Obesity in pregnancy: a retrospective prevalence-based study on health service utilisation and costs on the NHS

Kelly L Morgan, Muhammad A Rahman, Steven Macey, Mark D Atkinson, Rebecca A Hill, Ashrafunnesa Khanom, Shantini Paranjothy, Muhammad Jami Husain, Sinead T Brophy, Kelly L Morgan, Muhammad A Rahman, Steven Macey, Mark D Atkinson, Rebecca A Hill, Ashrafunnesa Khanom, Shantini Paranjothy, Muhammad Jami Husain, Sinead T Brophy

Abstract

Objective: To estimate the direct healthcare cost of being overweight or obese throughout pregnancy to the National Health Service in Wales.

Design: Retrospective prevalence-based study.

Setting: Combined linked anonymised electronic datasets gathered on a cohort of women enrolled on the Growing Up in Wales: Environments for Healthy Living (EHL) study. Women were categorised into two groups: normal body mass index (BMI; n=260) and overweight/obese (BMI>25; n=224).

Participants: 484 singleton pregnancies with available health service records and an antenatal BMI.

Primary outcome measure: Total health service utilisation (comprising all general practitioner visits and prescribed medications, inpatient admissions and outpatient visits) and direct healthcare costs for providing these services in the year 2011-2012. Costs are calculated as cost of mother (no infant costs are included) and are related to health service usage throughout pregnancy and 2 months following delivery.

Results: There was a strong association between healthcare usage cost and BMI (p<0.001). Adjusting for maternal age, parity, ethnicity and comorbidity, mean total costs were 23% higher among overweight women (rate ratios (RR) 1.23, 95% CI 1.230 to 1.233) and 37% higher among obese women (RR 1.39, 95% CI 1.38 to 1.39) compared with women with normal weight. Adjusting for smoking, consumption of alcohol, or the presence of any comorbidities did not materially affect the results. The total mean cost estimates were £3546.3 for normal weight, £4244.4 for overweight and £4717.64 for obese women.

Conclusions: Increased health service usage and healthcare costs during pregnancy are associated with increasing maternal BMI; this was apparent across all health services considered within this study. Interventions costing less than £1171.34 per person could be cost-effective if they reduce healthcare usage among obese pregnant women to levels equivalent to that of normal weight women.

Keywords: Health Economics; Public Health.

Figures

Figure 1
Figure 1
Flow diagram displaying participant involvement throughout study selection (BMI, body mass index).

