Cost of prenatal versus postnatal myelomeningocele closure for both mother and child at 1 year of life

OBJECTIVEPrenatal myelomeningocele (MMC) closure has been performed in the United States for 2 decades. While prior work has focused on clinical outcomes of prenatal MMC closure, the cost of this procedure in comparison with that of postnatal MMC closure is unclear. The authors’ aim was to compare the cost of prenatal versus postnatal MMC closure for both the child and mother at 1 year.METHODSA prospective database of patients undergoing prenatal and postnatal MMC closure between 2011 and 2018 with 1-year follow-up was retrospectively reviewed. Charge data for relevant admissions were converted to a cost estimate using the authors’ institution’s Medicare hospital-specific cost-to-charge ratio. Children, mothers, and mother/child pairs were considered separately. The primary outcome was cost. Secondary outcomes included the need for hydrocephalus treatment, length of stay (LOS), and readmissions. Other covariates included gestational age at birth, MMC lesion level, and obstetric complications.RESULTSThe median cost of care for children in the prenatal group was greater, although not significantly so, at $58,406.71 (IQR $16,900.24–$88,951.01) compared with $49,889.95 (IQR $38,425.18–$115,163.86) for children in the postnatal group (p = 0.204). The median cost for mothers in the prenatal group was significantly greater at $24,548.29 (IQR $20,231.55–$36,862.31) compared with $5087.30 (IQR $4430.72–$5362.56) (p < 0.001). The median cost for mother/child pairs in the prenatal group was $102,377.75 (IQR $37,384.30–$118,527.74) compared with $55,667.82 (IQR $42,840.78–$120,058.06) (p = 0.45). Children in the prenatal group had a lower gestational age at birth (235.81 days vs 265.77 days, p < 0.001) and fewer readmissions (33.3% vs 72.7%, p < 0.001), and hydrocephalus treatment was less common (33.3% vs 90.9%, p < 0.001). Index LOS did not differ between children in the prenatal and postnatal groups (26.8 days vs 23.5 days, p = 0.63). Mothers in the prenatal group had longer LOS (15.92 days vs 4.68 days, p < 0.001) and more readmissions (18.5% vs 0.0%, p = 0.06).CONCLUSIONSThe median cost of prenatal versus postnatal MMC closure did not significantly differ from a hospital perspective at 1 year, although variability in cost was high for both groups. When considering the mother alone, prenatal MMC closure was costlier. Future work is needed to assess cost from a patient and societal perspective both at 1 year and beyond.

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Cost Comparison of Prenatal Myelomeningocele Closure Versus Postnatal Closure for Both Mother and Child at 1 year of Life

Neurosurgery ◽

10.1093/neuros/nyz310_199 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Brice A Kessler ◽

Carolyn Quinsey ◽

William Goodnight ◽

Scott Elton

Keyword(s):

Gestational Age ◽

The United States ◽

Cost Of Care ◽

Cost Comparison ◽

Charge Ratio ◽

Hospital Perspective ◽

Shunt Placement ◽

Mother And Child ◽

Gestational Age At Birth ◽

Age At Birth

Abstract INTRODUCTION Prenatal myelomeningocele (MMC) closure has been performed in the United States for 2 decades, though economic impact in terms of cost to the hospital when comparing prenatal to postnatal MMC closure is unclear. METHODS A prospective database of patients undergoing prenatal and postnatal MMC closure between 2011 and 2018 with 1 yr follow up was reviewed. Charge data for relevant admissions was converted to a cost estimate using our institution's Medicare hospital-specific cost-to-charge ratio and corrected to the 2018 US dollar. Children, mothers, and mother/child pairs were considered separately. Additional data included length of stay (LOS), gestational age at birth, readmission, and need for ventriculoperitoneal shunt placement. RESULTS Average cost to prenatal MMC closure children was $67,331.49 (median $58,406.71), compared to $89,502.01 (median $49,889.95) for postnatal MMC closure children (P = .28). Cost to prenatal MMC closure mothers was $28,476.12 (median $24,548.29), compared to $5039.27 (median $5,087.30) (P < .001). Cost of care for prenatal MMC closure mother/child pairs was $95,803.11 (median $102,377.75), compared to $94,541.28 (median $55,667.82) (P = .45). Prenatal MMC closure children had shorter gestational age at birth (235.81 d vs 265.77 d, P < .001), fewer readmissions (33.3% vs 72.7%, P < .001), and shunt placement was less common (33.3% vs 90.9%, P < .001). Prenatal MMC closure mothers had longer total LOS (15.92 d vs 4.68 d, P < .001) and more readmissions (18.5% vs 0.0%, P = .06). Total LOS for prenatal MMC closure mother/child pairs was 43.70 d compared to 30.41 d, though not significant (P = .09). CONCLUSION Cost of prenatal versus postnatal MMC closure did not significantly differ from a hospital perspective at 1 yr. When considering the mother alone, prenatal MMC closure was costlier. Future work is needed assessing cost from a patient and societal perspective both at 1 yr and beyond.

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Prenatal cannabis exposure and childhood outcomes: Results from the ABCD study

10.1101/2019.12.18.19015164 ◽

2019 ◽

Cited By ~ 2

Author(s):

Sarah E. Paul ◽

Alexander Hatoum ◽

Jeremy D. Fine ◽

Emma C. Johnson ◽

Isabella Hansen ◽

...

Keyword(s):

United States ◽

Birth Weight ◽

Gestational Age ◽

The United States ◽

Maternal Knowledge ◽

Surgeon General ◽

Matter Volume ◽

Confounding Variables ◽

Gestational Age At Birth ◽

Age At Birth

ABSTRACTImportanceIn light of increasing cannabis use among pregnant women, the Surgeon General of the United States issued an advisory against the use of marijuana during pregnancy on August 29th, 2019.ObjectiveTo determine whether cannabis use during pregnancy is associated with adverse outcomes among offspring.DesignCross-sectional analysis of the baseline session of the ongoing longitudinal Adolescent Brain and Cognitive Development (ABCD) study.SettingData were collected from 22 sites across the United States between 2016 and 2018.ParticipantsChildren ages 9-11 (n=11,489) and their parent or caregiver.ExposurePrenatal marijuana exposure prior to and following maternal knowledge of pregnancy.Main Outcomes and MeasuresChild psychopathology symptomatology (i.e., psychotic-like experiences and internalizing, externalizing, attention, thought, and social problems), cognition, sleep, birth weight, gestational age at birth, body mass index (BMI), and brain structure (i.e., total intracranial volume, white matter volume, gray matter volume). Covariates included familial (e.g., income, familial psychopathology), pregnancy (e.g., prenatal vitamin use, whether the pregnancy was planned), and child (e.g., birth weight, substance use) variables.ResultsAmong 11,489 children (age 9.9±0.6 years; 47.78% female), 655 (5.70%) were prenatally exposed to cannabis in total. Marijuana use prior to (n=648; 5.64%) and following (n=242; 2.11%) maternal knowledge of pregnancy were associated with increased offspring psychopathology characteristics (i.e., psychotic-like experiences and internalizing, externalizing, attention, thought, social, and sleep problems) and BMI as well as reduced cognition, birth weight, and brain structure (i.e., total white and gray mater volumes; all psfdr<.007), but not gestational age at birth. Exposure following maternal knowledge of pregnancy remained significantly associated with psychopathology, cognition, and birth weight outcomes when including potentially confounding variables (all ps<0.046). All associations with exposure prior to maternal knowledge of pregnancy were nonsignificant when considering potentially confounding variables (all ps>0.06).Conclusions and RelevancePrenatal cannabis exposure, and its correlated factors, may increase risk for psychopathology and reduced cognition during middle childhood as well as reduced birthweight. Consistent with recent recommendations by the Surgeon General, marijuana use during pregnancy should be discouraged.

