{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T23:19:07Z","timestamp":1791674347437,"version":"4.3.4"},"reference-count":53,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Urinary incontinence (UI) is a common condition during pregnancy, significantly impacting the physical and mental well-being as well as quality of life. With advancements in mobile health technology, mobile apps provide innovative approaches for managing UI. Although small-scale studies have demonstrated their efficacy in alleviating maternal UI symptoms, there is a notable lack of large-scale, multicenter trials to validate these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This multicenter randomized controlled trial evaluated the effectiveness of a mobile app (\u201cUrinary Incontinence for Women\u201d) for self-management of UI among pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 295 participants were recruited from obstetric clinics at 5 hospitals and randomized to either a 12-week mobile app\u2013based intervention group (n=148) or a standard care group (n=147). The primary outcome was UI symptom severity, with secondary outcomes of the impact of UI on quality of life and self-efficacy in pelvic floor muscle training (PFMT). Assessments were conducted at baseline, postintervention (12 weeks), and 6\u20108 weeks postpartum via electronic questionnaires. Generalized estimating equation modeling was used to evaluate the intervention effects. Subgroup analyses were performed to examine intervention effects across different baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 267 participants (267\/295, 90.5%) completed all assessments. The intervention group showed significantly improved UI symptom severity compared with controls postintervention (\u03b2=\u2212.97, 95% CI \u22121.85 to \u22120.08;\n                      <jats:italic>P<\/jats:italic>\n                      =.03), with further improvement at 6\u20108 weeks postpartum (\u03b2=\u22121.93, 95% CI \u22122.70 to \u22121.17;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). The impact of UI on quality of life also improved in the intervention group postintervention (\u03b2=\u22121.05, 95% CI \u22121.95 to \u22120.15;\n                      <jats:italic>P<\/jats:italic>\n                      =.048) and at 6\u20108 weeks postpartum (\u03b2=\u22121.72, 95% CI \u22122.46 to \u22120.98;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). No significant between-group difference was observed in PFMT self-efficacy (\u03b2=1.49, 95% CI \u22122.93 to 5.90;\n                      <jats:italic>P<\/jats:italic>\n                      =.51), which decreased significantly from postintervention to 6\u20108 weeks postpartum (\u03b2=\u22124.66, 95% CI \u22128.11 to \u22121.22;\n                      <jats:italic>P<\/jats:italic>\n                      =.008). Subgroup analyses revealed significant interactions between intervention effects and education level, PFMT performing before enrollment, history of vaginal delivery, and baseline UI symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The \u201cUrinary Incontinence for Women\u201d app\u2013based self-management strategies significantly improved UI symptom severity and quality of life in pregnant and postpartum women, with pronounced effects in certain subgroups based on education level and baseline UI status. While PFMT self-efficacy was not enhanced, the app\u2019s benefits underscore the clinical relevance of personalized UI management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/72883","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T19:12:16Z","timestamp":1754593936000},"page":"e72883-e72883","source":"Crossref","is-referenced-by-count":9,"title":["Mobile App\u2013Based Self-Management of Urinary Incontinence in Pregnant Women: Multicenter Pragmatic Randomized Controlled Trial"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1148-6600","authenticated-orcid":false,"given":"Yuling","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2354-5199","authenticated-orcid":false,"given":"Wenzhi","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8271-3922","authenticated-orcid":false,"given":"Sha","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6579-4724","authenticated-orcid":false,"given":"Danli","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4133-742X","authenticated-orcid":false,"given":"Dan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4919-5433","authenticated-orcid":false,"given":"Shaoli","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7391-8836","authenticated-orcid":false,"given":"Wei","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3439-6480","authenticated-orcid":false,"given":"Lihua","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4309-6623","authenticated-orcid":false,"given":"Shuanghao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7835-6918","authenticated-orcid":false,"given":"Hengying","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4637-250X","authenticated-orcid":false,"given":"Ling","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00192-009-0976-9","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction","volume":"21","author":"Haylen","journal-title":"Int Urogynecol J"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-022-01920-2","article-title":"Urinary incontinence in pregnant women and its impact on health-related quality of life","volume":"20","author":"Wang","journal-title":"Health Qual Life Outcomes"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1111\/luts.12495","article-title":"Urinary incontinence in the postpartum 1-year period: its prevalence and effect on psychosocial status of women","volume":"15","author":"Suar","journal-title":"Low Urin Tract Symptoms"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.ajog.2024.02.307","article-title":"Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis","volume":"231","author":"Gallego-G\u00f3mez","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-88740-4","article-title":"Urinary incontinence and the association with depression, stress, and self-esteem in older Korean Women","volume":"11","author":"Lee","journal-title":"Sci Rep"},{"issue":"3","key":"R6","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.sxmr.2019.06.009","article-title":"The impact of urinary incontinence on sexual function: a systematic