Systematic Literature Review of the Costs of Pregnancy in the US
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The cost of pregnancy is increasing over time despite the decline in pregnancy rates.
To fully elucidate and evaluate the cost drivers of pregnancy in the US for payers, a systematic review was conducted to understand the main cost components and primary factors that contribute to the direct costs of pregnancy, pregnancy-related complications and unintended pregnancy among women of childbearing age (15–44 years).
We performed electronic searches in the PubMed database from January 2000 to December 2012, and major women’s health and pharmacoeconomics conference proceedings from 2011 to 2012.
The systematic review is comprised of studies that reported pregnancy, pregnancy-related complications, unplanned pregnancy, and pregnancy-induced monetary costs. The review excluded narrative reports, systematic reviews, model-derived cost of pregnancy papers, non-US-based studies, and reports based solely on expert opinions.
Study Appraisal and Synthesis Methods
Two reviewers independently applied the inclusion criteria and assessed the quality of the data collected. Disagreements between reviewers were resolved by consensus or by arbitration through a third party, with reference to the original sources. We collected information on the study design and outcomes for each included study. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines in designing, performing, and reporting of the systematic review.
We identified 40 studies from electronic and handsearching methods. We classified studies based on the primary research topic focusing on the overall cost of pregnancy (N = 10), cost of pregnancy-related complications (N = 26), cost of unintended pregnancy (N = 2), cost of planned pregnancy (N = 1), or cost of pregnancy by facilities (N = 1). In the quality assessment, randomized, non-randomized, and retrospective database studies had low to moderate risk of bias. We determined primary cost drivers based on the highest cost reported in each study. The identified cost drivers were inpatient care, pregnancy delivery, multiple births, complicated cesarean sections, high-risk pregnancy, preterm birth, low birth weight, complications due to conditions such as hypertension, diabetes, anemia, and cancer, and in vitro fertilization. In 2008, the overall mean cost per hospital stay for pregnancy-related incidence ranged from $3,306 to $9,234 in 2012 dollars. The mean cost of pregnancy-related complications that led to preterm birth was as high as $326,953 for an infant born at 25 weeks. It is estimated that over 50 % of live births were unintended in the US. The difference in the cost of unintended pregnancy and intended pregnancy was approximately $536 million.
One limitation of the systematic review was the exclusion of model-based cost studies which were excluded because of the high level of variation and heterogeneity across sources of reported cost. Another limitation of the review is that the cost of pregnancy perspective is restricted to the US.
Preventing pregnancy-related complications and reducing unintended pregnancies may lower the overall economic burden of pregnancy on the US health care system.
- Ventura S, et al. Estimated pregnancy rates and rates of pregnancy outcome for the United States, 1990–2008. National Vital Stat Rep. 2012;60(7):1–21.
- Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982–2010. Natl Health Stat Rep. 2012;55:1–28.
- Abma J, Martinez G, Copen C. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, national survey of family growth 2006–2008. Vital Health Stat. 2010;23(30):1–47.
- The healthcare costs of having a baby. Thomson Healthcare; 2007.
- Wier LM, Andrews RM. The national hospital bill: the most expensive conditions by payer, 2008. Statistical brief #107. Healthcare Cost and Utilization Project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2006.
- Agency for Healthcare Research and Quality (AHRQ). 2010 national statistics on all stays. Available from: http://hcupnet.ahrq.gov/HCUPnet.jsp. Accessed 1 Apr 2013.
- Conway P, et al. Patient-centered care categorization of U.S. health care expenditures. Health Serv Res. 2011;46(2):479–90. CrossRef
- Kjerulff KH, et al. The cost of being a woman: a national study of health care utilization and expenditures for female-specific conditions. Womens Health Issues. 2007;17(1):13–21. CrossRef
- Total Expenses and Percent Distribution for Selected Conditions by Source of Payment: United States, 2010. Medical expenditure panel survey household component data. Agency for Healthcare Research and Quality; 2010.
- Zupancic JA. The economics of elective cesarean section. Clin Perinatol. 2008;35(3):591–9, xii.
- MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35(2):293–307, v.
- Menacker F, Hamilton BE. Recent trends in cesarean delivery in the United States. NCHS Data Brief. 2010;35:1–8.
- Higgins JPT, Green, S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Available from: http://www.cochrane-handbook.org/. Accessed 6 Aug 2012.
- Wells G, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 6 Aug 2012.
- Motheral B, et al. A checklist for retrospective database studies: report of the ISPOR Task Force on Retrospective Databases. Value Health. 2003;6(2):90–7. CrossRef
- Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
- Fitch K, Johnson R, Pyenson B, Costales A, Law AW. Costs of contraceptive coverage and pregnancy care: an actuarial analysis. J Manag Care Pharmacy. 2011;17(3):242.
- Gazmararian JA, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol. 2002;100(1):94–100. CrossRef
- Machlin SR, Rohde F. Health care expenses for uncomplicated pregnancies. Research Findings No. 27. Rockville: Agency for Healthcare Research and Quality; 2007.
- Main J, et al. Median costs and outcomes related to multiple gestations. Am J Obstet Gynecol. 2011:S66.
- Merrill C, Steiner C. Hospitalizations related to childbirth, 2003. Statistical brief #11. Healthcare Cost and Utilization Project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2006.
