Kate Johnson

November 01, 2013

LAS VEGAS — Pregnancy and breastfeeding may improve pain and urinary urgency symptoms in more than half of women with interstitial cystitis bladder syndrome, according to the results of a new study.

The findings are encouraging, Peter O'Hare, MD, from Drexel University College of Medicine in Philadelphia, Pennsylvania, told Medscape Medical News. "My hope is that this information reaches reproductive-age women and empowers them to pursue pregnancy if they wish," he said.

Dr. O'Hare presented the results here American Urogynecologic Society (AUGS) 34th Annual Scientific Meeting.

Interstitial cystitis/bladder pain syndrome is typically diagnosed in women aged 40 to 60 years, but improved awareness and recognition of the condition have led to an increase in diagnoses among reproductive-age women, said Dr. O'Hare. There has also been an increase in "reproductive avoidance, possibly due to fear of what the pregnancy will do to their symptoms," he added.

To assess the validity of these concerns, his study used an Internet-based survey to investigate the effect of pregnancy and lactation on symptoms.

The survey included 384 women, with a mean age of 36.7 years, who reported physician-diagnosed interstitial cystitis and bladder pain before their first pregnancy. Among them, 102 women reported 2 pregnancies since their diagnosis.

When asked to rate their symptoms before pregnancy, 30% of women said they were mild, 52% reported them as moderate, and 18% as severe.

 
My hope is that this information reaches reproductive-age women and empowers them to pursue pregnancy if they wish. Dr. Peter O'Hare
 

Although 12% of the women were still pregnant at the time of the survey, modes of delivery among the rest included vaginal birth with anesthesia (36.2%), vaginal birth without anesthesia (16.7%), and cesarean (30.2%). One patient had a stillbirth, 12 had miscarriages, and an additional 5 patients reported terminations, "2 of which were said to be due to severe interstitial cystitis symptoms," said Dr. O'Hare.

During pregnancy, more women experienced an improvement or no change in their pain symptoms rather than a worsening, said Dr. O'Hare. Peak improvement was seen in the second trimester.

Symptoms of urinary frequency, a common complaint for many pregnant women, did not improve to the same degree as pain. In fact, in the first trimester, more women felt that their symptoms got worse rather than better.

Improvement in urinary urgency was more common through all trimesters. These patterns were mirrored for women who had a second pregnancy.

Table. Interstitial Cystitis and Bladder Symptoms During Pregnancy

Symptoms First Trimester (%) Second Trimester (%) Third Trimester (%)

Pain improved

39.3 51.8 44.2

Pain similar

35.6 19.4 16.8

Pain worse

25.1 28.8 39.0

Urinary frequency improved

27.0 35.8 27.6

Urinary frequency similar

33.5 36.6 16.5

Urinary frequency worse

39.5 27.6 56.3

Urinary urgency improved

39.3 51.8 44.2

Urinary urgency similar

35.6 19.4 16.8

Urinary urgency worse

25.1 28.8 39.0

 

A total of 265 women (71%) chose to breastfeed, with 52% reporting an improvement in pain compared with prepregnancy levels, 38% reporting no difference, and 10% reporting a worsening.

The majority of women (73%) discontinued their usual treatment when they became pregnant, with 50% reporting no treatment during pregnancy; 25% reporting that they followed an interstitial cystitis diet, which primarily involved avoidance of irritant foods or beverages; and 5% reporting use of narcotics, said Dr. O'Hare.

Symptoms eventually returned to pregestational levels for most (63%) women after a mean of 27.18 weeks.

"Young women diagnosed with interstitial cystitis and bladder pain often bear a burden of debilitating pain and lower urinary tract symptoms that manifest unpredictably and are difficult to treat," Dr. O'Hare told Medscape Medical News. "From our results, it appears that symptoms remain stable in pregnancy and in subsequent pregnancies. These data provide practitioners with more information to counsel patients and helps to alleviate some of the uncertainty."

Asked to comment on the findings, session moderator Shawn Menefee, MD, from the University of California, San Diego, said that an important limitation of the study is that it relies on patient perception and recall.

The fact that so many patients eliminated their treatment in pregnancy speaks to how little is known about the safety issues of the treatment, said Dr. Menefee. "But it's reassuring to see that a high number of patients got better or stayed the same despite eliminating therapy."

Comoderator Elizabeth Geller, MD, from the University of North Carolina at Chapel Hill, said she agrees that "it helps to have more information to counsel patients," but added that the elimination of therapy during pregnancy is an important confounder.

"Did their change in symptoms happen because of pregnancy, or because of the treatment withdrawal?" she asked.

Dr. O'Hare, Dr. Menefee, and Dr. Geller report no relevant financial relationships.

American Urogynecologic Society (AUGS) 34th Annual Scientific Meeting: Paper 12. Presented October 17, 2013.

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