Necrotizing Fasciitis: Association with Pregnancy-related Risk Factors Early in Life

Abstract

Background: Pregnancy-related risk factors for necrotizing fasciitis are poorly understood. We investigated pregnancy-related characteristics associated with the long-term risk of developing necrotizing fasciitis, a rare life-threatening infectious disease. Methods: We analyzed a longitudinal cohort of 1,344,996 parous women in Quebec, Canada between 1989 and 2020. The main exposure measures included complications of pregnancy such as gestational diabetes, preterm delivery, metabolic disorder, and other maternal characteristics. We followed the women over time to identify future hospitalizations for necrotizing fasciitis up to three decades after delivery. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association of pregnancy characteristics with risk of necrotizing fasciitis in time-varying Cox proportional hazards regression models. Results: A total of 420 women were hospitalized for necrotizing fasciitis during follow-up, including 83 (19.8%) with diabetes-related necrotizing fasciitis. The incidence of necrotizing fasciitis was elevated for women with gestational diabetes (2.9 per 100,000 person-years), preterm delivery (3.2 per 100,000 person-years), and metabolic disorders (5.4 per 100,000 person-years), compared with no pregnancy complication (1.1 per 100,000 person-years). Compared with no pregnancy complication, gestational diabetes was associated with 1.87 times the risk (95% CI 1.38-2.53), preterm delivery with 2.10 times the risk (95% CI 1.65-2.66), and metabolic disorder with 3.72 times the risk (95% CI 2.92-4.74) of developing necrotizing fasciitis over time. Pregnancy complications were more strongly associated with the risk of necrotizing fasciitis 5 years or more after delivery. Conclusions: Complications of pregnancy may be associated with the long-term risk of necrotizing fasciitis in women.

Keywords: Cesarean section; Gestational diabetes; Necrotizing fasciitis; Pregnancy complications; Premature birth; Risk factors.

Figure 1

Cumulative incidence of necrotizing fasciitis over time for selected pregnancy characteristics.

Figure 2

Change in the association between pregnancy characteristics and risk of necrotizing fasciitis over time. Association of pregnancy characteristics with necrotizing fasciitis at (a) 0 to 4 years (N=79), (b) 5 to 14 years (N=158), and (c) ≥15 years after delivery (N=183). These cutpoints are meant to reflect short, medium, and long-term risks of necrotizing fasciitis after pregnancy. Hazard ratios are for gestational diabetes vs. no diabetes, preeclampsia vs. no preeclampsia, and so on, adjusted for age, substance use disorders, socioeconomic deprivation, place of residence, and time period.