{"id":22401,"date":"2025-03-25T08:00:00","date_gmt":"2025-03-25T13:00:00","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=22401"},"modified":"2025-04-29T12:06:19","modified_gmt":"2025-04-29T17:06:19","slug":"obesidad-c-secion-de-antibioticos","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/es\/obesity-antibiotic-c-setion\/","title":{"rendered":"\u00bfPueden los antibi\u00f3ticos reducir las tasas de ces\u00e1reas en mujeres con obesidad?"},"content":{"rendered":"\n

Cesarean births, commonly referred to as C-sections, comprise about 1 of every 3 births in the United States, and 4 out of 5 mothers who have had one Cesarean will have a repeat C-section(s) [1]. While C-sections have become normalized in today\u2019s society, the reality is that a Cesarean is <\/em>a major abdominal surgery replete with the potential for complications that can occur both during and after surgery. Rates of C-sections are especially high in overweight and obese women due to medical comorbidities such as heart disease, high blood pressure, and diabetes. With the obesity epidemic on the rise alongside the increase in C-section rates<\/a>, researchers at the University of Oklahoma sought a way to protect pregnant women from unneeded invasive surgery. Specifically, they explored whether giving antibiotics during labor induction reduced C-section risk in women with obesity. <\/p>\n\n\n\n

Pregnant women with obesity are at risk for many pregnancy complications <\/span><\/h2>\n\n\n\n

Pregnant women with obesity can experience a host of serious medical complications including \u201cmiscarriage, gestational diabetes, preeclampsia, venous thromboembolism, induced labour, caesarean section, anaesthetic complications and wound infections\u201d and endometritis [2][3]. In particular, women with obesity who have their labor induced<\/a> are at higher risk of developing infection, be it chorioamnionitis, endometritis, or C-section wound infection [4].<\/p>\n\n\n\n

Because of the risks obese women face in pregnancy, birth, and postpartum, finding a way to decrease the likelihood of these infections as well as decreasing the rate of C-section delivery <\/a>is an important step in ensuring the health of mothers and babies. According to the Mayo Clinic<\/a>, C-sections in themselves can lead to a whole host of health complications including breathing problems or surgical injury to the baby, as well as infection, blood loss, blood clots, surgical injury to the bladder or bowel, and negative reactions to anesthesia in the mother.<\/p>\n\n\n\n

Both obesity and labor cause inflammation in the body, and inflammation can lead to infection <\/span><\/h2>\n\n\n\n

Obesity is characterized by chronic inflammation, and labor is also characterized by inflammation [5]. Too much inflammation (not just from a specific \u201cbug\u201d or type of bacteria) in a pregnant woman\u2019s body can lead to spontaneous development of chorioamnionitis [6]. One study<\/a> published in American Journal of Obstetrics and Gynecology<\/em> showed that 75% of mothers with spontaneous chorioamnionitis during labor experienced decreased uterine contractions, and 34% required a C-section due to labor failing to progress [7]. <\/p>\n\n\n\n

Researchers at the University of Oklahoma School of Medicine theorized that giving antibiotics during labor induction might prevent an infection severe enough to necessitate a C-section for delivery. While administering antibiotics before surgery\u2013including C-section\u2013is common practice, researchers had never before studied whether starting antibiotics at the onset of labor<\/em> would lead to lower levels of infection, and consequently, lower rates of Cesarean delivery. <\/p>\n\n\n\n

Could antibiotics reduce C-section rates in first time mothers with obesity?<\/span><\/h2>\n\n\n\n

The University of Oklahoma College of Medicine trial study<\/a> was published in 2022 in the American Journal of Obstetrics and Gynecology MFM<\/em> (Maternal-Fetal Medicine) [8]. The lead researcher was Stephanie Pierce, M.D., an OU Health maternal-fetal medicine specialist and associate professor in the OU College of Medicine. She tested whether administering antibiotics to obese women undergoing labor induction <\/a>would decrease the likelihood of needing to perform a C-section. <\/p>\n\n\n\n

Pierce stated<\/a>:<\/p>\n\n\n\n

\u201cToday, 40% of American women are obese when they become pregnant, and they [typically] have health problems that make them more likely to require [induced] delivery before their due date, typically at 39 weeks. Sometimes, a C-section is necessary, but it can cause other problems, such as wound infections and a higher risk of bleeding. Because labor inductions have increased along with the rise in obesity, we need a way to minimize C-sections so the mother can have the lowest risk for complications. We are conducting this study with first-time mothers with obesity because they have the highest risk for a C-section.\u201d <\/p>\n\n\n\n

