Maternal and infant hospitalization costs associated with hypertensive disorders of pregnancy in a California cohort*

Background The United States has higher health care costs than other developed nations. Hypertensive disorders of pregnancy are increasingly common, and longer hospital admissions and utilization of additional therapies are costly.Objective We sought to estimate maternal and neonatal hospital costs in a large cohort of pregnant women with and without hypertensive disorders of pregnancy.Study Design This was a retrospective cohort study of women in California with singleton, non-anomalous births with gestational ages between 23–42 weeks. Women were categorized into seven mutually exclusive groups: no hypertension, chronic hypertension (HTN), chronic HTN with superimposed preeclampsia, gestational HTN, mild preeclampsia, severe preeclampsia, and eclampsia. Hospitalization costs were estimated for women and neonates separately and included the cost for admission for delivery only. We used Chi squared and Kruskal–Wallis equality-of-populations rank tests for statistical analysis with a significance level of 0.05.Results In a California cohort of 1,918,482 women, 16,208 (0.8%) had chronic HTN, 5,912 (0.3%) had chronic HTN with superimposed preeclampsia, 39,558 (2.1%) had gestational HTN, 33,462 (1.7%) had mild preeclampsia, 17,184 (0.9%) had severe preeclampsia and 1252 (0.1%) had eclampsia. Median hospitalization costs and length-of-stays were statistically significantly different for women in each group (p<.001). Women with eclampsia had the highest median hospitalization costs ($25,437, IQR: $16,893–$37,261) and women without any hypertensive disorder of pregnancy had the lowest ($11,720, IQR: $8019–$17,530). Costs were significantly different between groups based on gestational age and mode of delivery, and with severe maternal morbidity and neonatal intensive care unit admission status (p<.001).Conclusions We found that hospitalization costs of hypertensive disorders of pregnancy were significantly higher than women without hypertension in pregnancy. These results highlight the economic burden of hypertensive disorders of pregnancy.