Preconception Care for Diabetic Women Could Potentially Save $5.5 Billion

Comprehensive care could yieldsignificant lifetime healthcare savings, say researchers in the AmericanJournal of Obstetrics & Gynecology

Philadelphia, PA, November 24, 2014

Pregnant women with diabetes are at an increased risk formany adverse birth outcomes. Preconception care (PCC) can significantly lowerthese risks by helping pregnant mothers with diabetes control their glucoselevels, resulting in healthier babies and less money spent on complicateddeliveries and lifelong medical complications. Effective, universal PCC fordiabetic mothers could avert an estimated $5.5 billion in health expendituresand lost employment productivity over affected children's lifetimes, accordingto a new study published in the latest issue of the American Journal of Obstetrics & Gynecology.

Diabetes in pregnant women has been linked to significantcomplications such as preterm deliveries, birth defects, and even perinataldeaths; however, access to PCC can mitigate the frequency of these outcomes byimproving glucose levels before and during the early stages of pregnancy. Aswell as being detrimental to the health and wellbeing of both mother and child,these diabetes-related complications represent a sizeable cost to healthcarepayers and society.

A team of health economists and researchers from the Centersfor Disease Control and Prevention (CDC) investigated the savings that PCCcould potentially generate by helping to avoid adverse birth outcomes. Thestudy estimated that 2.2% of all U.S. births are to women with pre-existingdiabetes, or pregestational diabetes mellitus (PGDM), some without a diabetesdiagnosis before pregnancy. The study found that among pregnant women withdiagnosed diabetes, effective PCC could avert $4.3 billion in costs tohealthcare payers and society over their children's' lifetimes. Effective PCCamong pregnant women with undiagnosed diabetes could potentially save an additional$1.2 billion, totaling $5.5 billion in averted costs.

"We estimated thousands of adverse birth outcomes might beprevented each year among U.S. women with PGDM through universal PCC at anestimated lifetime societal cost savings of up to $5.5 billion, includingnearly $1 billion in direct medical costs," says lead investigator CoraPeterson, PhD, from the CDC's National Center for Injury Prevention andControl. "Our results suggest a substantial health and cost burden associatedwith PGDM that could be prevented by universal PCC, which might offset the costof providing such care."

Along with avoiding unnecessary costs, universal PCC wouldalso help avoid critical birth complications. The study estimates that PCCmight avert 8,397 preterm deliveries, 3,725 birth defects, and 1,872 perinataldeaths annually.

"The preconception period is critical for preventing adversebirth outcomes in women with PGDM. By some estimates, nearly half of U.S.pregnancies, including pregnancies among women with PGDM, are unplanned,"comments Dr. Peterson. "To prevent adverse birth outcomes among women withundiagnosed diabetes, diagnosis in the preconception period is needed; thefirst step would be screening women of reproductive age to identify those withundiagnosed diabetes."

While PCC can help diagnose and manage PGDM, there are coststo mothers associated with obtaining proper care and treatment. Access toaffordable healthcare and insurance is a challenge for many women across theU.S. Investigators based their economic assessment on the idea that PCC wouldbe widely available and utilized by women, although they were not able toinclude the cost of obtaining care nor the cost of PCC in their calculations."Our estimates indicate the potential economic benefit of PCC if it were to befully utilized by eligible women," explains Dr. Peterson. "It is possible thatlack of insurance coverage might disproportionately affect women with bothunintended pregnancies and undiagnosed PGDM, creating a substantial costbarrier to PCC for such women."

While there are still many unanswered questions, this newstudy shines a light on the economic importance of identifying women with PGDMand why providing universal PCC may pay for itself going forward. Commenting onthis study, noted expert in the field Kim Boggess, MD, Professor, Division ofMaternal Fetal Medicine at the UNC School of Medicine notes, "While PCC forwomen with PGDM can avert adverse outcomes and save money, what should thecontent of this care be and how do we provide it for all women? Who pays forit? Despite these limitations the results [of this study] suggest that thePCC-preventable health and cost burdens associated with PGDM are substantial.Thus innovated researcher is needed to assess the costs and practicality ofdelivering this care."


Notes for editors
"Preventable Healthand Cost Burden of Adverse Birth Outcomes Associated with Diabetes in theUnited States," by Cora Peterson, PhD, Scott D. Grosse, PhD; Rui Li,PhD; Andrea Sharma, PhD; Hilda Razzaghi, PhD; William H. Herman, MD, MPH;Suzanne M. Gilboa, PhD (DOI:, AmericanJournal of Obstetrics & Gynecology, published online in advance ofVolume 212, Issue 1 (January 2015), by Elsevier.

Full text of the article is available to credentialedjournalists upon request. Contact Eileen Leahy at +1 732 238 3628or to obtain acopy. Journalists wishing to schedule interviews with Dr. Peterson shouldcontact CDC Media Relations at +1 404 639 3286 or 

CoraPeterson, PhD, Health Economist, National Center for Injury Prevention andControl, Centers for Disease Control and Prevention, Atlanta, GA
Scott D.Grosse, PhD, Health Economist, National Center on Birth Defects andDevelopmental Disabilities, Centers for Disease Control and Prevention,Atlanta, GA
Rui Li,PhD, Health Economist, National Center for Chronic Disease Prevention andHealth Promotion, Centers for Disease Control and Prevention, Atlanta, GA
AndreaSharma, PhD, Epidemiologist, National Center for Chronic Disease Prevention andHealth Promotion, Centers for Disease Control and Prevention, Atlanta, GA
HildaRazzaghi, PhD, Epidemiologist, National Center on Birth Defects andDevelopmental Disabilities, Centers for Disease Control and Prevention,Atlanta, GA and Oak Ridge Institute for Science and Education, Oak Ridge, TN
William H.Herman, MD, MPH, Professor, Department of Internal Medicine, University ofMichigan Medical School, Ann Arbor, MI
Suzanne M.Gilboa, PhD, Epidemiologist, National Center on Birth Defects and DevelopmentalDisabilities, Centers for Disease Control and Prevention, Atlanta, GA

About the American Journal of Obstetrics &Gynecology
TheAmerican Journal of Obstetrics & Gynecology (, known as "TheGray Journal," presents coverage of the entire spectrum of the field, from thenewest diagnostic procedures to leading-edge research. The Journal providescomprehensive coverage of the specialty, including maternal-fetal medicine,reproductive endocrinology/infertility, and gynecologic oncology. It alsopublishes the annual meeting papers of several of its seven sponsoring societies,including the Society for Maternal-Fetal Medicine and the Society ofGynecologic Surgeons.

TheAmerican Journal of Obstetrics & Gynecology's 2013 Impact Factor is 3.973.The journal now ranks second in Eigenfactor score, and continues to be first intotal citations and the number 5 journal in the Obstetrics & Gynecologycategory according to the 2013 Journal Citation Reports®, published by ThomsonReuters. The journal has also been recognized as one of the 100 mostinfluential journals in Biology & Medicine over the last 100 years, asdetermined by the BioMedical & Life Sciences Division of the SpecialLibraries Association (2009).

About Elsevier
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Media contact
Eileen Leahy
+1 732 238 3628