Maternal obesity and the risk of neonatal sepsis: a meta-analysis.

BACKGROUND: Maternal obesity is increasingly prevalent worldwide and has been associated with adverse neonatal outcomes. However, the association between maternal obesity and the risk of neonatal sepsis remains uncertain. This meta-analysis aimed to evaluate the association between maternal obesity before or during early pregnancy and the risk of neonatal sepsis in offspring. METHODS: PubMed, Embase, and Web of Science were searched for observational studies evaluating the association between maternal obesity and neonatal sepsis. Maternal obesity was generally defined as prepregnancy or early-pregnancy body mass index (BMI) ≥30 kg/m2. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model accounting for potential heterogeneity. RESULTS: Nine observational studies involving 2,146,883 women were included. Pooled analysis showed that maternal obesity was associated with a significantly increased risk of neonatal sepsis (RR: 1.46, 95% CI: 1.15-1.85, p = 0.002; I2 = 58%). Stratified analyses according to maternal obesity severity showed progressively increased RRs for neonatal sepsis among women with BMI values of 30-34.9, 35-39.9, and ≥40 kg/m2 (RRs: 1.34, 1.87, and 2.26, respectively; p for subgroup difference = 0.12). The association was significant in general obstetric populations but not in studies restricted to preterm delivery. Stronger associations were observed in studies reporting early-onset sepsis than overall neonatal sepsis. Meta-regression analysis showed that mean gestational age at delivery and neonatal birthweight significantly influenced the pooled effect size. CONCLUSIONS: Maternal obesity before or during early pregnancy is associated with an increased risk of neonatal sepsis in offspring. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420261400345.