Obesity and health care utilization
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Background/Aims: Maternal obesity (BMI ¬> 30) is associated with increased prenatal health care utilization and puts infants at risk for macrosomia and delivery complications. Our aim was to investigate whether obese women and their infants have higher rates of health care utilization in the first year postpartum.
Methods: We extracted EMR data of 1663 women who had singleton, live births in 2006-2009, height and weight measurements for BMI, known delivery and discharge dates, and continuous health insurance coverage for 12 months post partum. We used multivariate regression analyses to evaluate associations between maternal pre-pregnancy BMI category and maternal and infant outpatient visits and hospitalizations.
Results: During the first year post partum, women made an average of 7.0 + 7.3 ambulatory visits, including a wide variety of ancillary services as well as primary and specialty care. Thirty percent (492/1663) were hospitalized at least once, 19% (311/1663) had at least one emergency department visit and 25% (421/1663) visited urgent care. When adjusted for age, race/ethnicity, insurance status and delivery type, women with BMIs > 30 had significantly more ambulatory, urgent care and emergency visits. Women with BMIs > 40 had significantly more hospitalizations and outpatient visits of all types compared to women with normal BMIs. There were 1427 infants with adequate data for inclusion. During the first year of life, 21% (299 of 1427) were hospitalized, 32% (454/1427) had at least one emergency visit, and 47% (676 /1427) visited urgent care. Essentially all infants (99.7%) had an ambulatory visit. Maternal BMI was not significantly associated with infant hospitalization, emergency or urgent care visits. However, infants whose mothers had BMIs >30 had significantly fewer ambulatory visits compared to infants of mothers with normal BMIs (p=.008).
Conclusions: During the first year post partum, obese women had more ambulatory care and emergency visits than normal weight women, the greatest differences occurring between extreme obesity and normal BMI categories. In contrast, infants of obese women have fewer ambulatory visits. This finding merits investigation to determine whether the obese mother’s need for medical services after delivery competes with her ability to bring her infant for recommended care.