26 - The Impact of Maternal Obesity on NICU and Wellborn Nursery Costs

Poster Number: 26
Publication Number: 26.338

Sharmeen N. Azher, Albany Medical College, Albany, NY, United States; Joaquim Pinheiro, Albany Medical College, Albany, NY, United States; Brendan Philbin, Albany Medical College, Troy, NY, United States; Jamie Gifford, Albany Medical Center, Albany, NY, United States; Rubia Khalak, Albany Medical College, Albany, NY, United States

Background: Research surrounding the effects of maternal obesity on the neonatal period has focused on clinical outcomes such as macrosomia. Despite growing interest in obesity as a driver of healthcare expenditure, the financial impact of maternal obesity in the neonatal setting is not well understood.

Objective: To determine if maternal obesity is associated with higher incurred costs in the NICU and wellborn nursery.

Design/Methods: Our IRB approved study collected data for all live singleton births (1/1/14-12/31/19) at our academic medical center was obtained from the New York State Perinatal Data System for infants at >23 weeks gestational age. Financial data was obtained from the hospital’s cost-processing application. Mother-infant dyads with missing clinical or financial data were excluded. The NIH definition of obesity was used (Body Mass Index ≥ 30 kg/m2) to separate infants born to non-obese and obese mothers. Student’s t-tests and chi square tests were used to compare maternal data, delivery characteristics, and infant outcomes between study groups. A logistic regression model was used to compare infant outcomes using odds ratios while controlling for maternal risk factors (smoking status, pre-pregnancy and gestational diabetes, pre-pregnancy and gestational hypertension). Multivariate regression analysis adjusting for maternal risk factors was also used to compare length-of-stay, total and direct costs in the NICU and full-term nursery between infant groups.

Results: Of the 11,610 pregnancies in this retrospective cohort study, obese mothers were more likely to have other risk factors (smoking status, pre-pregnancy and gestational diabetes, and pre-pregnancy and gestational hypertension, Table 1. In initial analysis, infants born to obese mothers were more likely to be preterm, undergo Cesarean delivery, have lower APGAR scores, require assisted ventilation in the delivery room, and require NICU admission, Table 2. Adjusting for maternal risk factors, infants born to obese mothers were less frequently preterm, and less often required NICU admission, but more frequently had Cesarean births, Table 2. They also had longer adjusted LOS in the full-term nursery (2.03±1.51 vs. 1.92±1.45 days, p < 0.01) and demonstrated higher mean costs per infant in this setting ($3,638.34±$6,316.69 vs. $3,375.04 ±$4,994.18, p=0.03) but not in NICU, Table 3.Conclusion(s): Maternal obesity correlates with multiple risk factors. Infants born to obese mothers have increased LOS and costs in the full-term nursery. These findings may be explained by the prolonged maternal stay due to obesity-related risk factors.
Table 1. Characteristics of normal Body Mass Index (BMI) and obese mothers
Table 2. Delivery characteristics and outcomes of infants born to normal BMI and obese mothers