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

Abstract

ObjectiveTo estimate the direct healthcare cost of being overweight or obese throughout pregnancy to the National Health Service in Wales.DesignRetrospective prevalence-based study.SettingCombined 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).Participants484 singleton pregnancies with available health service records and an antenatal BMI.Primary outcome measureTotal 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.ResultsThere 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.ConclusionsIncreased 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.

Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials

“…Obesity and excessive gestational weight gain put mother and offspring at risk, both in pregnancy and in later life 456. The resultant costs to the health service and society are considerable 78. Increasingly, healthcare organisations and research funding bodies prioritise research on interventions and strategies to reduce maternal weight related adverse outcomes in pregnancy 9101112…”

Researchers’ position statement on tackling obesity in pregnancy: the International Weight Management in Pregnancy (i‐WIP) collaboration pleads for public health intervention

“…8 In the long term, pregnant women with excess gestational weight gain and obesity are at risk of weight retention, 9-11 diabetes, 12,13 and cardiovascular diseases. 14,15 Importantly, the problem is transgenerational, with adverse effects on infant birthweight as well as childhood and adult obesity.…”

The Effects of Exercise on Postpartum Weight Retention in Overweight and Obese Women

“…The prevalence of pre-gravid overweight and obese women has increased dramatically in recent years [6] and is associated with numerous negative maternal and foetal health implications [7,8]. Moreover, healthcare has been purported to cost 23% more for overweight women and 37% more for obese women compared with normal weight women [9]. As such, effective, appropriate interventions to limit excessive GWG and prevent postpartum weight retention are required, especially for overweight and obese women.…”