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344: Health care utilization during pregnancy: the impact of pre-pregnancy body mass index
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Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity
life-births and 4 fetal deaths (2.5%); 2 fetus with structural cardiac anomalies. Two (1.2%) neonatal deaths occurred after preterm delivery at 20 and 22⫹2 weeks gestation. Overall there were 6 fetus with structural cardiac anomalies in 75 women with congenital heart disease (8%).The mean gestational age at delivery was 265 days. The average birthweight at delivery was 3063 grams. Preterm delivery spontaneous or induced occurred in 29 (18%) patients. There were 20 (12.8%) neonates small for gestational age (⬍ 10th percentile) and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU). CONCLUSION: Pregnancy in women with heart disease is associated with preterm birth, small for gestational age and increased perinatal mortality. Even for women in NYHA I/II adverse perinatal outcome is high.
344 Health care utilization during pregnancy: the impact of pre-pregnancy body mass index Jaimey Pauli1, Junjia Zhu2, John Repke1, Kristen Kjerulff2 1 Penn State Hershey, Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hershey, PA, 2Penn State Hershey, Milton S. Hershey Medical Center, Department of Public Health, Hershey, PA
OBJECTIVE: Approximately two-thirds of women of reproductive age are overweight or obese. Increased body mass index (BMI) is associated with more complications during pregnancy, which may lead to increased use of healthcare services such as emergency room visits and hospital admissions during pregnancy. Our objective was to determine the use of these services by women during their first pregnancy in the context of pre-pregnancy BMI. STUDY DESIGN: A cohort of 3006 nulliparous women participating in the First Baby Study was surveyed one month postpartum for selfreported emergency room visits, hospital admissions, and outpatient procedures during pregnancy and in the postpartum period. The relationship between pre-pregnancy BMI category (in kg/m2: Normal ⬍25, Overweight 25-29.9, Obese 30-34.9, and Morbidly Obese ⱖ35) and healthcare utilization was analyzed using multivariate logistic regression models controlling for age, race, and insurance status. RESULTS: In this cohort, 22.1% were overweight, 11.4% were obese, and 9.2% were morbidly obese. During pregnancy, women with increased pre-pregnancy BMI were at increased risk for hospital admissions compared to normal weight women. Morbidly obese women were at increased risk for emergency room visits and outpatient procedures during pregnancy, as well as postpartum emergency room visits and hospital admissions (Table). During pregnancy, hypertension, labor symptoms, and fetal testing were the main indications for these services, while in the postpartum period the indications were infection, incisional issues, and pain. CONCLUSION: Increased pre-pregnancy BMI is associated increased utilization of healthcare services during pregnancy and in the postpartum period, particularly for morbidly obese women. Pre-pregnancy interventions to reduce BMI need to be instituted, as well as interventions to improve outpatient surveillance and education. These measures may reduce the need for expensive services such as emergency room visits and admissions in this high risk population.
Poster Session II
345 Use of surrogacy for women with chronic kidney disease: a cost-effectiveness analysis Jennifer Farwell1, Solange Wyatt2, Jose Rueda2, Jenna Emerson2, Jessica Page2, Jessica Fowler2, Allison Allen2, Aaron Caughey2 1 Rocky Vista University College of Osteopathic Medicine, Obstetrics & Gynecology, Parker, CO, 2Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR
OBJECTIVE: Chronic kidney disease affects up to 3% of women of childbearing age, and is a major contributor to morbidity in pregnancy. This study compares the costs and outcomes of pregnancy in women with chronic kidney disease (CKD) to the use of surrogate mothers in the same population. STUDY DESIGN: A decision analytic model was built using TreeAge software that compared pregnancy to the use of surrogate mothers for women with severe chronic kidney disease. Neonatal outcomes assessed include death, cerebral palsy, and mental retardation. Maternal outcomes include progression to ESRD, preeclampsia, preterm birth, and death. All probabilities and costs were derived from the literature. Utilities were applied to discounted life expectancy at a discount rate of 3% to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to test the robustness of our model to changes in baseline assumptions. RESULTS: Our model shows that the use of surrogate mothers as an alternative to pregnancy in women with CKD is a cost-effective strategy, leading to optimal maternal and neonatal outcomes. Out of 100,000 pregnancies in women with CKD, there would be 9,600 maternal deaths, 292 neonatal deaths, 212 neonates born with cerebral palsy, and 97 neonates with mental retardation due to the high incidences of preeclampsia and preterm birth in these patients. The cost savings generated by using a surrogate is $225,101.37 US per person with a gain of 9.41 quality-adjusted life years (QALYs). Risks and costs associated with neonatal cerebral palsy, mental retardation, and neonatal death due to preterm birth is significantly reduced when using a surrogate mother. CONCLUSION: The use of surrogate mothers for those with chronic kidney disease is dramatically cost effective and provides for far better maternal and neonatal outcomes. Much of this benefit is incurred by avoiding the high rates of preterm birth and its associated complications in pregnancies of women with CKD.
Decision analysis results, chronic kidney disease for a cohort of 100,000 women
Health care utilization and pre-pregnancy BMI in nulliparous women 346 Outcomes of pregnancies complicated by chronic kidney disease Jennifer Farwell1, Jenna Emerson2, Solange Wyatt2, Jose Rueda2, Yvonne Cheng2, Aaron Caughey2
ORs adjusted for maternal age, race, and insurance status (public vs private). Data are generated from multivariate logistic regression models.
1 Rocky Vista University College of Osteopathic Medicine, Obstetrics & Gynecology, Parker, CO, 2Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR
OBJECTIVE: This study aims to estimate the risk of various pregnancy outcomes in women with chronic kidney disease (CKD).