References

    1. Centre for Maternal and Child Enquiries Maternal obesity in the UK: findings from a national project. London: CMACE, 2010
    1. Arrowsmith S, Wray S, Quenby S. Maternal obesity and labour complications following induction of labour in prolonged pregnancy. BJOG 2011;118:578–88
    1. Green C, Shaker D. Impact of morbid obesity on the mode of delivery and obstetric outcome in nulliparous singleton pregnancy and the implications for rural maternity services. Aust N Z J Obstet Gynaecol 2011;51:172–4
    1. Cedergren MI. Non-elective caesarean delivery due to ineffective uterine contractility or due to obstructed labour in relation to maternal body mass index. Eur J Obstet Gynecol Reprod Biol 2009;145:163–6
    1. Sherrard A, Platt RW, Vallerand D, et al. Maternal anthropometric risk factors for caesarean delivery before or after onset of labour. BJOG 2007;114:1088–96
    1. Hilder L, Costeloe K, Thilaganathan B. Prolonged pregnancy: evaluating gestation-specific risks of fetal and infant mortality. BJOG 1998;105:169–73
    1. Denison FC, Price J, Graham C, et al. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG 2008;115:720–5
    1. Heslehurst N, Lang R, Rankin J, et al. Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services. BJOG 2007;114:334–42
    1. Larg A, Moss JR. Cost-of-illness studies: a guide to critical evaluation. Pharmacoeconomics 2011;29:653–71
    1. Raebel MA, Malone DC, Conner DA, et al. Health services use and health care costs of obese and nonobese individuals. Arch Intern Med 2004;164:2135–40
    1. Quesenberry CP, Jr, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med 1998;158:466–72
    1. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011;12:131–41
    1. Vellinga A, O'Donovan D, De La Harpe D. Length of stay and associated costs of obesity related hospital admissions in Ireland. BMC Health Serv Res 2008;8:88.
    1. Stringer M, Ratcliffe SJ, Evans EC, et al. The cost of prenatal care attendance and pregnancy outcomes in low-income working women. J Obstet Gynecol Neonatal Nurs 2005;34:551–60
    1. Harrison MJ, Kushner KE, Benzies K, et al. In-home nursing care for women with high-risk pregnancies: outcomes and cost. Obstet Gynecol 2001;97:982–7
    1. Elixhauser A, Wier LM. Complicating Conditions of Pregnancy and Childbirth, 2008. HCUP Statistical Brief #113. May 2011. Agency for Healthcare Research and Quality, Rockville, MD.
    1. Kolu P, Raitanen J, Rissanen P, et al. Health care costs associated with gestational diabetes mellitus among high-risk women—results from a randomised trial. BMC Pregnancy Childbirth 2012;12:71.
    1. BBC News W Wales faces deepest NHS cuts in UK says King's Fund. 2011
    1. Welsh Government A Strategic Vision for Maternity Services in Wales: Crown copyright 2011:1–31
    1. Hill R, Brophy S, Brunt H, et al. Protocol of the baseline assessment for the Environments for Healthy Living (EHL) Wales cohort study. BMC Public Health 2010;10:150.
    1. Ford D, Jones K, Verplancke J-P, et al. The SAIL Databank: building a national architecture for e-health research and evaluation. BMC Health Serv Res 2009;9:157.
    1. Brooks CJ, Stephens JW, Price DE, et al. Use of a patient linked data warehouse to facilitate diabetes trial recruitment from primary care. Prim Care Diabetes 2009;3:245–8
    1. Welsh Government Financial Information Strategy Programme. Consolidated Local Health Boards WCR1 Costing Returns. Wales, 2012
    1. Personal Social Services Research Unit Unit costs of health and social care 2011. In: Curtis L. ed, 2011:1–230
    1. British Medical Association and the Royal Pharmaceutical Society of Great Britain, ed. British national formulary. London: BMJ Group and Pharmaceutical Press, 2013
    1. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83
    1. Khan NF, Perera R, Harper S, et al. Adaptation and validation of the Charlson Index for Read/OXMIS coded databases. BMC Fam Pract 2010;11:1.
    1. Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost. Am J Clin Nutr 2000;71:1242S–8S
    1. Denison FC, Norrie G, Graham B, et al. Increased maternal BMI is associated with an increased risk of minor complications during pregnancy with consequent cost implications. BJOG 2009;116:1467–72
    1. Athukorala C, Rumbold AR, Willson KJ, et al. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010;10:56.
    1. Hinkle SN, Schieve LA, Stein AD, et al. Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age. Int J Obes 2012;36:1312–19
    1. Whitaker RC. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics 2004;114:e29–36
    1. Galtier-Dereure F, Montpeyroux F, Boulot P, et al. Weight excess before pregnancy: complications and cost. Int J Obes Relat Metab Disord 1995;19:443–8
    1. Health and Public Services Committee Tipping the scales childhood obesity in London. London: Greater London authority, 2011
    1. Harlow SD, Linet MS. Agreement between questionnaire data and medical records. The evidence for accuracy of recall. Am J Epidemiol 1989;129:233–48
    1. Shub A, Huning EY-S, Campbell K, et al. Pregnant women's knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Res Notes 2013;6:278.
    1. Nohr EA, Vaeth M, Baker JL, et al. Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status. Am J Clin Nutr 2009;90: 1288–94
    1. Kiel DWDE, Artal R, Boehmer TK, et al. Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol 2007;110:752–8
    1. Bodnar LMS-RA, Simhan HN, Himes KP, et al. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr 2010;91:1642–8
    1. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006;368:1164–70
    1. Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff 2002;21:245–53

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다