PDF herunterladen
Am J Perinatol 2024; 41(03): 349-354
DOI: 10.1055/a-1682-2976
Original Article

The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes

Iqra Sheikh
1   Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
,
Kylie A. Fuller
1   Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
,
Kateena Addae-Konadu
2   Division of Maternal Fetal Medicine, Duke University, Durham, North Carolina
,
Sarah K. Dotters-Katz
2   Division of Maternal Fetal Medicine, Duke University, Durham, North Carolina
,
Megan S. Varvoutis
1   Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period.

Study Design The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40–49.9, 50–59.9, 60–69.9, and >70 kg/m2).

Results Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50–59.9 kg/m2; 13.7% BMI: 60–69.9 kg/m2; and 21.9% BMI >70+ kg/m2; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50–59.9 kg/m2; 6.2% for BMI: 60–69.9 kg/m2; and 9.4% for BMI >70+ kg/m2; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37–29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35–4.02 for BMI 50–59.9 kg/m2; aOR = 4.91, 95% CI: 2.07–11.7 for BMI of 60–69.9 kg/m2; and aOR = 36.2, 95% CI: 7.45–176 for BMI >70 kg/m2).

Conclusion Women with BMI 50 to 70+ kg/m2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles.

Key Points

  • Women with super obesity have higher rates of wound complications.

  • Women at extremes of obesity experience worse postpartum infectious morbidity.

  • More research is needed on effective strategies to minimize morbidity in this population.

Keywords

postpartum infection - morbid obesity - cesarean - wound infection

Condensation

Women with body mass index of 50 to 70+ kg/m2 have a significantly increased risk of postpartum infectious morbidity compared with women with a body mass index of 40 to 49.9 kg/m2.


Note

This study was presented at the Seminar of Maternal-Fetal medicine, 41st Annual Pregnancy Meeting Poster Presentation, January 30, 2021.




Publikationsverlauf

Eingereicht: 23. März 2021

Angenommen: 24. Oktober 2021

Accepted Manuscript online:
28. Oktober 2021

Artikel online veröffentlicht:
16. Dezember 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (08) 806-814
    CrossrefPubMedGoogle Scholar
  • 2 Hibbard JU, Gilbert S, Landon MB. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol 2006; 108 (01) 125-133
    CrossrefPubMedGoogle Scholar
  • 3 Chu SY, Kim SY, Schmid CH. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8 (05) 385-394
    CrossrefPubMedGoogle Scholar
  • 4 Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Health Neonatol Perinatol 2017; 3: 12
    CrossrefPubMedGoogle Scholar
  • 5 Martin A, Krishna I, Ellis J, Paccione R, Badell M. Super obesity in pregnancy: difficulties in clinical management. J Perinatol 2014; 34 (07) 495-502
    CrossrefPubMedGoogle Scholar
  • 6 Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes 2013; 37 (06) 889-891
    CrossrefPubMedGoogle Scholar
  • 7 Gunatilake RP, Smrtka MP, Harris B. et al. Predictors of failed trial of labor among women with an extremely obese body mass index. Am J Obstet Gynecol 2013; 209 (06) 562.e1-562.e5
    CrossrefPubMedGoogle Scholar
  • 8 Tuuli MG, Liu J, Tita ATN. et al. Effect of prophylactic negative pressure wound therapy vs standard wound dressing on surgical-site infection in obese women after cesarean delivery: a randomized clinical trial. JAMA 2020; 324 (12) 1180-1189
    CrossrefPubMedGoogle Scholar
  • 9 Olsen MA, Butler AM, Willers DM, Gross GA, Hamilton BH, Fraser VJ. Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery. Infect Control Hosp Epidemiol 2010; 31 (03) 276-282
    CrossrefPubMedGoogle Scholar
  • 10 Landon MB, Leindecker S, Spong CY. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005; 193 (3, pt. 2): 1016-1023
    CrossrefPubMedGoogle Scholar
  • 11 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457
    CrossrefPubMedGoogle Scholar
  • 12 Saeed KB, Corcoran P, Greene RA. Incisional surgical site infection following cesarean section: a national retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 240: 256-260
    CrossrefPubMedGoogle Scholar
  • 13 Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers MS, Johnson DD. Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes. Acta Obstet Gynecol Scand 2010; 89 (07) 924-930
    CrossrefPubMedGoogle Scholar
  • 14 Smid MC, Vladutiu CJ, Dotters-Katz SK, Manuck TA, Boggess KA, Stamilio DM. Maternal super obesity and neonatal morbidity after term cesarean delivery. Am J Perinatol 2016; 33 (12) 1198-1204
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Smid MC, Dotters-Katz SK, Vaught AJ, Vladutiu CJ, Boggess KA, Stamilio DM. Maternal super obesity and risk for intensive care unit admission in the MFMU Cesarean Registry. Acta Obstet Gynecol Scand 2017; 96 (08) 976-983
    CrossrefPubMedGoogle Scholar
  • 16 Scholz R, Smith BA, Adams MG. et al. A multifaceted surgical site infection prevention bundle for cesarean delivery. Am J Perinatol 2021; 38 (07) 690-697
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 17 Mitchell CJ, Adkins L, Tucker A, Brown H, Siegel A, Dotter-Katz S. Impact of excess weight gain on risk of postpartum infection in class III obesity. AJP Rep 2020; 10 (03) e213-e216
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Tita AT, Szychowski JM, Boggess K. et al; C/SOAP Trial Consortium. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med 2016; 375 (13) 1231-1241
    CrossrefPubMedGoogle Scholar
  • 19 Zhang J, Landy HJ, Ware Branch D. et al; Consortium on Safe Labor. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010; 116 (06) 1281-1287
    CrossrefPubMedGoogle Scholar