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Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States

Cora Peterson, PhD; Scott D. Grosse, PhD; Rui Li, PhD; Andrea J. Sharma, PhD; Hilda Razzaghi, PhD; William H. Herman, MD, MPH; Suzanne M. Gilboa, PhD.  Am J Obstet Gynecol 2015;212:74.e1-9.


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.


STUDY DESIGN: 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.


CONCLUSION: 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.


American Journal of Obstetrics & Gynecology October 2012

Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis.

John F. Mission, MD; Mika S. Ohno, MD; Yvonne W. Cheng, MD, MPH; Aaron B. Caughey, MD, PhD   


CME/CE Released: 11/15/2012; Valid for credit through 11/15/2013

Preventive Services for Women: New and Important Changes in Covered Services

Rebekah E. Gee MD, MPH                                                                                                                                                  


Diabetes Care 35:529-535, 2012

Screening for Gestational Diabetes Mellitus: Are the Criteria Proposed by the International Association of the Diabetes and Pregnancy Study Groups cost-effective?

Erika F. Werner, MD, MS; Christian M. Pettker, MD; Lisa Zuckerwise, MD; Michael Reel, MD, MBA; Edmund F. Funai, MD; Janice Henderson, MD; Stephen F. Thung, MD

CONCLUSIONS: The IADPSG recommendation for glucose screening in pregnancy is costeffective. The model is most sensitive to the likelihood of preventing future diabetes in patients identified with GDM using postdelivery counseling and intervention.

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