and mitigating factors in urinary incontinence (UI) in 860 women, before, during and after pregnancy.

Key findings:

Prevalence:

• 1 in 3 women leak urine occasionally before becoming pregnant and 1 in 12 leak urine once a month or more frequently.
• In early pregnancy, more than 1 in 3 women leak urine during pregnancy and almost one in 5 leak urine once a month or more frequently.
• Three months after the birth, 1 in 2 women leaked some amount of urine and even 6 months after the birth, 1 in 5 women still leak urine once a month or more frequently.

Risk Factors:

Pre-pregnancy

• Women with raised odds of leaking urine were those with a high BMI and those who experienced bed wetting as a child. Women who were obese or very obese had 4 times the chance of leaking urine before pregnancy compared with women whose BMI was in the normal range.

During Pregnancy

• Women aged 35 years and more before pregnancy had 3 times the odds of experiencing new onset urinary leakage during pregnancy when compared with women aged 25-29 years of age.
• Women who were overweight before pregnancy had twice the odds of experiencing new onset urinary leakage during pregnancy.
• Women who leaked urine occasionally, less than once a month, before pregnancy had more than twice the odds of leaking urine during pregnancy.

Postnatally

• Women who experienced urinary leakage in pregnancy had 3 times the odds of having it at 3 and 6 months after the birth when compared with women with no leakage or leakage less than once a month during pregnancy.

Speaking about the feedback from women in the study who have experienced urinary leaking, Assistant Professor in Midwifery in the School of Nursing and Midwifery, Trinity, Dr Deirdre Daly said: “The key message for women is that leaking urine is common, but it is not normal and can be treated. Far too many women put up with urinary leakage during and after pregnancy because they think it is ‘normal’ or ‘to be expected’. Because of this, the majority of the women in the MAMMI study had not really talked to anyone about leaking urine.”

“The reality is that leaking urine can make some women miserable; while it affects them physically, it can also affect them emotionally and socially and affect the way women interact with their partner. Leaking urine can even make some women stop exercising or be cautious about socialising because they are afraid of leaking and of it being noticed by others. Unfortunately, and partly because we have no information on leaking urine in pregnant women or new mothers in Ireland, many women who leak urine think they are alone; this can make women feel isolated, embarrassed and reluctant to talk about it or to seek help.”

Dr Daly continued: “The reality is that routine antenatal care offers opportunities for promoting continence in all women but particularly in those with identifiable risk factors. If enquiry about UI and advice on effective preventative and curative treatments became routine some of these women could become or stay continent which would have huge benefits for their quality of life.”

Urinary incontinence means leaking urine, regardless of the amount, when you don’t mean to. It can be classified in certain ways relating to when it happens. For example, leaking urine when you cough, laugh, sneeze or take exercise, is called ‘stress urinary incontinence’, and leaking urine when you have to rush to or wait for the toilet is called ‘urge’ incontinence, because you have an urge to go when it happens. Leaking urine when you exercise, and with a sense of urgency, is called ‘mixed’ incontinence.

Some women leak urine when they exercise, and this can be embarrassing and be enough to stop women from exercising. Not taking exercise is likely to contribute to gaining weight, which in turn can raise the odds of leaking urine.

As part of the UI strand of the MAMMI study, a number of videos were produced on pelvic floor exercises and urinary incontinence and are available here: http://www.mammi.ie/videos.php or on the Rotunda Hospital website here: http://www.rotunda.ie/en-gb/maternitycare/postnatalcareformother/postnatalexercises.aspx or on YouTube: https://www.youtube.com/watch?v=j0UTzKgdPWI&list=PL2LN7sEFgcpOQSsD1XaihBQdlTp3FHaDn

The MAMMI study is funded by the Health Research Board. Certain strands also received funding from Friends of the Coombe and Friends of the Rotunda.

If any women are concerned about UI or any of the issues being covered by the MAMMI study they should contact their healthcare provider for advice and support.

More information on the MAMMI study is available from http://www.mammi.ie

Media Coverage:

• Irish Times, March 3rd, 2015
• Irish Independent, March 3rd, 2015
• Examiner, March 3rd, 2015
• Ireland AM, March 3rd, 2015
• Newstalk, Moncrieff Show, March 3rd, 2015 (scroll to 8.55 minutes)
• TheJournal.ie, March 3rd, 2015
• IrishHealth.ie, March 3rd, 2015