Utilization of Health Care Services of Pregnant Women Complicated by Preeclampsia in Ontario

OBJECTIVE: To assess the utilization of health care services by pregnant women affected by preeclampsia (PE). DESIGN: Population-based study. SETTING: Perinatal partnership hospitals in Ontario. POPULATION: Obstetric deliveries in 2005 Canadian province of Ontario (about 95% of births). METHODS: For each PE case, four subjects without PE matched by age, parity, plurality, and hospital at childbirth were chosen as the controls. We compared the utilization of intra-partum care services and infant outcomes between the two groups. We also estimated the extra costs to the health care system in Ontario for caesarean delivery and caring of extremely low birth weight infants attributable to PE during the neonatal period and in the first 2 years of life. MAIN OUTCOME MEASURES: Cesarean delivery, hospital stay, extremely low birth weight infants, cost. RESULTS: Of the 120,611 obstetric deliveries included in this analysis, 1240 (1.3%) were diagnosed with PE. Patients with PE and matched controls were similar in maternal age, parity, and other demographic characteristics. Compared with study subjects without PE, those with PE had increased uses of spinal anesthesia, maternal transfer, Cesarean delivery, labour induction, neonatal transfer, newborn resuscitation, longer hospital stay for childbirth, and higher rates of preterm births and low birth weight. The extra costs to the health care system for cesarean delivery and caring of extremely low-birth-weight infants attributable to PE during the neonatal period and in the first 2 years of life in Ontario were $0.5 millions, 3.1 millions, and $5.1 million per year, respectively, if we use the reported PE rate in this database. CONCLUSION: PE is associated with substantially increased costs to the health care system.