title: 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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Obstetric departments at three hospitals in Denmark.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Obesity increases the risk of post-cesarean infections and diabetes further strengthens this association.
authors.affiliation: Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Denmark. ritaleth@rm.dk
authors.forename: Rita Andersen
authors.initials: RA
authors.lastname: Leth
authors.forename: Niels
authors.initials: N
authors.lastname: Uldbjerg
authors.forename: Mette
authors.initials: M
authors.lastname: Nørgaard
authors.forename: Jens Kjølseth
authors.initials: JK
authors.lastname: Møller
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects*; D003718:Denmark / Q000453:epidemiology; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D007297:Inpatients / Q000706:statistics & numerical data*; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D010351:Patient Discharge; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology