Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section

Shayna D. Cunningham, Carolina Herrera, Ifeyinwa E. Udo, Katy B. Kozhimannil, Eric Barrette, Urania Magriples, Jeannette R. Ickovics

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. Objective The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery. Methods We conducted secondary analyses of 2010–2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute. Allowed charges were summed for the prenatal and childbirth periods. Ordinary least squares regressions tested associations between maternal health conditions and health care expenditures during pregnancy. Results Thirty-four percent of pregnant women had one or more comorbidities; 8% had two or more. Pregnant women with one or more comorbidities had significantly higher allowed charges than those without comorbidities (p <.001). Spending during the prenatal period was nearly three times higher for women with preexisting diabetes compared with women with no comorbid conditions. Average levels of prenatal period spending associated with maternal comorbidities were similar for women who had vaginal and cesarean deliveries. Patient characteristics accounted for 30% of the variance in prenatal period expenditures. Conclusions The impact of maternal comorbidities, and in particular preexisting diabetes, on prenatal care expenditures should be taken into account as provider payment reforms, such as pay-for performance incentives and bundled payments for episodes of care, extend to maternal and child health-related services.

Original languageEnglish (US)
Pages (from-to)551-558
Number of pages8
JournalWomen's Health Issues
Issue number5
StatePublished - Sep 1 2017

Bibliographical note

Funding Information:
Funding statement: This work was supported by a grant from the Health Resources and Services Administration (R40MC28308).

Publisher Copyright:
© 2017 Jacobs Institute of Women's Health


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