573 Effect of increasing body mass index on infectious morbidity at the extremes of obesity

Abstract

While the risks associated with obesity in pregnancy are well-appreciated, very little data on the effects of extreme obesity on postpartum outcomes exists. The objective of this study was to evaluate the impact of extreme obesity on infectious morbidity and wound complications during the postpartum period. Retrospective cohort analysis included women with a body mass index (BMI) ≥40kg/m2 delivering at a single tertiary care hospital from 2013-2017. The primary outcome was postpartum infectious morbidity including endometritis, wound infection, and wound seroma. Bivariate statistics was used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2). Regression modeling was used to estimate odds of primary infectious composite and components. Of 374 women included, 244(65.2%) had a BMI 40-49.9kg/m2, 113(35.5%) BMI 50-59.9kg/m2, 13(3.4%) BMI 60-69.9kg/m2, and 4(1.0%) BMI>70kg/m2. Rates of chronic hypertension and weight gain increased with BMI category (Table 1). Increased estimated blood loss and lower rates of vaginal delivery were also seen with increasing BMI category (Table 1). The composite was not significantly different among increasing BMI groups, though rates of postpartum wound infection (2.9% vs 5.3% vs 23.1 % vs 0%, p<0.01) did vary (Table 2). After adjusting for confounders, compared to women with BMI40-49.9, adjusted odds of infectious composite and postpartum wound infection for women with BMI 60-69.9 were 1.91 (95% 0.31-11.8) and 11.01 (95% 1.90-64.0) respectively. Women with BMI 50-70 are at an increased risk of infectious morbidity compared to women with BMI 40-49.9. The lower probability of successful vaginal delivery among women with extremes of BMI raises the question regarding the utility of attempted vaginal delivery in this population. Providers should consider the increased infectious risk when counseling women with BMI>50.View Large Image Figure ViewerDownload Hi-res image Download (PPT)