Pierce is correct. Approximately 40% of women in America are obese, measured by a BMI (body mass index) of 30 kg\/m2<\/sup> or greater. BMI is a measurement calculated by dividing a person\u2019s weight by their height squared, and while there are outliers in the reliability of relating BMI to health or fat-mass, for the average person, they are relatively strongly correlated. <\/p>\n\n\n\n

OU researchers separated participants into categories by weight<\/span><\/h2>\n\n\n\n

The study took 186 women that were at least 37 weeks pregnant with a planned induced labor of their first child at 39 weeks gestation. Researchers separated women by obesity class to determine whether antibiotics impacted them differently. 101 women had Class I obesity (BMI 30-34.9), 47 women had Class II obesity (BMI 35-39.9), and 38 women had Class III obesity (BMI 40+). All women were pregnant with only one baby, were free of any infections requiring antibiotics before<\/em> the induction of labor, and all the babies were in good health. <\/p>\n\n\n\n

Women in each of the three tested BMI Classes were divided into two groups\u2014one receiving both 2g of the antibiotic cefazolin at the start of labor induction (and every 8 hours for a total of 3 doses), as well as 500mg of the antibiotic azithromycin at the start of labor, with the other group receiving a saline solution placebo at the same intervals.The two groups of women were randomly selected in a \u201ctriple-blind\u201d trial where the investigators, medical staff, and<\/em> patients were all unaware of the treatment group the women were in. Aside from the administration of the antibiotic or placebo, all women received the standard labor, delivery, and postpartum care as any other obstetrics patient at that hospital, including management of any other health conditions. <\/p>\n\n\n\n

Measuring rates of C-section delivery and postpartum infection in women who did or didn\u2019t receive antibiotics<\/span><\/h2>\n\n\n\n

The two primary outcomes studied were rates of delivery via C-section, and rates of postpartum infection within the first 30 days after birth (specifically chorioamnionitis, endometritis, and\/or Cesarean wound infection). The secondary outcomes studied were rates of postpartum hemorrhage, blood transfusion, ICU admission, or maternal or infant hospital admission after delivery. <\/p>\n\n\n\n

Here\u2019s what the OU researchers learned <\/span><\/h2>\n\n\n\n

While infection rates were not markedly different between women who did and didn’t receive antibiotics, those who received antibiotics at the outset of labor had a 27% lower rate of C-sections. <\/p>\n\n\n\n

While infection rates were not markedly different between women who did and didn\u2019t receive antibiotics, those who received antibiotics at the outset of labor had a 27% lower rate of C-sections.  <\/em><\/p><\/blockquote><\/figure>\n\n\n\n

It\u2019s complicated to calculate exact numbers, but let\u2019s make some approximations in order to contextualize how much difference antibiotics at the start of labor might make for women with obesity. In 2020, there were 3,605,621 births in the United States, according to the Centers for Disease Control and Prevention (CDC)<\/a>. 31.8%, or 1,146,587 were Cesarean deliveries. If 40% of all pregnant women had obesity, that would represent 458,635 of the women who had C-sections. And if the 27% reduction observed in the trial study from administering antibiotics to women at the start of labor applied to all (not just first-time) laboring women with obesity, there would have been 123,831 fewer<\/em> C-sections that year. <\/p>\n\n\n\n

An additional surprising finding in the trial was that there was a higher <\/em>chance of sepsis in the babies whose mothers received antibiotics throughout labor. While reduction of C-sections, with their attendant risks for both mothers and babies, is a laudable goal, an increase in neonatal sepsis (which can lead to death, though all newborns in the study survived) should give clinicians pause. Researchers want to assess this outcome more thoroughly in future studies in order to find out why that unexpected correlation was noticed and if it can be replicated (confirmed by additional research).\u00a0<\/p>\n\n\n\n

How might the OU research impact maternal health practices?<\/span><\/h2>\n\n\n\n

The first-line medical recommendation to lower the chances of C-section for pregnant women with obesity will always be to reduce BMI before <\/em>conceiving. Once a woman with obesity has <\/em>conceived, the goalpost shifts to risk mitigation. <\/p>\n\n\n\n

