Western University

Research Spotlight

 

Highlighted publication:

 

The Association of Adverse Pregnancy Outcomes with Overactive Bladder Anticholinergics

Welk B, McClure JA, McArthur E, Leong Y. The Association of Adverse Pregnancy Outcomes With Overactive Bladder Anticholinergics. Urogynecology (Phila). 2024 Aug 8. doi: 10.1097/SPV.0000000000001563. Epub ahead of print. PMID: 39115417.

Medication safety during pregnancy remains under-researched, with limited data on the fetal and obstetric effects of prescription drugs. The FDA label for oxybutynin notes that its safety in pregnancy is unestablished, while animal studies of other overactive bladder (OAB) anticholinergics—such as solifenacin and tolterodine—have shown adverse outcomes like low birth weight and congenital anomalies at high doses. However, human studies are lacking. Despite this, OAB medications may be used during pregnancy in certain cases, such as unrecognized early pregnancy, severe symptoms, or to preserve renal function in patients with neurologic disorders.

This study evaluated whether OAB anticholinergics used during pregnancy are associated with adverse outcomes. Using Ontario health administrative data from 2004 to 2022, the study included 138,271 births among women aged 18–45 with drug benefit eligibility. Of these, 479 pregnancies (0.3%) involved OAB anticholinergic exposure, typically for a median of 60 days. Oxybutynin was most common (84%), followed by solifenacin (6.9%) and tolterodine (5.4%). Exposure most often occurred in the first trimester (95.4%), but extended into the second (29.6%) and third (19.0%) trimesters.

In the weighted cohort, the risk of a pregnancy complication was significantly elevated (RR, 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.01; absolute risk difference + 9.9% [95% CI, +5.9, +13.9]), with a dose response relationship close to statistical significance (P = 0.07). The risk of congenital malformations with OAB anticholinergic use was not significant (RR, 1.24; 95% CI, 0.85–1.80; P = 0.26).The authors concluded knowing the number needed to harm (specifically 18 for preterm births and 13 for low-birth-weight infants) will help physicians and women make decisions around the use of this medication during childbearing or while trying to become pregnant.

 

Current Studies/Investigations:

The Division of Urogynecology, Dept. Obs/Gyn at the Schulich School of Medicine and Dentistry at Western University is involved in research projects in the following areas:

  • Surgical and Non-surgical outcomes for Urinary Incontinence, Pelvic Organ Prolapse and other Pelvic Floor conditions
  • Cadaver dissection of the Female Pelvic Floor to characterize neurovascular anatomy
  • Interstitial Cystitis/Bladder Pain Syndrome
  • Conservative Management of Pelvic Organ Prolapse with customized pessaries (in association with COSM)
  • The effect of Overactive Bladder (OAB) medications on cognition
  • Imaging of the Female Pelvic Floor

We have research collaborations with MIS Gyn colleagues, Urology colleagues and Basic Scientists in the Anatomy Department, and ICES scientists within our group of faculty consultants for the fellowship program. 

There is an opportunity for fellows to work towards obtaining a Master of Surgery degree through the School of Graduate Studies although it may require an additional third year to the two clinical years for completion.

 

2023-2025 Publication List

  1. Welk B, McClure JA, McArthur E, Leong Y. The association of adverse pregnancy outcomes with overactive bladder anticholinergics. Urogynecology (Phila). 2024 Aug 8. doi: 10.1097/SPV.0000000000001563. Epub ahead of print. PMID: 39115417.
  2. Welk B, Etaby K, McArthur E, Chou Q. The risk of delirium and falls or fractures with the use of overactive bladder anticholinergic medications. Neurourol Urodyn. 2022 Jan;41(1):348–356. doi: 10.1002/nau.24827. Epub 2021 Oct 31. PMID: 34719044.
  3. Welk B, Reid J, Kelly E, Wu YM. Association of transvaginal mesh complications with the risk of new-onset depression or self-harm in women with a midurethral sling. JAMA Surg. 2019 Apr 1;154(4):358–360. doi: 10.1001/jamasurg.2018.4644. PMID: 30624560; PMCID: PMC6484799.
  4. Kelly EC, Winick-Ng J, McClure JA, Peart T, Chou Q, MacMillan B, et al. Hysterectomy in Ontario: a population-based study of outcomes and complications in minimally invasive compared with abdominal approaches. J Obstet Gynaecol Can. 2019 Aug;41(8):1168–1176. doi: 10.1016/j.jogc.2018.10.026. Epub 2019 Jan 25. PMID: 30686606.
  5. Wu YM, Reid J, Chou Q, MacMillan B, Leong Y, Welk B. Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study. Int Urogynecol J. 2019 Apr;30(4):537–544. doi: 10.1007/s00192-018-3792-2. Epub 2018 Oct 16. PMID: 30327850.
  6. Melon J, Kelly EC, van Delft KWM. Cystourethroscopy following midurethral slings: is it always necessary? Int Urogynecol J. 2018 Jun;29(6):789–793. doi: 10.1007/s00192-018-3611-9. Epub 2018 Mar 21. PMID: 29564509.
  7. Wu YM, McInnes N, Leong Y. Pelvic floor muscle training versus watchful waiting and pelvic floor disorders in postpartum women: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg. 2018 Mar-Apr;24(2):142–149. doi: 10.1097/SPV.0000000000000513. PMID: 29474288.
  8. Kelly E, Wu MY, MacMillan JB. Robotic-assisted vesicovaginal fistula repair using an extravesical approach without interposition grafting. J Robot Surg. 2018 Mar;12(1):173–176. doi: 10.1007/s11701-017-0694-0. Epub 2017 Mar 28. PMID: 28353196.
  9. Kelly EC, Winick-Ng J, Welk B. Surgeon experience and complications of transvaginal prolapse mesh. Obstet Gynecol. 2016 Jul;128(1):65–72. doi: 10.1097/AOG.0000000000001450. PMID: 27275803.
  10. Harvey MA, Pierce M, Alter JE, Chou Q, Diamond P, Epp A, et al. Obstetrical anal sphincter injuries (OASIS): prevention, recognition, and repair. J Obstet Gynaecol Can. 2015 Dec;37(12):1131–1148. doi: 10.1016/s1701-2163(16)30081-0. Erratum in: J Obstet Gynaecol Can. 2016 Apr;38(4):421. doi: 10.1016/j.jogc.2016.02.004. PMID: 26637088.
  11. Welk B, Al-Hothi H, Winick-Ng J, Chou Q, MacMillan B, Lawendy AR. The effect of pelvic fractures on future stress incontinence and pelvic organ prolapse surgery. Int Urogynecol J. 2015 Jun;26(6):805–811. doi: 10.1007/s00192-014-2624-2. Epub 2015 Feb 6. PMID: 25656453.
  12. Hafidh BA, Chou Q, Khalil MM, Al-Mandeel H. De novo stress urinary incontinence after vaginal repair for pelvic organ prolapse: one-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2013 Jun;168(2):227–230. doi: 10.1016/j.ejogrb.2012.12.029. Epub 2013 Jan 29. PMID: 23369340.