Maternal pre-pregnancy obesity and health care utilization and costs in the offspring

Abstract

Background/objective: The association between maternal pre-pregnancy obesity and adverse child health outcomes is well described, but there are few data on the relationship with offspring health service use. We examined the influence of maternal pre-pregnancy obesity on offspring health care utilization and costs over the first 18 years of life.

Methods: This was a population-based retrospective cohort study of children (n = 35,090) born between 1989 and 1993 and their mothers, who were identified using the Nova Scotia Atlee Perinatal Database and linked to provincial administrative health data from birth through 2014. The primary outcome was health care utilization as determined by the number and cost of physician visits, hospital admissions and days, and high utilizer status (>95th percentile of physician visits). The secondary outcome was health care utilization by ICD chapter. Maternal pre-pregnancy weight was categorized as normal weight, overweight, or obese. Multivariable-adjusted regression models were used to examine the association between maternal weight status and offspring health care use.

Results: Children of mothers with pre-pregnancy obesity had more physician visits (10%), hospital admissions (16%), and hospital days (10%) than children from mothers of normal weight over the first 18 years of life. Offspring of mothers with obesity had C$356 higher physician costs and C$1415 hospital costs over 18 years than offspring of normal weight mothers. Children of mothers with obesity were 1.74 times more likely to be a high utilizer of health care and had higher rates of physician visits and hospital stays for nervous system and sense organ disorders, respiratory disorders, and gastrointestinal disorders compared to children of normal weight mothers.

Conclusion: Our findings suggest that maternal pre-pregnancy overweight and obesity are associated with slightly higher offspring health care utilization and costs in the first 18 years of life.

Fig. 1

Directed acyclic graph representing the effect of maternal pre-pregnancy weight on offspring health care utilization

Fig. 2

Smoothed incidence rate ratios with 95% confidence intervals of offspring physician visits (top) and hospital admissions (bottom) over the first 18 years of life by maternal pre-pregnancy weight status (relative to normal weight)

Fig. 3

Children’s mean number of physician visits (top) and hospital admissions (bottom) per year over the first 18 years of life, by ICD chapter and maternal pre-pregnancy weight status