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. 2014 Feb 27;4(2):e003983.
doi: 10.1136/bmjopen-2013-003983.

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

Kelly L Morgan  1 , Muhammad A Rahman, Steven Macey, Mark D Atkinson, Rebecca A Hill, Ashrafunnesa Khanom, Shantini Paranjothy, Muhammad Jami Husain, Sinead T Brophy
Affiliations

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

Kelly L Morgan et al. BMJ Open. .

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.

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Figures

Figure 1
Figure 1
Flow diagram displaying participant involvement throughout study selection (BMI, body mass index).
See this image and copyright information in PMC

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