Association between maternal body mass index during pregnancy, short-term morbidity and increased health service costs: a population based study

FC Denison, P Norwood, S Bhattacharya, A Duffy, T Mahmood, C Morris, EA Raja, JE Norman, AJ Lee, G Scotland

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Abstract

Objective
To investigate the impact of maternal body mass index (BMI, kg/m2) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland.

Design
Retrospective cohort study using an unselected population database.

Setting
Obstetric units in Scotland, 2003–2010.

Population
A total of 124 280 singleton deliveries in 109 592 women with a maternal BMI recorded prior to 16 weeks of gestation.

Methods
Population-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs.

Main outcome measures
Maternal and offspring outcomes, number and duration of hospital admissions, and healthcare costs.

Results
Using multivariable analysis, in comparison with women of normal weight, women who were overweight, obese, or severely obese had an increased risk of essential hypertension [1.87 (1.18–2.96), 11.90 (7.18–19.72), and 36.10 (18.33–71.10)], pregnancy-induced hypertension [1.76 (1.60–1.95), 2.98 (2.65–3.36), and 4.48 (3.57–5.63)], gestational diabetes [3.39 (2.30–4.99), 11.90 (7.54–18.79), and 67.40 (37.84–120.03)], emergency caesarean section [1.94 (1.71–2.21), 3.40 (2.91–3.96), and 14.34 (9.38–21.94)], and elective caesarean section [2.06 (1.84–2.30), 4.61 (4.06–5.24), and 17.92 (13.20–24.34)]. Compared with women of normal weight, women who were underweight, overweight, obese, or severely obese were associated with an 8, 16, 45, and 88% increase in the number of admissions, respectively, and women who were overweight, obese, or severely obese were associated with a 4, 9, and 12% increase in the duration of stay (all P < 0.001). The additional maternity costs [mean (95% CI), adjusted analyses] for women who were underweight, overweight, obese, or severely obese were £102.27 (£48.49–156.06), £59.89 (£41.61–78.17), £202.46 (£178.61–226.31), and £350.75 (£284.82–416.69), respectively.

Conclusions
Maternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.
Original languageEnglish
Pages (from-to)72-82
Number of pages11
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume121
Issue number1
Early online date18 Sep 2013
DOIs
Publication statusPublished - Jan 2014

Fingerprint

Health Care Costs
Health Services
Body Mass Index
Mothers
Morbidity
Pregnancy
Population
Thinness
Scotland
Cesarean Section
Cohort Studies
Weights and Measures
Costs and Cost Analysis
Pregnancy Induced Hypertension
Gestational Diabetes
Hospital Costs
National Health Programs
Inpatients
Emergencies
Retrospective Studies

Keywords

  • economics
  • healthcare costs
  • medical complications
  • obesity
  • pregnancy

Cite this

@article{6d21260edfca4301935aa863ee1c5146,
title = "Association between maternal body mass index during pregnancy, short-term morbidity and increased health service costs: a population based study",
abstract = "ObjectiveTo investigate the impact of maternal body mass index (BMI, kg/m2) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland.DesignRetrospective cohort study using an unselected population database.SettingObstetric units in Scotland, 2003–2010.PopulationA total of 124 280 singleton deliveries in 109 592 women with a maternal BMI recorded prior to 16 weeks of gestation.MethodsPopulation-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs.Main outcome measuresMaternal and offspring outcomes, number and duration of hospital admissions, and healthcare costs.ResultsUsing multivariable analysis, in comparison with women of normal weight, women who were overweight, obese, or severely obese had an increased risk of essential hypertension [1.87 (1.18–2.96), 11.90 (7.18–19.72), and 36.10 (18.33–71.10)], pregnancy-induced hypertension [1.76 (1.60–1.95), 2.98 (2.65–3.36), and 4.48 (3.57–5.63)], gestational diabetes [3.39 (2.30–4.99), 11.90 (7.54–18.79), and 67.40 (37.84–120.03)], emergency caesarean section [1.94 (1.71–2.21), 3.40 (2.91–3.96), and 14.34 (9.38–21.94)], and elective caesarean section [2.06 (1.84–2.30), 4.61 (4.06–5.24), and 17.92 (13.20–24.34)]. Compared with women of normal weight, women who were underweight, overweight, obese, or severely obese were associated with an 8, 16, 45, and 88{\%} increase in the number of admissions, respectively, and women who were overweight, obese, or severely obese were associated with a 4, 9, and 12{\%} increase in the duration of stay (all P < 0.001). The additional maternity costs [mean (95{\%} CI), adjusted analyses] for women who were underweight, overweight, obese, or severely obese were £102.27 (£48.49–156.06), £59.89 (£41.61–78.17), £202.46 (£178.61–226.31), and £350.75 (£284.82–416.69), respectively.ConclusionsMaternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.",
keywords = "economics, healthcare costs, medical complications, obesity, pregnancy",
author = "FC Denison and P Norwood and S Bhattacharya and A Duffy and T Mahmood and C Morris and EA Raja and JE Norman and AJ Lee and G Scotland",
note = "Funding This study was funded by a Chief Scientist Office Grant (CZG/2/471).",
year = "2014",
month = "1",
doi = "10.1111/1471-0528.12443",
language = "English",
volume = "121",
pages = "72--82",
journal = "BJOG-An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "John Wiley & Sons, Ltd (10.1111)",
number = "1",