review","volume":"8","author":"Pinheiro Sobreira Bezerra","journal-title":"Sex Med Rev"},{"issue":"7","key":"R7","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1002\/nau.25007","article-title":"The burdens of incontinence: quantifying incontinence product usage and costs in women","volume":"41","author":"Chisholm","journal-title":"Neurourol Urodyn"},{"issue":"7","key":"R8","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.1002\/nau.24989","article-title":"Healthcare resource use and cost burden of urinary incontinence to United States payers","volume":"41","author":"Datar","journal-title":"Neurourol Urodyn"},{"issue":"12","key":"R9","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1111\/aogs.14275","article-title":"Stress and urgency urinary incontinence one year after a first birth-prevalence and risk factors. A prospective cohort study","volume":"100","author":"Jansson","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"7","key":"R10","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1007\/s00192-020-04636-3","article-title":"Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis","volume":"32","author":"Moossdorff-Steinhauser","journal-title":"Int Urogynecol J"},{"issue":"7","key":"R11","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1007\/s00192-021-04885-w","article-title":"Prevalence of urinary incontinence in pregnant and postpartum women in the Democratic Republic of Congo","volume":"32","author":"Maroyi","journal-title":"Int Urogynecol J"},{"issue":"6","key":"R12","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1007\/s00192-021-05011-6","article-title":"Cumulative incidence of urinary incontinence and associated factors during pregnancy and after childbirth: a cohort study","volume":"33","author":"Chang","journal-title":"Int Urogynecol J"},{"issue":"3","key":"R13","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.ajur.2022.03.016","article-title":"The prevalence, associated factors, and impact of urinary incontinence in pregnant and postpartum women in Nanjing, China: a cross-sectional study","volume":"10","author":"Yang","journal-title":"Asian J Urol"},{"issue":"11","key":"R14","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1007\/s00192-020-04442-x","article-title":"Maternal, obstetrical and neonatal risk factors\u2019 impact on female urinary incontinence: a systematic review","volume":"31","author":"Siahkal","journal-title":"Int Urogynecol J"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1111\/aogs.14027","article-title":"Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: a systematic review and meta-analysis","volume":"100","author":"Hage-Fransen","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"10","key":"R16","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005654.pub4","article-title":"Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women","volume":"10","author":"Dumoulin","journal-title":"Cochrane Database Syst Rev"},{"issue":"9","key":"R17","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012337.pub2","article-title":"Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews","volume":"9","author":"Todhunter-Brown","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1136\/bjsports-2012-091758","article-title":"Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review","volume":"48","author":"M\u00f8rkved","journal-title":"Br J Sports Med"},{"issue":"12","key":"R19","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009508","article-title":"Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women","volume":"12","author":"Hay-Smith","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"R20","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007471.pub4","article-title":"Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women","volume":"5","author":"Woodley","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","first-page":"e122","DOI":"10.1097\/SPV.0000000000000852","article-title":"Evaluation of awareness, adherence, and barriers of pelvic floor muscle training in pregnant women: a cross-sectional study","volume":"27","author":"Bayat","journal-title":"Female Pelvic Med Reconstr Surg"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1007\/s00192-020-04566-0","article-title":"Urinary incontinence during pregnancy: prevalence, experience of bother, beliefs, and help-seeking behavior","volume":"32","author":"Moossdorff-Steinhauser","journal-title":"Int Urogynecol J"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S242432","article-title":"Knowledge, attitude, and practices (KAP) survey towards pelvic floor muscle training (PFMT) among pregnant women","volume":"12","author":"Temtanakitpaisan","journal-title":"Int J Womens Health"},{"issue":"6","key":"R24","doi-asserted-by":"publisher","first-page":"300060520914226","DOI":"10.1177\/0300060520914226","article-title":"Performance of self-reported and unsupervised antenatal pelvic floor muscle training and its effects on postpartum stress urinary incontinence among Chinese women: a cohort study","volume":"48","author":"Chen","journal-title":"J Int Med Res"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/50508","article-title":"User engagement with mHealth interventions to promote treatment adherence and self-management in people with chronic health conditions: systematic review","volume":"26","author":"Eaton","journal-title":"J Med Internet Res"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/19439","article-title":"A mobile app for self-management of urgency and mixed urinary incontinence in women: randomized controlled trial","volume":"23","author":"Wadensten","journal-title":"J Med Internet Res"},{"issue":"10","key":"R27","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1111\/aogs.13192","article-title":"Self-management of stress urinary incontinence via a mobile app: two-year follow-up of a randomized controlled trial","volume":"96","author":"Hoffman","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-040819","article-title":"Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study","volume":"11","author":"Rygh","journal-title":"BMJ Open"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","DOI":"10.2196\/17114","article-title":"User experiences and preferences regarding an app for the treatment of urinary incontinence in adult women: qualitative study","volume":"8","author":"Wessels","journal-title":"JMIR