Brülle et al. conducted a prospective cohort study involving a large Danish population and 23-year follow-up evaluating risk factors and their contribution to development of pelvic organ prolapse (POP). As POP is highly prevalent with significant societal and individual impact, and prior published studies may be limited and/or contradictory because of their small size and short follow-up, the authors aim to identify what factors of a woman’s reproductive history and anthropometry are associated with POP.

The authors utilized data from the Danish Nurse Cohort, which included questionnaire data from nurses recruited via the Danish Nurse Organization. Data for this study were included only if the responders participated at all three time points (i.e., 1993, 1999, and 2009), and the incidence of POP was identified via International Classification of Diseases (ICD) codes. Data collected included height, weight, body mass index (BMI), age at menarche, age at first childbirth, and parity. Women with a BMI > 25, age of menarche < 12 years, and higher parity had an increased risk of POP.

The authors identified risk factors previously established in the literature for development of POP. While they propose mechanisms by which age of menarche may impact development of POP, this variable is likely confounded by parity, a strong predictor of POP. The authors identify “threshold” effects which may exist for weight and BMI and age at first childbirth; this introduces an interesting but limited concept because of the small number of patients meeting the specific criteria of obesity and age > 34 years at first childbirth. Overall, the authors completed the objective of their study as one of the longest follow-up studies regarding development of POP; however, it confirms parity and BMI as risk factors for POP but adds little in terms of new findings to the existing literature.