Senior Medical Director, Women's Health Optum Health Optum Health Manhasset, NY, United States
Introduction: With obesity (BMI >=30 kg/m2), hypertension, and diabetes posing maternal and neonate/fetal health risks, this study examined whether early enrollment (<=20 weeks gestation) in a maternity case management program resulted in lower incidence of adverse maternal and neonate outcomes than individual enrolling late in their pregnancy (>20 weeks gestation). Methods: Claims and biometrics data identified obese, hypertensive, or diabetic females between 18 to 50 years insured in a commercial health plan. The evaluation divided obese, diabetic, and hypertensive participants into early and late enrollees based on start date. The investigation utilized a quasi-experimental design with propensity matching to reduce covariate differences caused by lack of randomization. Multivariate regression examined mean cesarean, preterm birth, low birthweight, and NICU admit incidence. Results: The analyses found early enrollment for obese females reduced cesarean delivery (medically indicated), NICU baby costs and length-of-stay (LOS), antenatal inpatient admissions, and low birthweight ( < 1,500 g and 2,500 g) incidence. For hypertension, early enrollees experienced significant reductions in NICU baby costs/LOS, antenatal inpatient admissions, preterm birth ( < 32 weeks gestation), very low birthweight, and severe maternal morbidities. Finally, for diabetes, early enrollment contributed to lower NICU baby costs/LOS, very low birthweight, and cesarean delivery (all and medically indicated). Conclusion/Implications: These findings indicate that early enrollment in maternal coaching may reduce adverse maternal and neonate outcomes for obese, hypertensive, and diabetic females.
