TY - JOUR
T1 - Longitudinal changes in the genital hiatus preceding the development of pelvic organ prolapse
AU - Handa, Victoria L.
AU - Blomquist, Joan L.
AU - Carroll, Megan
AU - Roem, Jennifer
AU - Muñoz, Alvaro
N1 - Funding Information:
This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grants R01HD082070 and R01HD056275). Conflict of interest: none declared.
Funding Information:
This work was supported by the National Institute on Aging (grant K01-AG050699 to A.L.G.). Conflict of interest: none declared.
Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
PY - 2019/12/31
Y1 - 2019/12/31
N2 - We aimed to explore relationships between changes in genital hiatus (GH) and development of pelvic organ prolapse using data from the Mothers' Outcomes After Delivery (MOAD) Study, a Baltimore, Maryland, cohort study of parous women who underwent annual assessments during 2008-2018. Prolapse was defined as any vaginal segment protrusion beyond the hymen or reported prolapse surgery. For each case, 5 controls (matched on birth type and interval from first delivery to study enrollment) were selected using incidence sampling methods. We used a mixed model whose fixed effects described the initial size and slope of the GH as a function of prolapse status (case vs. control) and with nested (women within matched sets) random effects. Among 1,198 women followed for 1.0-7.3 years, 153 (13%) developed prolapse; 754 controls were matched to those women, yielding 3,664 visits for analysis. GH was 20% larger among the cases at enrollment (3.16 cm in cases vs. 2.62 cm in controls; P < 0.001), and the mean rate of increase in the size of the GH was more than 3 times greater (0.56 cm per 5-year period vs. 0.15 cm per 5-year period in controls; P < 0.001). Thus, to identify women at highest risk for developing prolapse, health-care providers could evaluate not simply the size of the GH but also changes in the GH over time.
AB - We aimed to explore relationships between changes in genital hiatus (GH) and development of pelvic organ prolapse using data from the Mothers' Outcomes After Delivery (MOAD) Study, a Baltimore, Maryland, cohort study of parous women who underwent annual assessments during 2008-2018. Prolapse was defined as any vaginal segment protrusion beyond the hymen or reported prolapse surgery. For each case, 5 controls (matched on birth type and interval from first delivery to study enrollment) were selected using incidence sampling methods. We used a mixed model whose fixed effects described the initial size and slope of the GH as a function of prolapse status (case vs. control) and with nested (women within matched sets) random effects. Among 1,198 women followed for 1.0-7.3 years, 153 (13%) developed prolapse; 754 controls were matched to those women, yielding 3,664 visits for analysis. GH was 20% larger among the cases at enrollment (3.16 cm in cases vs. 2.62 cm in controls; P < 0.001), and the mean rate of increase in the size of the GH was more than 3 times greater (0.56 cm per 5-year period vs. 0.15 cm per 5-year period in controls; P < 0.001). Thus, to identify women at highest risk for developing prolapse, health-care providers could evaluate not simply the size of the GH but also changes in the GH over time.
KW - empirical Bayes methods
KW - genital hiatus
KW - mixed-effects models
KW - nested case-control studies
KW - pelvic organ prolapse
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U2 - 10.1093/aje/kwz195
DO - 10.1093/aje/kwz195
M3 - Article
C2 - 31565742
AN - SCOPUS:85080851582
SN - 0002-9262
VL - 188
SP - 2196
EP - 2201
JO - American journal of epidemiology
JF - American journal of epidemiology
IS - 12
ER -