Obesity, diabetes, and the risk of infections diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study

Abstract

Objective: To assess the impact of obesity and diabetes on the risk of post-cesarean infections.

Design: Prospective cohort study.

Setting: Obstetric departments at three hospitals in Denmark.

Population: 2,492 consecutive women having cesarean section (CS) from February 2007 to August 2008.

Methods: We collected complete data from medical records and databases on CS, body mass index, diabetes (type 1, type 2, and gestational), and post-cesarean infections. Post-discharge infections diagnosed by general practitioners were ascertained through positive microbiological cultures and antibiotic prescriptions.

Main outcome measures: Cumulative incidences of infections within 30 days after CS.

Results: Of 2,492 women having CS, 373 (15.2%) were obese and 123 (4.9%) had diabetes. Overall, 458 women (18.4%) had a post-cesarean infection within 30 days and 174 (7.0%) were diagnosed in-hospital. The risk of post-cesarean infections was higher among obese than non-obese women: adjusted (for diabetes and emergency/elective CS) odds ratio (OR)=1.43; 95% confidence interval (CI): 1.09-1.88, particularly for in-hospital infections (OR=1.86; 95%CI: 1.28-2.72). After controlling for obesity and mode of CS, type 2 or gestational diabetes were weak predictors of infection risk (OR=1.18; 95%CI: 0.72-1.93), whereas the adjusted OR in women with type 1 diabetes was 1.65 (95%CI: 0.64-4.25). Among diabetic women, obesity increased the risk of post-cesarean infections more than twofold; the adjusted ORs were 2.06 (95%CI: 1.13-3.75) for infections overall and 2.74 (95%CI: 1.25-6.01) for in-hospital infections.

Conclusion: Obesity increases the risk of post-cesarean infections and diabetes further strengthens this association.