August 1, 2017 / 7:10 PM / 3 months ago

Pregnancy disorder exacts toll on mothers, babies, healthcare funds

(Reuters Health) - A little-understood syndrome likely afflicted nearly 157,000 pregnant women and new mothers in the United States in 2012, killed 72 of them, and cost the U.S. healthcare system more than $2 billion, researchers estimate.

The number of pregnant women in the U.S. diagnosed with preeclampsia - a condition marked by elevated blood pressure and impaired flow of blood between the mother and the fetus - has been rising since 1980. When expectant mothers have preeclampsia, doctors often deliver their babies early in an effort to avoid seizures, strokes and other complications in the mothers and to save the infants, who may be deprived of oxygen and nutrients.

Costs associated with preeclampsia amounted to $1.15 billion for babies and $1.03 billion for mothers in 2012, according to new calculations. Estimates varied dramatically, from $23,000 to $312,000 for the first year of life for each mother and child, depending upon how early the infant was born, the research team reported in the American Journal of Obstetrics and Gynecology.

But the true costs likely are higher, because researchers estimated expenditures for only one year after birth while health issues related to preeclampsia can plague mothers for decades and children for a lifetime, said senior author Dr. Anupam Bapu Jena of Harvard Medical School in Boston.

“Preeclampsia is a disease that affects families at a time that is typically thought to be the most joyous time of life,” he said. “This is a substantive clinical and economic health issue that probably deserves more private and public research than it has currently received.”

Jena said in a phone interview that left unchecked, preeclampsia has the potential to cause breathing problems and life-threatening infections in infants and to kill a mother the same day her child is born.

In an accompanying editorial, researchers from the U.S. Centers for Disease Control and Prevention called the study’s findings “a stark reminder” of the need for more research into the “underrecognized” and “underresearched” condition that represents one of the biggest challenges in maternity care.

Dr. Elliott Main, a professor of obstetrics and gynecology at Stanford University in California who was not involved with the study, stressed the toll on mothers, babies and families.

“Preeclampsia’s a big deal, and cost is a marker of burden of complications,” he said in a phone interview. “It’s not just dollars.”

“It’s suffering for both mother and baby, and dollars is a way of adding up the amount of suffering,” he said.

Jena and his team analyzed California hospital discharge and birth certificate data from 2008-2011, along with nationally representative estimates of healthcare costs, to estimate the costs associated with preeclampsia.

They calculated that in 2012, for an estimated 156,681 mothers, preeclampsia doubled the probability of a health complication soon after giving birth and nearly doubled the probability of a complication in their newborns.

“Those data present a troubling portrait of a growing public-health problem,” Dr. Francis Collins, director of the U.S. National Institutes of Health said in a statement.

The disorder is more likely to strike African-American women, who had nearly twice the rate of preeclampsia as white women in California from 2008 until 2011, the study shows.

African-American women have more underlying hypertension, but other than that, it’s not clear why they are more likely to develop preeclampsia, Main said.

Delaying childbirth to a later age and obesity partly explain the increased incidence of preeclampsia, researchers say. Increased use of assisted reproduction, which leads to more multiple births, also is a factor.

Women with early preeclampsia should be seen in hospitals with highly skilled obstetrical teams experienced in treating the syndrome, Main said. Hospitals have been adding neonatal intensive-care units but have been slower to bring on high-level obstetrics units, he said.

“The only treatment we have right now for preeclampsia is delivery, basically separating the mother from the baby,” he said. He tells his medical students, “This is a classic example of where you’re taking care of two patients at once who may have different interests.”

SOURCE: bit.ly/2tgx6yZ and bit.ly/2trpvBN American Journal of Obstetrics and Gynecology, online July 11, 2017.

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