Obesity in pregnancy: outcomes and economics**
The prevalence of obesity is increasing worldwide and this trend also affects women of reproductive age. Maternal obesity is now the commonest risk factor for maternal mortality in developed countries1 and is also associated with a wide spectrum of adverse pregnancy outcomes. In the longer term, obesity and excessive weight gain during pregnancy are also associated with increased risks of cardiovascular and metabolic disease2 for the mother and with increased risks of obesity in the offspring3.
The health implications for mothers and babies resulting from obesity in pregnancy have important economic implications. Increased cost to health care providers, who manage obesity in pregnancy and its consequences, are expected. Interventions that reduce the problem will be costly themselves, but may pay dividends from reduced future economic costs, and may increase health benefits for mothers and their infants.
It is clear that obese women require more health-care resources during pregnancy and women of normal body weight. However, definitive data demonstrating the efficacy of interventions to treat obesity during pregnancy are lacking. Decision-makers working in this area of health services need to understand whether obesity and its effects on pregnancy can be reduced, and if so, at what cost. Further, we need to quantify potential cost savings and health benefits which may accrue in the future from a reduced prevalence of obesity. These data, if made available and analyzed appropriately, would show whether interventions to reduce obesity are cost-effective given the many other competing demand for health care resources.
Begin the prevention before pregnancy
Most of the available economic data only describes the increased costs associated with outcomes arising from obesity in pregnancy. Further information is required to understand whether interventions designed to reduce the problem are effective and how much they cost to implement.
One way of preventing obesity in pregnancy might be to prevent obesity in young women to ensure they enter pregnancy at a healthy weight.
Yet another approach may be to target overweight and obesity through preconception counseling and care4. There are a number of barriers to this, including low pregnancy planning rates5 and poor compliance with even relatively simple peri-conceptual health recommendations such as folic acid supplementation6. The complex lifestyle changes required for weight loss prior to pregnancy are likely to be very difficult to achieve in many obese women. However, a high-quality preconception care program may have a large impact on a range of health conditions (such as reduced smoking and alcohol intake) rather than solely those associated with obesity.
Other potential interventions include the weighing of women during pregnancy in order to assist in limiting weight gain; the provision of extra care following a careful clinical assessment in early pregnancy; and the administration of interconception care to help reduce risk of subsequent complications.
In terms of resources, the costs of reducing the impact of maternal obesity are likely to be positive, yet these may be partially or completely offset by downstream cost savings. The clinical consequences of obesity for mothers and infants are real and will drive health costs upward; so reducing obesity should reduce healthcare costs.
Just as cost can be saved from reducing obesity, it is expected that health would improve for both mother and infant. There may be reductions in maternal and neonatal mortality risk, and improvements to quality of life for both groups, resulting in fewer obesity-related morbidities.
Obesity has substantial implications for maternal, fetal and neonatal health and is a major problem in the delivery of obstetric and neonatal care. The high-risk nature of pregnancies among women who are obese means that they warrant increased care by health care providers. Consequently, managing and treating obese women in pregnancy has a large impact on obstetric resources and service delivery, and the financial costs incurred are likely to be large. Because of the multitude of short and long-term implications of maternal obesity, and potentially large economic impact, it is important that efforts are made to address this problem. However, there is a paucity of evidence to inform recommendations in this area with an urgent need for good quality research. Research that aims to reduce the impact of maternal obesity may contribute towards reducing the financial costs incurred, and improve maternal and infant health. Measuring the effectiveness of interventions may be difficult but it's important for improving decision-making and service delivery.
*The following is an edited version of the article which first appeared in Seminars in Fetal & Neonatal Medicine 15 (2010) 94–99
- Confidential Enquiry into Maternal and Child Health (CEMACH). Why mothers die. The sixth report into maternal deaths in the United Kingdom. London: RCOG Press; 2004.
- Callaway LK, et al. Med J Aust 2006;184:56–9.
- Lawlor DA, et al. Am J Epidemiol; 2006.
- Johnson K, et al. MMWR Recomm Rep 2006;55:1–23.
- Rosenfeld JA, Everett KD. J Fam Pract 1996;43:161–6.
- Knudsen VK, et al. Public Health Nutr 2004;7:843–50.