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Health Care Utilization in the First 7 Years in Children with Fetal Growth Abnormalities: A Retrospective Cohort
Stefan Kuhle1, Mary Margaret Brown1, Linda Dodds1
1Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Infants born small for gestational age (SGA) utilized more healthcare services and incurred higher costs in early childhood compared to appropriate for gestational age (AGA) infants. Large for gestational age (LGA) birth did not show increased healthcare utilization.
Area of Science:
- Perinatal Health
- Pediatric Healthcare Utilization
- Health Economics
Background:
- Birth weight for gestational age is a key indicator of fetal growth.
- Understanding early childhood healthcare needs is crucial for resource allocation.
- Previous studies have explored links between birth size and later health outcomes.
Purpose of the Study:
- To examine the association between birth weight for gestational age and healthcare utilization in term infants up to age 7.
- To determine if small for gestational age (SGA) or large for gestational age (LGA) birth influences healthcare costs and service use.
Main Methods:
- Population-based retrospective cohort study of 42,050 term infants in Nova Scotia (2003-2007).
- Linked perinatal records with administrative health data from birth to age 7.
- Analyzed physician visits, hospital admissions, and associated costs, categorizing birth weight as SGA, appropriate for gestational age (AGA), or LGA.
Main Results:
- Children born SGA exhibited increased specialist visits, hospital admissions, and longer birth admission stays compared to AGA infants.
- SGA infants incurred an average of Can $1222 more in physician and hospital costs by age 7.
- No significant differences in healthcare utilization or costs were observed between LGA and AGA infants.
Conclusions:
- Term infants born SGA experience moderately increased healthcare use and costs during early childhood.
- Birth at term and large for gestational age (LGA) is not associated with elevated healthcare utilization.
- Findings highlight the long-term economic impact of SGA births on healthcare systems.
Objective:
To investigate the relationship between birth weight for gestational age and health care utilization of term offspring from birth to 7 years.
Study Design:
We used a population-based retrospective cohort study of infants (≥37 weeks' gestational age) born between 2003 and 2007 in the Canadian province of Nova Scotia (n = 42 050). Perinatal records were linked to provincial administrative health data from birth to age 7 years. The primary outcome was health care utilization (physician visits and hospital admissions) and costs. Birth weight was categorized as small for gestational age (SGA, <10th percentile), appropriate for gestational age (AGA), or large for gestational age (LGA, >90th percentile). Regression models adjusted for potential confounders were used to investigate the associations.
Results:
Children born SGA had a higher number of specialist visits and hospital admissions, a longer length of stay for the birth admission, and, as a result, higher physician and hospital costs amounting to a cost differential of Can $1222 during the first 7 years of life compared with children born AGA. By contrast, health care use and costs did not differ between children born LGA and AGA.
Conclusion:
Former SGA term infants have a moderate increase in health care use and costs in early childhood compared with former AGA infants, and LGA birth at term is not associated with higher health care utilization.
