Modeling the Independent Effects of Gestational Diabetes Mellitus on Maternity Care and Costs

OBJECTIVE To explore the independent effects of gestational diabetes mellitus (GDM) on maternity care and costs. RESEARCH DESIGN AND METHODS Estimates for maternity care resource activity and costs for 4,372 women, of whom 354 (8.1%) were diagnosed with GDM, were generated from data from the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) database. Multivariate regression analysis was applied to explore the effects of GDM on 1) mode of delivery, 2) neonatal unit admission, and 3) maternity care cost, while controlling for a range of other demographic and clinical variables. RESULTS Women with a diagnosis of GDM had significantly higher levels of emergency caesarean section (odds ratio [OR] 1.75 [95% CI 1.08-2.81]), their infants had significantly higher levels of neonatal unit admission (3.14 [2.27-4.34]), and costs of care were 34% greater (25-43) than in women without GDM. Other variables that significantly increased costs were weight, age, primiparity, and premature delivery. CONCLUSIONS GDM plays an independent role in explaining variations in rates of emergency caesarean section, neonatal unit admission, and costs of care, placing a substantial economic burden on maternity care services. Interventions that prevent the onset of GDM have the potential to yield substantial economic and clinical benefits.