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S153
Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity
life-births and 4 fetal deaths (2.5%); 2 fetus with structural cardiac anomalies. Two (1.2%) neonatal deaths occurred after preterm delivery at 20 and 22⫹2 weeks gestation. Overall there were 6 fetus with structural cardiac anomalies in 75 women with congenital heart disease (8%).The mean gestational age at delivery was 265 days. The average birthweight at delivery was 3063 grams. Preterm delivery spontaneous or induced occurred in 29 (18%) patients. There were 20 (12.8%) neonates small for gestational age (⬍ 10th percentile) and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU). CONCLUSION: Pregnancy in women with heart disease is associated with preterm birth, small for gestational age and increased perinatal mortality. Even for women in NYHA I/II adverse perinatal outcome is high.
344 Health care utilization during pregnancy: the impact of pre-pregnancy body mass index Jaimey Pauli1, Junjia Zhu2, John Repke1, Kristen Kjerulff2 1 Penn State Hershey, Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hershey, PA, 2Penn State Hershey, Milton S. Hershey Medical Center, Department of Public Health, Hershey, PA
OBJECTIVE: Approximately two-thirds of women of reproductive age are overweight or obese. Increased body mass index (BMI) is associated with more complications during pregnancy, which may lead to increased use of healthcare services such as emergency room visits and hospital admissions during pregnancy. Our objective was to determine the use of these services by women during their first pregnancy in the context of pre-pregnancy BMI. STUDY DESIGN: A cohort of 3006 nulliparous women participating in the First Baby Study was surveyed one month postpartum for selfreported emergency room visits, hospital admissions, and outpatient procedures during pregnancy and in the postpartum period. The relationship between pre-pregnancy BMI category (in kg/m2: Normal ⬍25, Overweight 25-29.9, Obese 30-34.9, and Morbidly Obese ⱖ35) and healthcare utilization was analyzed using multivariate logistic regression models controlling for age, race, and insurance status. RESULTS: In this cohort, 22.1% were overweight, 11.4% were obese, and 9.2% were morbidly obese. During pregnancy, women with increased pre-pregnancy BMI were at increased risk for hospital admissions compared to normal weight women. Morbidly obese women were at increased risk for emergency room visits and outpatient procedures during pregnancy, as well as postpartum emergency room visits and hospital admissions (Table). During pregnancy, hypertension, labor symptoms, and fetal testing were the main indications for these services, while in the postpartum period the indications were infection, incisional issues, and pain. CONCLUSION: Increased pre-pregnancy BMI is associated increased utilization of healthcare services during pregnancy and in the postpartum period, particularly for morbidly obese women. Pre-pregnancy interventions to reduce BMI need to be instituted, as well as interventions to improve outpatient surveillance and education. These measures may reduce the need for expensive services such as emergency room visits and admissions in this high risk population.
Poster Session II
345 Use of surrogacy for women with chronic kidney disease: a cost-effectiveness analysis Jennifer Farwell1, Solange Wyatt2, Jose Rueda2, Jenna Emerson2, Jessica Page2, Jessica Fowler2, Allison Allen2, Aaron Caughey2 1 Rocky Vista University College of Osteopathic Medicine, Obstetrics & Gynecology, Parker, CO, 2Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR
OBJECTIVE: Chronic kidney disease affects up to 3% of women of childbearing age, and is a major contributor to morbidity in pregnancy. This study compares the costs and outcomes of pregnancy in women with chronic kidney disease (CKD) to the use of surrogate mothers in the same population. STUDY DESIGN: A decision analytic model was built using TreeAge software that compared pregnancy to the use of surrogate mothers for women with severe chronic kidney disease. Neonatal outcomes assessed include death, cerebral palsy, and mental retardation. Maternal outcomes include progression to ESRD, preeclampsia, preterm birth, and death. All probabilities and costs were derived from the literature. Utilities were applied to discounted life expectancy at a discount rate of 3% to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to test the robustness of our model to changes in baseline assumptions. RESULTS: Our model shows that the use of surrogate mothers as an alternative to pregnancy in women with CKD is a cost-effective strategy, leading to optimal maternal and neonatal outcomes. Out of 100,000 pregnancies in women with CKD, there would be 9,600 maternal deaths, 292 neonatal deaths, 212 neonates born with cerebral palsy, and 97 neonates with mental retardation due to the high incidences of preeclampsia and preterm birth in these patients. The cost savings generated by using a surrogate is $225,101.37 US per person with a gain of 9.41 quality-adjusted life years (QALYs). Risks and costs associated with neonatal cerebral palsy, mental retardation, and neonatal death due to preterm birth is significantly reduced when using a surrogate mother. CONCLUSION: The use of surrogate mothers for those with chronic kidney disease is dramatically cost effective and provides for far better maternal and neonatal outcomes. Much of this benefit is incurred by avoiding the high rates of preterm birth and its associated complications in pregnancies of women with CKD.
Decision analysis results, chronic kidney disease for a cohort of 100,000 women
Health care utilization and pre-pregnancy BMI in nulliparous women 346 Outcomes of pregnancies complicated by chronic kidney disease Jennifer Farwell1, Jenna Emerson2, Solange Wyatt2, Jose Rueda2, Yvonne Cheng2, Aaron Caughey2
ORs adjusted for maternal age, race, and insurance status (public vs private). Data are generated from multivariate logistic regression models.
1 Rocky Vista University College of Osteopathic Medicine, Obstetrics & Gynecology, Parker, CO, 2Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR
OBJECTIVE: This study aims to estimate the risk of various pregnancy outcomes in women with chronic kidney disease (CKD).
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S153