title: Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States.
abstract: OBJECTIVE
  Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC)-preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States.
  
  
  METHODS
  Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs.
  
  
  RESULTS
  We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost.
  
  
  CONCLUSIONS
  Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Electronic address: cora.peterson@cdc.hhs.gov.
authors.forename: Cora
authors.initials: C
authors.lastname: Peterson
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Grosse
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA; US Public Health Service Commissioned Corps, Atlanta, GA.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Sharma
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN.
authors.forename: Hilda
authors.initials: H
authors.lastname: Razzaghi
authors.affiliation: Departments of Internal Medicine and Epidemiology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Gilboa
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy*; D005260:Female; D006801:Humans; D016742:Preconception Care / Q000191:economics*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000191:economics* / Q000517:prevention & control*; D014481:United States; D055815:Young Adult
keywords: diabetes mellitus; economic analysis; pregnancy complications