The Impact Of Maternal Comorbidities On The Costs Of Care For Pregnant Women and Newborns
Title: The Impact Of Maternal Comorbidities On The Costs Of Care For Pregnant Women and Newborns
- Awareness of specific comorbidities that are prevalent among pregnant women that could be helpful for patient care
- Knowledge of which comorbidities could increase the costs of pre-natal care and labor and delivery
- Awareness of potential links in mother’s comorbidities to the costs of their infants during the first 3 months
Design: Retrospective comparative cohort database analysis
Setting: Truven Health MarketScan Commercial Claims and Encounters Database, 2007—2011
Sample: Women, ages 15-49, with commercial healthcare insurance, a medical claim of live birth, and continuous medical and drug benefit coverage 12 months before the first medical claim for pregnancy and 3 months following the birth.
Methods: Comorbid conditions among women with live births were identified during the 12 months prior to the first pregnancy claim (index date) using an adaptation of the AHRQ Clinical Classification. Women and their newborns were linked using a unique family identifier; the first live-birth event in the study period was retained for analysis. Medical (inpatient and outpatient) and pharmacy costs accrued between the index date and the day before delivery for the mothers and 3 months following delivery for the mothers and newborns were assessed. Healthcare utilization and costs were descriptively analyzed for the women with one or more pre-specified comorbidity and compared to women without the comorbidity, both during pregnancy and 3 months following delivery. The incremental pregnancy or newborn costs associated with the comorbidity was assessed using multivariable regression controlling for maternal demographics, all comorbidities evaluated, and compared to mothers without comorbidities.
Results: A total of 322,141 mothers with live births were found in the database. Of these, 135,572 were linked to 137,040 newborns after applying the inclusion criteria. The most prevalent comorbidities (among all mothers) included back disorders (9.5%), mental disorders (excluding psychoses) (6.4%), allergic rhinitis (5.9%), headache/migraine (5.6%), osteoarthritis (4.9%), hypertension (2.1%), and diabetes (1.1%). The estimated cost of care for mothers without a comorbid condition and their newborns were $10,221 (SE=219) and $1,653 (SE=171), respectively. The presence of maternal non-gestational diabetes and hypertension were associated with the highest incremental costs of care in both the mother ($6,211 [CI: 5,720, 6,702] and $3,367 [CI: 2,935, 3,799], respectively) and newborn ($2,067 [CI: 1,515, 2,618] and $1,210 [CI: 725, 1,695], respectively). Inpatient care was the largest single contributor to incremental costs across all comorbidities.
Conclusion/Implications for nursing practice: Particular comorbidities lead to significant incremental costs of care for both the mother during pregnancy and the newborn. Comorbidities with the highest cost represent opportunities where additional focus may potentially improve care and reduce costs.
Keywords: comorbidities, pregnancy costs, newborn care, prenatal care