987: Wound complications according to prepregnancy body mass index and gestational weight gain.

Abstract

Wound complications are one of the most common complications after cesarean delivery. Obesity is associated with increased risks of wound complications. However, the association between gestational weight gain (GWG), defined by the Institute of Medicine (IOM) guidelines, and wound complications is not studied well. We sought to examine the rates of wound complications according to prepregnancy body mass index (BMI kg/m2) and GWG. This was a retrospective study of all women with singleton pregnancies undergoing cesarean delivery at ≥23 weeks’ gestation between 2012 and 2017at an urban hospital with an average of 1,200 cesarean deliveries per year. Women were categorized into normal/underweight (BMI <25 kg/m2), overweight (BMI 25-29.9 kg/m2), and obesity (BMI ≥30 kg/m2). Women were also categorized according to GWG: below, within, and above the IOM guidelines. Our primary outcome was wound complications defined as a composite of cellulitis, hematoma/seroma, and dehiscence >1 cm. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios (OR) and 95% confidence intervals (95%CI) for outcomes, controlling for predefined covariates (age, gestational age, race/ethnicity, labor, and rupture of membranes). Of 5,648 women, there were 1,982 (35.1%) normal weight/underweight women, 1,494 (26.5%) overweight women, and 2,172 (38.5%) obese women using prepregnancy BMI. Compared to normal/underweight women, overweight women did not have increased odds of wound complications (adjusted OR 1.10; 95%CI 0.81-1.75), whereas obese women had increased odds of wound complications (adjusted OR 1.88; 95%CI 1.35-2.62), cellulitis (adjusted OR 2.12; 95%CI 1.37-3.28), and wound dehiscence (adjusted OR 2.60; 95%CI 1.63-4.15) (Table 1). Among normal/underweight women, women with GWG less than IOM guidelines compared to women with GWG within IOM guidelines had increased odds of wound complications (adjusted OR 2.01; 95%CI 1.01-3.97). Among overweight women or obese women, GWG was not associated with increased odds of wound complications (Table 2). In women undergoing cesarean delivery, prepregnancy obese women had increased odds of wound complications compared to normal/underweight women. Among obese women, GWG was not associated with wound complications, suggesting the importance of weight control before pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)