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Gestational Age at Birth, 1994 and 2004

PsycEXTRA Dataset ◽

10.1037/e411542008-001 ◽

2006 ◽

Keyword(s):

Gestational Age ◽

Gestational Age At Birth ◽

Age At Birth

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Faculty Opinions recommendation of Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14264188.15777343 ◽

2012 ◽

Author(s):

Mark Sullivan

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Gestational Age ◽

Population Based ◽

Gestational Age At Birth ◽

Age At Birth

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Prenatal household air pollutant exposure is associated with reduced size and gestational age at birth among a cohort of Ghanaian infants

Environment International ◽

10.1016/j.envint.2021.106659 ◽

2021 ◽

Vol 155 ◽

pp. 106659

Author(s):

Ashlinn K. Quinn ◽

Irene Apewe Adjei ◽

Kenneth Ayuurebobi Ae-Ngibise ◽

Oscar Agyei ◽

Ellen Abrafi Boamah-Kaali ◽

...

Keyword(s):

Gestational Age ◽

Air Pollutant ◽

Gestational Age At Birth ◽

Age At Birth

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Coeliac disease presenting atypically: A much wider spectrum

Tropical Doctor ◽

10.1177/0049475521991348 ◽

2021 ◽

pp. 004947552199134

Author(s):

Avinash Lomash ◽

Abhinaya Venkatakrishnan ◽

Meenakshi Bothra ◽

Bhavna Dhingra ◽

Praveen Kumar ◽

...

Keyword(s):

Coeliac Disease ◽

Gestational Age ◽

Dermatitis Herpetiformis ◽

Mode Of Delivery ◽

Gastrointestinal Symptoms ◽

Stunted Growth ◽

Significant Difference ◽

High Index Of Suspicion ◽

Gestational Age At Birth ◽

Age At Birth

Atypical coeliac disease in young children is frequently missed when it presents atypically as non-gastrointestinal presentations to different specialties. There was a greater delay (54 months) in establishing the diagnosis in those with atypical coeliac disease (p < 0.001). No difference was observed in the mode of delivery or duration of breast feeding, but significant difference was observed between gestational age at birth (p < 0.001). Most cases showed stunted growth and underweight. Irritability, anaemia, rickets, dermatitis herpetiformis, alopecia and intussusception were other common predictors of atypical coeliac disease. Because of a myriad spectrum of non-gastrointestinal symptoms, at any age with diverse presentation, a high index of suspicion is therefore required.

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Maternal biological age assessed in early pregnancy is associated with gestational age at birth

Scientific Reports ◽

10.1038/s41598-021-94281-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eva E. Lancaster ◽

Dana M. Lapato ◽

Colleen Jackson-Cook ◽

Jerome F. Strauss ◽

Roxann Roberson-Nay ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Early Pregnancy ◽

Gestational Age ◽

Cellular Aging ◽

Biological Age ◽

Potential Candidate ◽

A Genome ◽

Gestational Age At Birth ◽

Age At Birth

AbstractMaternal age is an established predictor of preterm birth independent of other recognized risk factors. The use of chronological age makes the assumption that individuals age at a similar rate. Therefore, it does not capture interindividual differences that may exist due to genetic background and environmental exposures. As a result, there is a need to identify biomarkers that more closely index the rate of cellular aging. One potential candidate is biological age (BA) estimated by the DNA methylome. This study investigated whether maternal BA, estimated in either early and/or late pregnancy, predicts gestational age at birth. BA was estimated from a genome-wide DNA methylation platform using the Horvath algorithm. Linear regression methods assessed the relationship between BA and pregnancy outcomes, including gestational age at birth and prenatal perceived stress, in a primary and replication cohort. Prenatal BA estimates from early pregnancy explained variance in gestational age at birth above and beyond the influence of other recognized preterm birth risk factors. Sensitivity analyses indicated that this signal was driven primarily by self-identified African American participants. This predictive relationship was sensitive to small variations in the BA estimation algorithm. Benefits and limitations of using BA in translational research and clinical applications for preterm birth are considered.

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