title: Maternal obesity in high-risk pregnancies and postpartum infectious complications.
abstract: OBJECTIVE
  To analyze the association between maternal obesity and postnatal infectious complications in high-risk pregnancies.
  
  
  METHODS
  Prospective study from August 2009 through August 2010 with the following inclusion criteria: women up to the 5(th) postpartum day; age ≥ 18 years; high-risk pregnancy; singleton pregnancy with live fetus at labor onset; delivery at the institution; maternal weight measured on day of delivery. The nutritional status in late pregnancy was assessed by the body mass index (BMI), with the application of the Atalah et al. curve. Patients were graded as underweight, adequate weight, overweight, or obese. Postpartum complications investigated during the hospital stay and 30 days post-discharge were: surgical wound infection and/or secretion, urinary infection, postpartum infection, fever, hospitalization, antibiotic use, and composite morbidity (at least one of the complications mentioned).
  
  
  RESULTS
  374 puerperal women were included, graded according to the final BMI as: underweight (n = 54, 14.4%); adequate weight (n = 126, 33.7%); overweight (n = 105, 28.1%); and obese (n = 89, 23.8%). Maternal obesity was shown to have a significant association with the following postpartum complications: surgical wound infection (16.7%, p = 0.042), urinary infection (9.0%, p = 0.004), antibiotic use (12.3%, p < 0.001), and composite morbidity (25.6%, p = 0.016). By applying the logistic regression model, obesity in late pregnancy was found to be an independent variable regardless of the composite morbidity predicted (OR: 2.09; 95% CI: 1.15-3.80, p = 0.015).
  
  
  CONCLUSIONS
  Maternal obesity during late pregnancy in high-risk patients is independently associated with postpartum infectious complications, which demonstrates the need for a closer follow-up of maternal weight gain in these pregnancies.
authors.affiliation: USP, São Paulo, Brasil.
authors.forename: Letícia Vieira de
authors.initials: LV
authors.lastname: Paiva
authors.forename: Roseli Mieko Yamamoto
authors.initials: RM
authors.lastname: Nomura
authors.forename: Maria Carolina Gonçalves
authors.initials: MC
authors.lastname: Dias
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D009752:Nutritional Status / Q000502:physiology*; D009765:Obesity / Q000453:epidemiology*; D049590:Postpartum Period; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D011645:Puerperal Infection / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000150:complications; D015430:Weight Gain; D055815:Young Adult