}

TY - JOUR

T1 - Association between maternal body mass index during pregnancy, short-term morbidity and increased health service costs

T2 - a population based study

AU - Denison, FC

AU - Norwood, P

AU - Bhattacharya, S

AU - Duffy, A

AU - Mahmood, T

AU - Morris, C

AU - Raja, EA

AU - Norman, JE

AU - Lee, AJ

AU - Scotland, G

N1 - Funding This study was funded by a Chief Scientist Office Grant (CZG/2/471).

PY - 2014/1

Y1 - 2014/1

N2 - ObjectiveTo investigate the impact of maternal body mass index (BMI, kg/m2) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland.DesignRetrospective cohort study using an unselected population database.SettingObstetric units in Scotland, 2003–2010.PopulationA total of 124 280 singleton deliveries in 109 592 women with a maternal BMI recorded prior to 16 weeks of gestation.MethodsPopulation-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs.Main outcome measuresMaternal and offspring outcomes, number and duration of hospital admissions, and healthcare costs.ResultsUsing multivariable analysis, in comparison with women of normal weight, women who were overweight, obese, or severely obese had an increased risk of essential hypertension [1.87 (1.18–2.96), 11.90 (7.18–19.72), and 36.10 (18.33–71.10)], pregnancy-induced hypertension [1.76 (1.60–1.95), 2.98 (2.65–3.36), and 4.48 (3.57–5.63)], gestational diabetes [3.39 (2.30–4.99), 11.90 (7.54–18.79), and 67.40 (37.84–120.03)], emergency caesarean section [1.94 (1.71–2.21), 3.40 (2.91–3.96), and 14.34 (9.38–21.94)], and elective caesarean section [2.06 (1.84–2.30), 4.61 (4.06–5.24), and 17.92 (13.20–24.34)]. Compared with women of normal weight, women who were underweight, overweight, obese, or severely obese were associated with an 8, 16, 45, and 88% increase in the number of admissions, respectively, and women who were overweight, obese, or severely obese were associated with a 4, 9, and 12% increase in the duration of stay (all P < 0.001). The additional maternity costs [mean (95% CI), adjusted analyses] for women who were underweight, overweight, obese, or severely obese were £102.27 (£48.49–156.06), £59.89 (£41.61–78.17), £202.46 (£178.61–226.31), and £350.75 (£284.82–416.69), respectively.ConclusionsMaternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.

AB - ObjectiveTo investigate the impact of maternal body mass index (BMI, kg/m2) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland.DesignRetrospective cohort study using an unselected population database.SettingObstetric units in Scotland, 2003–2010.PopulationA total of 124 280 singleton deliveries in 109 592 women with a maternal BMI recorded prior to 16 weeks of gestation.MethodsPopulation-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs.Main outcome measuresMaternal and offspring outcomes, number and duration of hospital admissions, and healthcare costs.ResultsUsing multivariable analysis, in comparison with women of normal weight, women who were overweight, obese, or severely obese had an increased risk of essential hypertension [1.87 (1.18–2.96), 11.90 (7.18–19.72), and 36.10 (18.33–71.10)], pregnancy-induced hypertension [1.76 (1.60–1.95), 2.98 (2.65–3.36), and 4.48 (3.57–5.63)], gestational diabetes [3.39 (2.30–4.99), 11.90 (7.54–18.79), and 67.40 (37.84–120.03)], emergency caesarean section [1.94 (1.71–2.21), 3.40 (2.91–3.96), and 14.34 (9.38–21.94)], and elective caesarean section [2.06 (1.84–2.30), 4.61 (4.06–5.24), and 17.92 (13.20–24.34)]. Compared with women of normal weight, women who were underweight, overweight, obese, or severely obese were associated with an 8, 16, 45, and 88% increase in the number of admissions, respectively, and women who were overweight, obese, or severely obese were associated with a 4, 9, and 12% increase in the duration of stay (all P < 0.001). The additional maternity costs [mean (95% CI), adjusted analyses] for women who were underweight, overweight, obese, or severely obese were £102.27 (£48.49–156.06), £59.89 (£41.61–78.17), £202.46 (£178.61–226.31), and £350.75 (£284.82–416.69), respectively.ConclusionsMaternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.

KW - economics

KW - healthcare costs

KW - medical complications

KW - obesity

KW - pregnancy

U2 - 10.1111/1471-0528.12443

DO - 10.1111/1471-0528.12443

M3 - Article

VL - 121

SP - 72

EP - 82

JO - BJOG-An International Journal of Obstetrics and Gynaecology

JF - BJOG-An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 1

ER -