title: Incremental charges, costs, and length of stay associated with obesity as a secondary diagnosis among pregnant women.
abstract: BACKGROUND
  Elevation in prepregnancy body mass index (BMI) has been linked to a host of perinatal complications, but increases in charges or costs associated with obesity during pregnancy have not been quantified.
  
  
  METHODS
  To evaluate the economic impact of obesity as a diagnosis on hospitalizations of pregnant women, we performed descriptive, univariate, and multivariable analysis of the 1999 to 2005 Nationwide Inpatient Sample, a nationally representative sample of admissions to US community hospitals.
  
  
  RESULTS
  Hospitalizations with a diagnosis of obesity were rare (0.7%), but when obesity was a diagnosis, it was associated with significant increases in length of stay (LOS), charges, and costs. Cesarean section was more frequent among women hospitalized with a diagnosis of obesity, with increases in this procedure across nearly every pregnancy-related diagnostic category. Controlled for cesarean section, diagnosed obesity was associated with significant increases in LOS (0.55 day), charges ($2015), and costs ($1805). Increases in LOS were sustained across nearly every diagnostic category when cesarean section was incorporated into the modeling, whereas increased cesarean section explained increases in costs for hemorrhage during pregnancy and abnormal glucose tolerance during pregnancy.
  
  
  CONCLUSIONS
  Although these hospitalizations represent a relatively small sample of all obese pregnant women, diagnosed obesity seems to contribute heavily to increased costs among pregnant women. Further studies are needed to identify reasons increased health care costs of caring for women with obesity during pregnancy besides increased cesarean section. These data may encourage insurers to provide fiscal incentives to prevent complications of obesity during pregnancy.
authors.affiliation: Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. leo.trasande@mssm.edu
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
authors.forename: Menjean
authors.initials: M
authors.lastname: Lee
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Liu
authors.forename: Michael
authors.initials: M
authors.lastname: Weitzman
authors.forename: David
authors.initials: D
authors.lastname: Savitz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D009765:Obesity / Q000191:economics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics*; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States