Abstract
BackgroundWomen who have an overweight or obese BMI are more likely to experience pregnancy complications. However, little is known on the cost of childbirth in this group and no studies have been undertaken in England to date. The aim of this paper is therefore to investigate whether women with overweight and obese pre-pregnancy body mass index (BMI) incur higher average hospital costs of childbirth.MethodsWe employed data from 7564 women in the first wave of data collection of the Millennium Cohort Study. Using interval regression, we investigated the association between hospital costs of childbirth and pre-pregnancy BMI, fitting four models, progressively adjusting for additional potential confounders and mediators. Model 1 was a univariate model; model 2 adjusted for maternal age, education, marital status, ethnicity, income, and region; model 3 additionally included number of previous children, number of babies delivered, whether birth was at term, and type of delivery; model 4 also included length of hospital stay.ResultsChildbirth costs incurred by women who were overweight, obese class I and obese class II and III were £22, £82 and £126 higher than those incurred by women whose BMI was in the normal range (p ≤ 0.05). Delivery method, pre-term delivery, and length of hospital stay accounted for the observed difference.ConclusionsWomen with elevated pre-pregnancy BMI make greater use of services resulting in higher hospital costs. Interventions promoting healthy BMI in pre-pregnancy among women of child-bearing age have the potential to reduce pregnancy complications and be cost-effective.
Highlights
Women who have an overweight or obese body mass index (BMI) are more likely to experience pregnancy complications
We explored the association between pre-pregnancy BMI and costs of childbirth using rich data from a large cohort study, the Millennium Cohort Study, linked to administrative data on use of maternity services, Hospital Episodes Statistics
We have replicated findings that pre-pregnancy overweight and obesity are associated with greater delivery complications and longer length of stay (LOS) and we have shown that these are responsible for higher cost of childbirth £22, £82 and £126 for overweight, obese class I, and obese class II and III mothers, respectively
Summary
Women who have an overweight or obese BMI are more likely to experience pregnancy complications. The aim of this paper is to investigate whether women with overweight and obese pre-pregnancy body mass index (BMI) incur higher average hospital costs of childbirth. Growing evidence suggests that high levels of pre-gravid body mass index (BMI) are associated with poor pregnancy and birth outcomes [4, 5]. Only five studies have investigated differences in the cost of childbirth between mothers with normal and overweight/obese BMI [11,12,13,14,15]. In spite of the heterogeneity in regional settings and health systems (Australia [13]; United States [14, 16]; France [12, 15]), all studies found that mothers who were obese incurred higher hospital costs compared to
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