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.