Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers

Abstract

Background: The objective was to estimate whether maternal obesity and/or obstetric interventions are associated with diagnosed maternal post-partum sepsis.

Methods: A retrospective observational cohort study including all deliveries in Sweden between 1997 and 2012 (N = 1,558,752). Cases of sepsis (n = 376) were identified by International Classification of Diseases, (ICD-10) codes A40, A41 and O 85 in the Medical Birth Register and the National Patient Register. The reference population was non-infected, and therefore, women with any other infection diagnosis and/or with dispensed antibiotics within eight weeks post-partum were excluded. Information on dispensed drugs was available in the prescribed drug Register. Women with sepsis were compared with non-infected women concerning maternal characteristics and obstetric interventions. Adjusted odds ratios (aOR) were determined using the Mantel–Haenszel technique. Adjustments were made for maternal age, parity and smoking.

Results: Obese women (body mass index ≥30) had a doubled risk of sepsis (3.6/10,000) compared with normal weight women (2.0/10,000) (aOR 1.85 (95%CI: 1.37–2.48)). Induction of labour (aOR 1.44 (95%CI: 1.09–1.91)), caesarean section overall (aOR 3.06 (95%CI: 2.49–3.77)) and elective caesarean section (aOR 2.41 (95%CI: 1.68–3.45)) increased the risk of sepsis compared with normal vaginal delivery. Post-partum anaemia due to acute blood loss was associated with maternal sepsis (aOR 3.40 (95%CI: 2.59–4.47)).

Conclusions: Maternal obesity, obstetric interventions and post-partum anaemia due to acute blood loss increased the risk of diagnosed post-partum sepsis indicating that interventions in obstetric care should be considered carefully and anaemia should be treated if resources are available.

Keywords:

• Post-partum
• sepsis
• obesity
• caesarean section
• anaemia

Acknowledgements

The study was made possible by unrestricted financial support from Region Ostergotland.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The study was made possible by unrestricted financial support from Region Ostergotland.