Prenatal Pelvic Floor Workout Cuts Postpartum SUI in Primiparous Women

Key Takeaways

• At 6 weeks postpartum, the exercise group had a lower SUI rate than the usual-care group in this multicenter randomized trial.
• Pelvic floor strength was higher at 6 weeks, and SUI rates were lower at 3, 6, and 12 months postpartum; the 37-week comparison was not significant.
• Within the exercise group, higher training intensity was associated with lower SUI at selected later assessments, and no PEFLOW-related adverse events were observed.

In a multicenter randomized trial in China, primiparous women assigned to PEFLOW plus usual care had lower SUI rates at 6 weeks postpartum than those receiving usual care alone. Rates were 8.7% (32/367) and 13.9% (50/360), a 5.17 percentage-point difference (95% CI, 0.36 to 10.03; P=.03).

The trial used a 2-arm, parallel design across 9 hospitals in China and randomized 764 primiparous women 1:1. Eligible participants were aged 20 to 40 years, carried a singleton pregnancy under 16 weeks' gestation, and could provide informed consent. Major exclusions covered severe complications, SUI or pelvic organ prolapse, and prior cervical insufficiency, recurrent miscarriage, or induced labor. The cohort had a median age of 29 years, and recruitment ran from August 2020 through June 2022 in a first-pregnancy population without baseline SUI or pelvic organ prolapse.

PEFLOW started at 28 weeks' gestation and continued until delivery, combining daily pelvic floor muscle training with two weekly sessions of global postural exercises. The program used a specially designed video guide and mobile app for health education, procedural video instruction, reminders, and online supervision, with in-clinic reinforcement. Exercise-group participants received checkups and guidance every 2 weeks, while controls received usual medical care with obstetric examinations every 2 weeks from 28 weeks to delivery.

At 6 weeks postpartum, Modified Oxford Scale scores of 4 or higher occurred in 17.8% of the exercise group and 7.9% of controls (P<.001). SUI rates were 22.0% versus 25.7% at 37 weeks' gestation, then 11.0% versus 17.8%, 13.1% versus 18.8%, and 19.4% versus 29.8% at 3, 6, and 12 months postpartum. The corresponding postpartum risk differences were 6.81, 5.76, and 10.47 percentage points, while the 37-week comparison was not statistically significant at P=.23.

Within the exercise group, women reaching intensity of 80% or greater had lower SUI rates than those reaching 50% to less than 80%: 7.8% versus 16.8% at 37 weeks' gestation. The same comparison was 2.7% versus 11.9% at 6 months postpartum and 6.9% versus 16.9% at 12 months postpartum.

Researchers observed no PEFLOW-related adverse events; maternal-fetal event proportions included premature rupture of membranes in 17.6% versus 23.5%, fetal distress only in controls, and postpartum hemorrhage in 0.3% versus 3.8%.