Costs of maternal and neonatal medical care for triplet and quadruplet pregnancies in Japan

Abstract

Aims: It is well documented that maternal morbidity and neonatal morbidity and mortality increase alike in high-order multiple (HOM) births. There have, however, been few reports concerning the costs of maternal and neonatal medical care associated with HOM births. This is the first such report on the situation in Japan. Materials and methods: All triplet and quadruplet pregnancies managed at this institution from before 16 weeks' gestation, and delivered at no earlier than 22 weeks' gestation, between 1997 and 2002 were included. Prophylactic cervical ligature, hospitalization to prevent premature labor from 23 weeks' gestation until delivery, and delivery by cesarean section, were all routine for HOM pregnancies. All women with singleton and twin pregnancies, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and also delivered their babies at no earlier than 22 weeks' gestation at this institution, between 1997 and 2002, were also examined as controls. Prophylactic cervical ligature, preventive hospitalization, and cesarean section were not routine in the control group. Results: The average gestational ages at delivery in singleton (n = 58), twin (n = 21), triplet (n = 14) and quadruplet (n = 1) pregnancies, were 39.4, 35.6, 31.9 and 25.1 weeks, respectively (P < 0.001 by anova). Birthweights were 2886 ± 425 g, 2117 ± 623 g, 1430 ± 373 g, and 633 ± 77 g (mean ± SD), respectively (P < 0.001). The average inpatient medical care cost for mother and child(ren), from maternal admissions after 12 weeks' gestation to the discharge of all family members from hospital, was ¥703 279 yen (∼US$5861), ¥4 903 270 (∼US$40 861), ¥11 810 327 (∼US$98 419), and ¥44 961 000 (∼US$374 675), respectively (P < 0.001). Conclusion: The present study outlined the high costs of medical care for HOM pregnancies. Not only from a medical viewpoint, but also from the viewpoint of medical costs, it is important to avoid HOM pregnancies as a result of infertility treatment. (Reprod Med Biol 2004; 3: 159-164).

Keywords: quadruplet; maternal; medical care costs; neonatal; triplet.

Figure 1

The relationship between gestational age at delivery or birthweight and the costs of neonatal medical care. For all high‐order multiple (HOM) neonates, both (a) gestational age at delivery and (b) birthweight correlated negatively with the neonatal medical care costs were calculated. A similar relationship was also seen in triplet neonates delivered by elective cesarean section between 32 and 34 weeks (c, d).