Economic Impact of Severe Early-Onset Foetal Growth Restriction: A Multicentre Prospective Cohort Study.

Abstract

Foetal growth restriction (FGR) affects 10% of pregnancies, contributing to 30% of stillbirths. Current management of early-onset FGR (< 32 + 0 weeks' gestation) delivers the foetus before stillbirth or irreversible organ damage. The resulting preterm births create additional risks independent of FGR. We determined the economic cost associated with severe early-onset FGR. Economic analysis of EVERREST prospective study, a 6-year multicentre prospective cohort study. UK, Spain, Germany, Sweden. Pregnant women with estimated foetal weight < 3rd centile, 20 + 0-26 + 6 weeks of gestation. Between antenatal recruitment and 2 years post-delivery, maternal and infant resource use was collected using the Global Pregnancy CoLaboratory (COLAB) data set and an adapted client service receipt inventory (CSRI) questionnaire. Cost differences between gestational age groups with Multivariable Generalised Linear Models. Of 135 births, 46% were extremely preterm (EPT, < 28 + 0 weeks), 23% very preterm (VPT, 28 + 0-< 32 + 0 weeks), 16% late/moderate preterm (MLPT, 32 + 0-< 37 + 0 weeks) and 14% term. Neonatal Unit (NNU) costs accounted for the largest costs incurred by either mother or infant, exhibiting the largest differences between gestational age groups. EPT infants costed an additional £157 832 (95% CI: £96 904-£218 760) on average per infant compared to the term group, VPT infants an additional £93 709 (95% CI: £62 656-£124 761) and MLPT infants an additional £20 182 (£11 882-£28 482). Early-onset FGR has substantial costs, predominantly incurred during infants' NNU admissions. Births < 32 + 0 weeks have significantly higher costs than term births, providing economic justification to research therapies that reduce iatrogenic preterm birth. ClinicalTrials.gov identifier: NCT02097667.