Mhealth Uhealth"},{"issue":"3","key":"R30","doi-asserted-by":"publisher","DOI":"10.2196\/11296","article-title":"User experience of an app-based treatment for stress urinary incontinence: qualitative interview study","volume":"21","author":"Asklund","journal-title":"J Med Internet Res"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-021-01477-0","article-title":"Quality of life in women with urinary incontinence seeking care using e-health","volume":"21","author":"\u00c5str\u00f6m","journal-title":"BMC Womens Health"},{"issue":"11","key":"R32","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1097\/SPV.0000000000000670","article-title":"The adherence of home pelvic floor muscles training using a mobile device application for women with urinary incontinence: a randomized controlled trial","volume":"26","author":"Araujo","journal-title":"Female Pelvic Med Reconstr Surg"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1370\/afm.2585","article-title":"App-based treatment in primary care for urinary incontinence: a pragmatic, randomized controlled trial","volume":"19","author":"Loohuis","journal-title":"Ann Fam Med"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.2196\/43528","article-title":"Effect of a mobile app-based urinary incontinence self-management intervention among pregnant women in China: pragmatic randomized controlled trial","volume":"25","author":"Chen","journal-title":"J Med Internet Res"},{"key":"R35","unstructured":"Hintze J . NCSS and PASS: number cruncher statistical systems. 2001. URL: https:\/\/www.ncss.com [Accessed 16-01-2025]"},{"issue":"4","key":"R36","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.cct.2006.11.003","article-title":"Sample size calculation for multicenter randomized trial: taking the center effect into account","volume":"28","author":"Vierron","journal-title":"Contemp Clin Trials"},{"issue":"4","key":"R37","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1002\/nau.20041","article-title":"ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence","volume":"23","author":"Avery","journal-title":"Neurourol Urodyn"},{"issue":"6","key":"R38","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1002\/nau.20546","article-title":"The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence","volume":"27","author":"Huang","journal-title":"Neurourol Urodyn"},{"issue":"5","key":"R39","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1007\/BF00451721","article-title":"Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group","volume":"3","author":"Shumaker","journal-title":"Qual Life Res"},{"issue":"7","key":"R40","first-page":"505","volume":"46","author":"Zhu","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"issue":"4","key":"R41","first-page":"258","volume":"19","author":"Broome","journal-title":"Urol Nurs"},{"issue":"15","key":"R42","first-page":"1857","volume":"18","author":"Bai","journal-title":"Chinese Gen Pract"},{"issue":"4","key":"R43","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1093\/aje\/kwf215","article-title":"Statistical analysis of correlated data using generalized estimating equations: an orientation","volume":"157","author":"Hanley","journal-title":"Am J Epidemiol"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-022-00812-6","article-title":"Effectiveness of mobile apps to improve urinary incontinence: a systematic review of randomised controlled trials","volume":"21","author":"Widdison","journal-title":"BMC Nurs"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103527","article-title":"Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: a randomized controlled trial","volume":"104","author":"Wang","journal-title":"Int J Nurs Stud"},{"issue":"4","key":"R46","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1097\/01.AOG.0000257120.23260.00","article-title":"Urinary incontinence during pregnancy","volume":"109","author":"Wesnes","journal-title":"Obstet Gynecol"},{"issue":"2","key":"R47","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1097\/JNR.0b013e3181a53e7e","article-title":"Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence","volume":"17","author":"Chen","journal-title":"J Nurs Res"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1080\/09593985.2018.1482583","article-title":"Predictors for adherence to a home-based pelvic floor muscle exercise program for treating female urinary incontinence in Brazil","volume":"36","author":"Sacomori","journal-title":"Physiother Theory Pract"},{"issue":"4","key":"R49","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19042332","article-title":"Preliminary effectiveness of mHealth app-based pelvic floor muscle training among pregnant women to improve their exercise adherence: a pilot randomised control trial","volume":"19","author":"Jaffar","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"R50","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.wcn.2024.07.003","article-title":"Trajectory of pelvic floor muscle training adherence in Chinese women with postpartum stress urinary incontinence and its related factors: A longitudinal study","volume":"2","author":"Wang","journal-title":"Women Child Nurs"},{"issue":"7","key":"R51","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-051827","article-title":"Prediction model study focusing on eHealth in the management of urinary incontinence: the Personalised Advantage Index as a decision-making aid","volume":"12","author":"Loohuis","journal-title":"BMJ Open"},{"issue":"9","key":"R52","doi-asserted-by":"publisher","DOI":"10.2196\/25878","article-title":"Barriers and facilitators associated with app-based treatment for female urinary incontinence: mixed methods evaluation","volume":"9","author":"Wessels","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-022-02067-4","article-title":"Attitudes and barriers to pelvic floor muscle exercises of women with stress urinary incontinence","volume":"22","author":"Sawettikamporn","journal-title":"BMC Womens Health"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2025\/1\/e72883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:03:20Z","timestamp":1782842600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2025\/1\/e72883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":53,"URL":"https:\/\/doi.org\/10.2196\/72883","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"article-number":"v27i1e72883"}}