Abstract
BACKGROUND: Poor wound healing (PWH) are significant complications following cesarean deliveries, particularly in patients with gestational diabetes mellitus (GDM) due to hyperglycemia-induced immune dysfunction and impaired wound healing. Identifying specific risk factors is essential for developing effective preventive strategies and improving maternal outcomes. METHODS: This retrospective study, conducted from January 2020 to August 2023, followed STROBE guidelines. A total of 268 GDM patients who underwent cesarean delivery were included, with 5 lost to follow-up, yielding a 98.2% follow-up rate. Patients were divided into two groups: the PWH group (n = 26) and the control group (n = 242). Comprehensive data on maternal age, gestational age, pre-pregnancy BMI, IVF-ET use, uterine scarring, surgery type (emergency vs. elective), operative time, and infections (Candida albicans and Group B Streptococcus) were collected. Statistical analyses included Chi-square, Fisher's exact tests, and multivariate logistic regression to identify independent risk factors for PWH. RESULTS: The overall incidence of PWH was 9.7%, with the majority being superficial infections, including suture reactions (38.5%), bleeding and exudation (30.8%), abscesses (15.4%), and fat liquefaction (11.5%). Deep infections were rare, with only 3.8% presenting as endometritis and no cases of pelvic abscess. Multivariate logistic regression identified the following significant independent risk factors for PWH: premature rupture of membranes (OR = 10.88, 95% CI: 1.70-71.25, P = 0.002), Candida infection (OR = 5.77, 95% CI: 1.89-18.65, P = 0.003), emergency cesarean delivery (OR = 2.32, 95% CI: 1.02-5.48, P = 0.047), a scarred uterus (OR = 3.68, 95% CI: 1.43-9.39, P = 0.006), and prolonged operative time (≥ 1 h; OR = 2.55, 95% CI: 1.02-3.73, P = 0.031). CONCLUSIONS: Prolonged operative time, premature rupture of membranes (PROM), emergency cesarean delivery, and uterine scarring were identified as independent risk factors for PWH in GDM patients. Candida infection also showed a statistical association but was based on limited case numbers and should be interpreted cautiously. Targeted perioperative strategies may help reduce PWH risk in this population.