Abstract
The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women’s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m2 (range: 14.7 kg/m2–64 kg/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0–39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or “midwifery-in-the-home-visits”.
Highlights
Obesity in pregnancy has become a major challenge for obstetric care in high-income countries [1].Approximately 50% of women who become pregnant have overweight (body mass index (BMI) >25 kg/m2 –30 kg /m2 ) or obesity (BMI > 30 kg/m2 ) [1], and the prevalence of obesity is rising [2]
There is insufficient evidence of the cost of nutrition interventions in pregnancy [10]. Given this absence of evidence, data on maternal dietary intake, obesity and their relationship with healthcare-resource use is needed to inform research, guidelines and decision makers of the economic impacts of current antenatal health promotion and clinical practice [21]. To address these evidence gaps, a cross-sectional population-based study was designed to quantify specific perinatal-healthcare-resource use associated with maternal weight status and diet quality in a sample of pregnant women attending a public hospital in New South Wales, Australia
Independent of a woman’s BMI, those with an Australian Recommended Food Score (ARFS) score in Quintile 1 had a 27% increase in average length of stay when compared to women with an ARFS score in Quintile 5
Summary
Obesity in pregnancy has become a major challenge for obstetric care in high-income countries [1].Approximately 50% of women who become pregnant have overweight (body mass index (BMI) >25 kg/m2 –30 kg /m2 ) or obesity (BMI > 30 kg/m2 ) [1], and the prevalence of obesity is rising [2]. Given the elevated risk to the mother and infant, obstetric and midwifery clinical practice guidelines recommend that healthcare facilities have well-defined pathways for the care of women with obesity, with increased care and monitoring relative to the antenatal care pathways of non-obese women [6,7]. This has resource use implications for the healthcare system. The economic implications of poor maternal nutrition, and its relationship with BMI and the use of healthcare resources ( referred to as healthcare-resource use) is underexplored [10]
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