Unveiling the economic burden of adverse perinatal outcomes from birth to early childhood in high-income countries: a systematic review

Background Adverse perinatal outcomes, including preterm birth, small-for-gestational-age/low birthweight (SGA/LBW), congenital anomalies, and/or stillbirth, carry substantial health and economic consequences. However, their economic burden, from direct healthcare costs to wider societal impacts, remains insufficiently synthesised. Therefore, this systematic review synthesises the evidence on costs associated with adverse perinatal outcomes from birth to five years of age in high-income countries. Methods We systematically searched six databases (CINAHL Ultimate, EconLit, Embase, Global Health, Medline, and PubMed) for studies published between January 2010 and June 2024. Search terms covered three key domains: (i) costs, (ii) adverse perinatal outcomes (preterm birth, SGA/LBW, congenital anomalies, neonatal death, stillbirth), and (iii) high-income countries. Eligible studies reported costs related to one or more adverse outcomes, assessed from individual, healthcare system, and/or societal perspectives. Three reviewers independently screened studies and extracted data, the review is reported in line with PRISMA guidelines. Costs were standardised to 2022 US dollars ($) using country-specific consumer price indices and purchasing power parity. Results were summarised per child, by outcome type, and by cost category. Results Eighty-nine studies met the inclusion criteria: 38 focused on preterm birth, 37 on congenital anomalies, five on SGA/LBW, five on stillbirth, and four on multiple adverse outcomes. Most studies ( n = 74) applied a healthcare system perspective, and nearly half ( n = 45) reported only hospitalisation costs. Across time horizons of up to five years of age, the median cost per child was $17,420 to 31,718 for preterm birth, $68,421 (IQR: $41,322 to 150,660) for congenital anomalies, and $104,713 (IQR: $28,881 to 115,763) for SGA/LBW. The median cost per stillbirth was $10,189 (IQR: $9,082 to 14,883). The highest costs were observed among children with multiple adverse outcomes (median $18,034, IQR: $7,814 to 225,184). Costs varied considerably across studies, reflecting differences in cost categories, perspectives, time horizons, and methods. Conclusions Adverse perinatal outcomes are linked with considerable economic burden during early childhood, particularly for those with congenital anomalies and multiple adverse conditions. Wide variation in reported costs highlights the importance of context-specific assessments and underscores the need for standardised approaches to cost estimation in this field. PROSPERO registration number CRD42023400215.