- Podulka J, Stranges E, Steiner C. Hospitalizations related to childbirth, 2008. Statistical brief #110. Healthcare Cost and Utilization Project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2011.
- Ray GT, Lieu TA. Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization. Health Care Poor Underserved. 2003;14(3):420–35. CrossRef
- Monea E, Thomas A. Unintended pregnancy and taxpayer spending. Perspect Sex Reprod Health. 2011;43(2):88–93. CrossRef
- Sonfield A, et al. The public costs of births resulting from unintended pregnancies: national and state-level estimates. Perspect Sex Reprod Health. 2011;43(2):94–102. CrossRef
- Katz P, et al. Costs of infertility treatment: results from an 18-month prospective cohort study. J Fertil Steril. 2011;95(3):915–21. CrossRef
- DelliFraine J, et al. Cost comparison of baby friendly and non-baby friendly hospitals in the United States. Pediatrics. 2011;127(4):e989–94. CrossRef
- Barton JR, et al. Cost-savings analysis of an outpatient management program for women with pregnancy-related hypertensive conditions. Dis Manag. 2006;9(4):236–41. CrossRef
- Chinthammit C, Skrepnek G. Cancer during pregnancy: clinical and economic characteristics associated with inpatient cases in the United States. Value Health. 2012;15:A208. CrossRef
- Gabbe SG, et al. Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus. Am J Obstet Gynecol. 2000;182(6):1283–91. CrossRef
- James AH, et al. An assessment of medical resource utilization and hospitalization cost associated with a diagnosis of anemia in women with obstetrical bleeding in the United States. Women’s Health. 2008;17(8):1279–84. CrossRef
- Rein DB, et al. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol. 2000;95(3):397–402. CrossRef
- Goler NC, et al. Early start: a cost-beneficial perinatal substance abuse program. Obstet Gynecol. 2012;119(1):102–10. CrossRef
- Thorsen N, Khalil L. Cost savings associated with smoking cessation for low-income pregnant women. WMJ. 2004;103(5):67–9, 73.
- Grobman WA, Welshman EE, Calhoun EA. Does fetal fibronectin use in the diagnosis of preterm labor affect physician behavior and health care costs? A randomized trial. Obstet Gynecol. 2004;191(1):235–40. CrossRef
- Brooten D, et al. A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs. J Manag Care. 2001;7(8):793–803.
- Jones JS, et al. Is 34 weeks an acceptable goal for a complicated singleton pregnancy? J Manag Care. 2002;11(10):42–7.
- Russell RB, et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007;120(1):e1–9. CrossRef
- Gilbert WM, Nesbitt TS, Danielsen B. The cost of prematurity: quantification by gestational age and birth weight. Obstet Gynecol. 2003;102(3):488–92. CrossRef
- Magriples U, et al. Delivery at 34 weeks is more costly than at 35 weeks in pregnancies with premature rupture of membranes. J Matern Fetal Neonatal Med. 2003;14(1):22–5. CrossRef
- Fonseca L, Monga M, Silva J. Postdates pregnancy in an indigent population: the financial burden. Obstet Gynecol. 2003;188(5):1214–6. CrossRef
- Adams EK, et al. Costs of poor birth outcomes among privately insured. J Health Care Finance. 2003;29(3):11–27.
- Phibbs CS, Schmitt SK. Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants. Early Hum Dev. 2006;82(2):85–95. CrossRef
- Schmitt SK, Sneed L, Phibbs CS. Costs of newborn care in California: a population-based study. Pediatrics. 2006;117(1):154–60. CrossRef
- Clements KM, et al. Preterm birth-associated cost of early intervention services: an analysis by gestational age. Pediatrics. 2007;119(4):e866–74. CrossRef
- Kirkby S, et al. Clinical outcomes and cost of the moderately preterm infant. Adv Neonatal Care. 2007;7(2):80–7. CrossRef
- Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol. 2007;27(10):614–9. CrossRef
- Nicholson J, et al. The active management of risk in pregnancy at term (AMOR-IPAT) cost-effectiveness study. Am J Obstet Gynecol. 2011:S63.
- Morrison J, et al. Telemedicine: cost-effective management of high-risk pregnancy. J Manag Care. 2001;10(11):42–6, 48–9.
- Xu X, et al. Cost of racial disparity in preterm birth: evidence from Michigan. J Health Care Poor Underserved. 2009;20(3):729–47. CrossRef
- Rolnick SJ, et al. Impact of birthweight on healthcare charges within a managed care organization. J Manag Care. 2000;6(12):1289–96.
- Cuevas KD, et al. The cost of prematurity: hospital charges at birth and frequency of rehospitalizations and acute care visits over the first year of life: a comparison by gestational age and birth weight. Am J Nursing. 2005;105(7):56–64. CrossRef
- Unal ER, et al. Planned evening labor induction: the cost of convenience. Am J Obstet Gynecol. 2012:S280.
- Trussell J, et al. Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception. Contraception. 2013;87(2):154–61. CrossRef
- Systematic Literature Review of the Costs of Pregnancy in the US
Volume 31, Issue 11 , pp 1005-1030
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston, MA, 02199, USA
- 2. Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ, USA
- 3. Groupe d’analyse, Ltée, Montreal, QC, Canada
- 4. Veritech Corporation, Mercer Island, WA, USA