Body mass index-related cesarean section complications in sub-Saharan Africa: A systematic review and meta-analysis

Background: Obesity and cesarean section (CS) rates are rising in sub-Saharan Africa (SSA), where risks for complications that adversely affect maternal health, such as infections, are high. Objective: To conduct a systematic review and meta-analysis to report on the incidence and types of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters)-related complications following CS in SSA. Search strategy: A systematic search was conducted in PubMed/MEDLINE, EMBASE, and Global Health Library up to August 2020 using (MeSH) terms related to CS, BMI, and SSA. Selection criteria: Quantitative studies that evaluated BMI-related complications of CS in English. Data collection and analysis: Data were extracted using a standardized form. The risk of bias was assessed using the Newcastle-Ottawa Scale. The incidence of BMI-related complications at 95% confidence interval was calculated and a meta-analysis conducted. Main results: Of 84 articles screened, five were included. Complications associated with a higher BMI were: wound infection, hemorrhage, post-dural puncture headache, and prolonged surgery time in comparison with patients with a normal BMI. Women with a high BMI (>25.0) have a two-fold increased risk for post-cesarean wound infection compared with women with a normal BMI (20.0–24.9) (odds ratio 1.91, 95% confidence interval 1.11–3.52). Conclusion: Overweight and obesity were associated with CS complications in SSA, but limited research is available.