Preeclampsia: Study Highlights Need for More Effective Treatment, Prevention

Posted on July 11th, 2017 by Dr. Francis Collins

It’s well known that preeclampsia, a condition characterized by a progressive rise in a pregnant woman’s blood pressure and appearance of protein in the urine, can have negative, even life-threatening impacts on the health of both mother and baby. Now, NIH-funded researchers have documented that preeclampsia is also taking a very high toll on our nation’s economic well-being. In fact, their calculations show that, in 2012 alone, preeclampsia-related care cost the U.S. health care system more than $2 billion.

These findings are especially noteworthy because preeclampsia rates in the United States have been steadily rising over the past 30 years, fueled in part by increases in average maternal age and weight. This highlights the urgent need for more research to develop new and more effective strategies to protect the health of all mothers and their babies.

The causes of preeclampsia remain somewhat mysterious, though recent data suggest a role for proteins produced by the placenta. Because preeclampsia affects a pregnant woman’s vascular system, her unborn child can be deprived of needed oxygen and nutrients. In mild cases, the condition can often be managed with careful monitoring and blood pressure medications. But if the symptoms become severe and potentially life-threatening to either mother or child, the only answer is to induce early delivery, which carries its own health risks and high health care costs.

In the study reported in the American Journal of Obstetrics & Gynecology, a team led by Anupam Jena at Harvard Medical School, Boston, set out for the first time to quantify those costs up to a year after delivery. Because there was no one good place to look for the needed data, they combined information from several sources, including hospital discharge and birth certificate data from California, commercial insurance claims data, and nationally representative estimates of healthcare costs. For the latter, they used data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project.

Extrapolating from more than 2 million mothers and their infants born in California during 2012, the researchers estimated the national incidence, birth outcomes, and costs of preeclampsia within the first 12 months after delivery. Those data present a troubling portrait of a growing public-health problem..

In 2012, the researchers estimated that preeclampsia affected more than 156,000 pregnancies nationally with a predicted 21,460 adverse events. For mothers, preeclampsia doubles the chances of developing a health complication soon after giving birth—to about 10 percent. The most common complications were related to bleeding and a deficiency of blood platelets called thrombocytopenia.

Babies born to mothers with preeclampsia were delivered on average about 1.7 weeks early. The chances of these babies developing a complication nearly doubled to more than 15 percent. The most common complications were breathing problems, caused by immature lungs, and potentially life-threatening infections.

Jena’s team estimated the added short-term costs associated with those health complications at $2.18 billion, about evenly divided between the care of mothers and their babies. Those costs depended heavily on an infant’s gestational age at birth. For instance, the care delivered to babies born more than 12 weeks before their due dates cost the health-care system more than $280,000 per birth on average. For babies born less than 3 weeks early, the added costs per birth came in at about $6,000.

As hefty as these numbers might seem, they are likely to underestimate the true cost of preeclampsia. For one thing, rates of preeclampsia are likely underreported in existing databases. Women with preeclampsia may also be at greater risk for heart disease within five years after pregnancy, and their prematurely born babies can have long-lasting health problems.

Treatment for preeclampsia hasn’t changed much in decades. The mainstays of care remain early delivery and management of disease symptoms, including high blood pressure. However, a successful way to treat the underlying disease itself has not been developed. That needs to change. These findings come as a timely reminder of the value of continued research to better understand, predict, and intervene in a condition that is on the rise as a leading cause of illness and death for American mothers and their babies.

Reference:

[1] Short-term costs of preeclampsia to the United States health care system. Stevens W, Shih T, Incerti D, Ton TGN, Lee HC, Peneva D, Macones GA, Sibai BM, Jena AB.  Am J Obstet Gynecol. 2017 Jun 14. [Epub ahead of publication]

Links:

Preeclampsia and Eclampsia (National Institute of Child Health and Human Development/NIH)

Anupam Jena (Harvard Medical School, Boston, MA)

Healthcare Cost and Utilization Project (Agency for Healthcare Research and Quality/HHS)

NIH Support: Eunice Kennedy Shriver National Institute of Child Health and Human Development