Inflammation in Obese Parturients: Surgical Outcomes After Elective Caesarean Section

NCT01836315 | Completed

• 1 other identifier: B2012:123
• Study Type: observational
• Target: 25
• Locations: 1 country
• Sites: 1

Brief Summary

Hypothesis: The investigators propose that obese parturients will have an increased inflammatory response and a decreased anti-inflammatory response to the surgical and anesthetic insult of caesarean section and that this will be associated with a higher rate of perioperative complications, as compared to non-obese parturients.2 Background: Obese patients exhibit higher levels of inflammatory markers than non-obese patients. Furthermore, obese patients have a higher incidence of perioperative complications, especially wound infections, and this is well documented in the caesarean section population. The pregnant population is unique as a result of the immunologic changes that occur at baseline, and an increase in pro-inflammatory markers is seen in serum and in placental tissue of obese subjects, and has been demonstrated to correlate with adverse fetal outcomes. Specific Objectives: To determine the baseline levels of three established markers of inflammation in term pregnant obese and non-obese patients (defined by a BMI \> and \< 35 kg/M2 respectively), and examine how they change in response to the stress of surgery/anesthesia. The investigators will correlate the inflammatory response with the incidence of postoperative wound infections. Methods: Patients will be recruited to the study prior to the planned caesarean section. Blood samples for inflammatory marker levels will be performed preoperatively, immediately postoperatively, and at 24 hours postoperatively. Samples will be analyzed for pentraxin-3 (a relatively novel inflammatory marker), C reactive protein (CRP) (a well-known and clinically relevant inflammatory marker), and interleukin-10 (IL-10) (an established anti-inflammatory marker). Plasma will be analyzed by ELISA to determine levels of each biomarker. Patient charts will be reviewed to determine which patients have experienced surgical complications in the 30 days postoperatively. Surgical complications will then be correlated with the measured levels of inflammatory markers. Assuming that the levels of inflammatory cytokines in obese patients will be 15% higher in obese parturients and assuming an alpha error level of 5% and a beta error level of 20%, the investigators would need to study 18 patients per group to prove our hypothesis that inflammatory cytokine levels are correlated with postoperative infections. The investigators plan to study 20 patients per group to account for a potential patient attrition rate of 10% during the study. Significance/Importance: The connection between obesity and dysregulation of the perioperative inflammatory response has not been well established nor has perioperative inflammation in the obese population been linked to the observed increased in perioperative morbidity. The investigators hope to demonstrate these connections and hopefully will be able to identify at risk patients earlier, and in a subsequent study intervene to reduce the risk of postoperative wound infections with pharmacokinetically targeted antimicrobial prophylaxis.

Conditions

Obesity; Pregnancy; Cesarean Section

Outcome Measures

Primary Outcomes (1)

• Level of inflammatory biomarkers

  Levels of inflammatory biomarkers (specifically pentraxin-3 (a relatively novel inflammatory marker), C reactive protein (CRP) (a well-known and clinically relevant inflammatory marker), and interleukin-10 (IL-10) (an established anti-inflammatory marker)).

  2 days

Secondary Outcomes (1)

• Incidence of postoperative wound infections

  28 days

Study Arms (2)

Obese

Defined by a BMI \>35 kg/M2

Other: Observational Study

Non-Obese

Defined by a BMI \<35 kg/M2

Other: Observational Study

Interventions

Observational Study OTHER

Also known as: Observational Study Only

Non-Obese; Obese

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: female
• Age Groups: Adult (18-64)
• Sampling Method: Probability Sample

Study Population

We will undertake a prospective cohort study to examine the levels of circulating inflammatory cytokines in obese and non-obese parturients undergoing elective cesarean section and correlate them with the rate of postoperative wound infections. We will recruit 20 patients in each arm of the study.

You may qualify if:

• obese (defined as a body bass index (BMI) of greater than 35 kg/M2) or non-obese (BMI \<35 kg/M2)
• female
• Over 18 years of age

You may not qualify if:

• Any acute or chronic medical illness acquired before or during pregnancy

Sponsors & Collaborators

• University of Manitoba: lead

Study Sites (1)

Health Sciences Center

Winnipeg, Manitoba, R3A1R9, Canada

Location

Biospecimen

Retention: SAMPLES WITHOUT DNA

Serum

MeSH Terms

Conditions

Obesity

Interventions

Observation

Condition Hierarchy (Ancestors)

Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Methods; Investigative Techniques

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: April 16, 2013
• First Posted: April 19, 2013
• Study Start: January 1, 2013
• Primary Completion: December 1, 2013
• Study Completion: December 1, 2013
• Last Updated: December 10, 2013

Record last verified: 2013-12

Locations

CA (1)