Impact of Bariatric Surgery on Postpartum Urinary Incontinence in Women with Gestational Diabetes: A Retrospective Case-Control Analysis.

Background: Prenatal obesity and gestational diabetes mellitus (GDM) are recognized contributors to the development of postpartum urinary incontinence (PPUI). Pregnant women with obesity and GDM are at an elevated risk, and while bariatric surgery (BS) has proven effective for sustained weight loss and may mitigate urinary incontinence, its influence on postpartum outcomes has not been thoroughly examined. This study evaluates the relationship between BS and PPUI outcomes-including symptom duration and subtype.

Methods: In this retrospective case-control investigation, we analyzed pregnancies of women with a history of BS who later developed GDM. A control cohort without prior BS was established via 1:2 matching according to preoperative body mass index (BMI), maternal age, parity, and delivery year. This matching strategy ensured a robust comparative analysis between groups.

Results: The no-BS control group experienced a significantly longer duration of PPUI (median: 18.2 weeks) compared to the BS group (median: 12.1 weeks; log-rank p < 0.001). Additionally, by 12 months postpartum, 82.6% of the BS group achieved symptom resolution versus 67.4% of controls (p = 0.03). Multivariate analysis further identified postoperative diarrhea as an independent predictor of extended PPUI duration (p = 0.002).

Conclusions: Our findings suggest that BS may contribute to improved PPUI outcomes by shortening the duration of urinary incontinence. However, complications such as postoperative diarrhea appear to adversely affect recovery, emphasizing the need for integrated perioperative and postpartum management in this high-risk group.