Because of the marked rate of C-section reduction in this small trial study, combined with the relatively low cost and easy access to antibiotics, the National Institutes of Health (NIH) awarded the University of Oklahoma team a $3.1 million grant to expand their study to several hospitals across the country. Working together under Dr. Pierce\u2019s guidance, Duke University, University of Alabama at Birmingham, University of Florida, and Case Western University in Cleveland\u2019s MetroHealth Medical Center hospitals will enroll around 800 mothers with obesity in the next five years<\/a>.<\/p>\n\n\n\n

\u201cThis is an exciting opportunity to develop a new intervention that can improve outcomes for pregnant women with obesity,\u201d Pierce said<\/a>. \u201cThe issue of obesity has been challenging to obstetricians, and the average BMI during pregnancy is only increasing. It is very gratifying to be part of a team that is developing a solution that has the potential to decrease complications and improve the health of mother and baby alike.\u201d<\/p>\n\n\n\n

This article was updated on March 26th, 2025, to correct the BMI Class weight ranges included in the 2022 University of Oklahoma study. This article was updated April 29, 2025, to add further context to the finding of increased sepsis rates in newborns whose mothers received preventative antibiotics. <\/em><\/p>\n\n\n\n

References:<\/span><\/h2>\n\n\n\n[1] Osterman MJK. Changes in primary and repeat cesarean delivery: United States, 2016\u20132021. Vital Statistics Rapid Release; no 21. Hyattsville, MD: National Center for Health Statistics. July 2022. DOI: https:\/\/dx.doi.org\/10.15620\/ cdc:117432.<\/p>\n\n\n\n[2] Fitzsimons KJ, Modder J, Greer IA. Obesity in pregnancy: risks and management. Obstet Med. 2009 Jun;2(2):52-62. doi: 10.1258\/om.2009.090009. Epub 2009 May 22. PMID: 27582812; PMCID: PMC4989730.<\/p>\n\n\n\n[3] Axelsson, D., Brynhildsen, J., & Blomberg, M. (2023). Maternal obesity and the risk of postpartum infections according to mode of delivery. The Journal of Maternal-Fetal &amp; Neonatal Medicine<\/em>, 36<\/em>(2). https:\/\/doi.org\/10.1080\/14767058.2023.2245102<\/a><\/p>\n\n\n\n[4] Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, Saade G, Eddleman K, Carter SM, Craigo SD, Carr SR, D’Alton ME; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate–a population-based screening study. Am J Obstet Gynecol. 2004 Apr;190(4):1091-7. doi: 10.1016\/j.ajog.2003.09.058. PMID: 15118648.<\/p>\n\n\n\n[5] Chandrashekara Kyathanahalli, Madeline Snedden, Emmet Hirsch, Is human labor at term an inflammatory condition?, Biology of Reproduction<\/em>, Volume 108, Issue 1, January 2023, Pages 23\u201340, https:\/\/doi.org\/10.1093\/biolre\/ioac182<\/a><\/p>\n\n\n\n[6] Jain VG, Willis KA, Jobe A, Ambalavanan N. Chorioamnionitis and neonatal outcomes. Pediatr Res. 2022 Jan;91(2):289-296. doi: 10.1038\/s41390-021-01633-0. Epub 2021 Jul 1. PMID: 34211129; PMCID: PMC8720117.<\/p>\n\n\n\n[7] Duff, Patrick, et al. \u201cThe Course of Labor in Term Patients with Chorioamnionitis.\u201d American Journal of Obstetrics and Gynecology, Mosby, 21 Dec. 2016, www.sciencedirect.com\/science\/article\/abs\/pii\/S0002937816322311.<\/p>\n\n\n\n

 
[8] Pierce SL, Peck JD, Zornes C, Standerfer E, Edwards RK. Antibiotic Prophylaxis to Prevent Obesity-Related Induction Complications in Nulliparae at Term: a pilot randomized controlled trial. Am J Obstet Gynecol MFM. 2022 Sep;4(5):100681. doi: 10.1016\/j.ajogmf.2022.100681. Epub 2022 Jun 18. PMID: 35728781; PMCID: PMC9611553.<\/p>\n","protected":false},"excerpt":{"rendered":"Prometedora investigaci\u00f3n de la Universidad de Oklahoma","protected":false},"author":129,"featured_media":22400,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":true,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5378,5185],"tags":[6375,5627],"class_list":{"0":"post-22401","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-labor-delivery","8":"category-pregnancy-childbirth","9":"tag-c-section-2","10":"tag-induction","11":"cs-entry","12":"cs-video-wrap"},"acf":[],"yoast_head":"\nCan antibiotics lower C-section rates for women with obesity? 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