Costs of maternal conditions attributable to smoking during pregnancy

  • E.Kathleen Adams
    Address correspondence to: E. Kathleen Adams, PhD, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 656, Atlanta, Georgia 30322
    Rollins School of Public Health, Emory University (Adams), Atlanta, Georgia 30322 USA
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  • Cathy L. Melvin
    Program Services and Development Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (Melvin), Atlanta, Georgia 30341 USA
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      Context: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior.
      Objective: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion.
      Design: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a “normal” delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery.
      Setting: National estimates for 1993.
      Participants: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country.
      Results: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million.
      Conclusions: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.


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