Economic Impact of Severe Early-Onset Foetal Growth Restriction: A Multicentre Prospective Cohort Study

George Bray; Kasia Maksym; Maurvi Dilipkumar; Rebecca N Spencer; Yuval Ginsberg; Tal Weissbach; Donald M Peebles; Neil Marlow; Angela Huertas-Ceballos; Gina Buquis; Jade Okell; Kurt Hecher; Anke Diemert; Dominique Singer; Stefan R Hansson; David Ley; Francesc Figueras; Eduard Gratacós; Fatima Crispi; Anna L David; Rachael Hunter

doi:10.1111/1471-0528.18266

Economic Impact of Severe Early-Onset Foetal Growth Restriction: A Multicentre Prospective Cohort Study

BJOG. 2025 Jun 24. doi: 10.1111/1471-0528.18266. Online ahead of print.

Authors

George Bray¹, Kasia Maksym², Maurvi Dilipkumar², Rebecca N Spencer^{2

3}, Yuval Ginsberg^{2

4}, Tal Weissbach^{2

5}, Donald M Peebles², Neil Marlow^{2

6}, Angela Huertas-Ceballos⁶, Gina Buquis⁶, Jade Okell⁶, Kurt Hecher⁷, Anke Diemert⁷, Dominique Singer⁷, Stefan R Hansson⁸, David Ley⁹, Francesc Figueras¹⁰, Eduard Gratacós¹⁰, Fatima Crispi¹⁰, Anna L David^{2

11}, Rachael Hunter¹

Affiliations

¹ Department of Applied Health Research, University College London, London, UK.
² Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
³ Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
⁴ Department of Obstetrics and Gynecology, Rambam Medical Centre, Haifa, Israel.
⁵ Department of Obstetrics and Gynecology, Sheba Tel Hashomer Hospital, Tel Aviv, Israel.
⁶ Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.
⁷ Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁸ Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Skane University Hospital, Lund University, Lund, Sweden.
⁹ Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden.
¹⁰ BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, IDIBAPS, IRSJD, Hospital Clinic, Hospital Sant Joan de Déu, University of Barcelona, CIBERER, Barcelona, Spain.
¹¹ National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, London, UK.

PMID: 40552422
DOI: 10.1111/1471-0528.18266

Abstract

Objective: Foetal growth restriction (FGR) affects 10% of pregnancies, contributing to 30% of stillbirths. Current management of early-onset FGR (< 32 + 0 weeks' gestation) delivers the foetus before stillbirth or irreversible organ damage. The resulting preterm births create additional risks independent of FGR. We determined the economic cost associated with severe early-onset FGR.

Design: Economic analysis of EVERREST prospective study, a 6-year multicentre prospective cohort study.

Setting: UK, Spain, Germany, Sweden.

Population: Pregnant women with estimated foetal weight < 3rd centile, 20 + 0-26 + 6 weeks of gestation.

Methods: Between antenatal recruitment and 2 years post-delivery, maternal and infant resource use was collected using the Global Pregnancy CoLaboratory (COLAB) data set and an adapted client service receipt inventory (CSRI) questionnaire.

Main outcome measure: Cost differences between gestational age groups with Multivariable Generalised Linear Models.

Results: Of 135 births, 46% were extremely preterm (EPT, < 28 + 0 weeks), 23% very preterm (VPT, 28 + 0-< 32 + 0 weeks), 16% late/moderate preterm (MLPT, 32 + 0-< 37 + 0 weeks) and 14% term. Neonatal Unit (NNU) costs accounted for the largest costs incurred by either mother or infant, exhibiting the largest differences between gestational age groups. EPT infants costed an additional £157 832 (95% CI: £96 904-£218 760) on average per infant compared to the term group, VPT infants an additional £93 709 (95% CI: £62 656-£124 761) and MLPT infants an additional £20 182 (£11 882-£28 482).

Conclusions: Early-onset FGR has substantial costs, predominantly incurred during infants' NNU admissions. Births < 32 + 0 weeks have significantly higher costs than term births, providing economic justification to research therapies that reduce iatrogenic preterm birth.

Trial registration: ClinicalTrials.gov identifier: NCT02097667.

Keywords: economic burden; economic evaluation; foetal growth restriction; healthcare costs; neonatal intensive care; preterm birth.

Associated data

ClinicalTrials.gov/NCT02097667

Abstract

Associated data

Grants and funding