title: Obesity in pregnancy: infant health service utilisation and costs on the NHS.
abstract: OBJECTIVE
  To estimate the direct healthcare cost of infants born to overweight or obese mothers to the National Health Service in the UK.
  
  
  METHODS
  Retrospective prevalence-based study.
  
  
  METHODS
  Combined linked anonymised electronic data sets on a cohort of mother-child pairs enrolled on the Growing Up in Wales: Environments for Healthy Living (EHL) study. Infants were categorised according to maternal early-pregnancy body mass index (BMI): healthy weight mother (18.5≤BMI<25 kg/m(2); n=342), overweight mother (25≤BMI≤29.9 kg/m(2); n=157) and obese mother (BMI≥30; n=110).
  
  
  METHODS
  609 singleton pregnancies with available health service records and an antenatal maternal BMI.
  
  
  METHODS
  Total health service utilisation and direct healthcare costs for providing these services in the year 2012-2013. Costs are calculated as cost of the infant (no maternal costs considered) and are related to health service usage from birth to age 1 year.
  
  
  RESULTS
  A strong association existed between healthcare usage cost and BMI (p<0.001). Mean total costs were 72% higher among children born to obese mothers (rate ratio (RR) 1.72, 95% CI 1.71 to 1.73) compared with infants born to healthy weight mothers. Higher costings were attributed to a significantly greater number (RR 1.39, 95% CI 1.04 to 1.84) and duration (RR 1.55, 95% CI 1.37 to 1.74) of inpatient visits and a higher number of general practitioner visits (RR 1.10, 95% CI 1.03 to 1.16). Total mean additional resource cost was estimated at £65.13 for infants born to overweight mothers and £1138.11 for infants born to obese mothers, when compared with infants of healthy weight mothers.
  
  
  CONCLUSIONS
  Increasingly infants born to mothers with high BMIs consume additional health service resources in the first year of life; this was apparent across inpatient and general practitioner services. Considering both maternal and infant health service use, interventions that cost less than £2310 per person in reducing obesity early pregnancy could be cost-effective.
authors.affiliation: Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Morgan
authors.affiliation: The Farr Institute, College of Medicine, Swansea University, Swansea, UK.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Rahman
authors.affiliation: The Farr Institute, College of Medicine, Swansea University, Swansea, UK.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hill
authors.affiliation: The Farr Institute, College of Medicine, Swansea University, Swansea, UK.
authors.forename: Ashrafunnesa
authors.initials: A
authors.lastname: Khanom
authors.affiliation: The Farr Institute, College of Medicine, Swansea University, Swansea, UK.
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Lyons
authors.affiliation: The Farr Institute, College of Medicine, Swansea University, Swansea, UK.
authors.forename: Sinead T
authors.initials: ST
authors.lastname: Brophy
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D016022:Case-Control Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D000068101:Maternal-Child Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D009765:Obesity / Q000191:economics* / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics*; D012189:Retrospective Studies; D047929:Term Birth; D014852:Wales; D055815:Young Adult
keywords: HEALTH ECONOMICS; PAEDIATRICS; PUBLIC HEALTH