New study estimates the costs of U.S. maternal morbidity

By Christopher Cheney

In 2019, the estimated costs associated with maternal morbidity for U.S. births from conception through the child’s firth birthday were $32.3 billion, a new study found.

The United States is experiencing a maternal health crisis. In 2019, the United States lagged other developed countries in maternal mortality ratio, with 20 maternal deaths per 100,000 live births.

The new study, which was published by The Commonwealth Fund, examined the medical and nonmedical costs associated with nine maternal morbidities: amniotic fluid embolism, cardiac arrest, gestational diabetes mellitus, hemorrhage, hypertensive disorders, maternal mental health conditions, renal disease, sepsis, and venous thromboembolism.

Medical costs include treatment and hospitalization of mothers and their infants. Nonmedical costs include productivity loss and use of social services, such as the Supplemental Nutrition Assistance Program; Special Supplemental Nutrition Program for Women, Infants, and Children; Medicaid; and Temporary Assistance for Needy Families.

The research features several key data points for 2019 from conception to the child’s fifth birthday:

  • Medical costs for the nine maternal morbidities were estimated at $18.723 billion
  • Nonmedical costs for the nine maternal morbidities were estimated at $13.576 billion.
  • Total costs for the nine maternal morbidities were estimated at $32.3 billion.
  • The costs associated with child outcomes were estimated at $24.0 billion.
  • The costs associated with maternal outcomes were estimated at $8.3 billion.
  • The healthcare system accounted for 58% of maternal morbidity costs.
  • Employers, public social services programs, and other nonmedical entities accounted for 42% of maternal morbidity costs, including losses in productivity ($6.6 billion) and costs linked to behavioral and developmental disorders in children ($6.5 billion).

In a prepared statement, the lead study author said maternal morbidity has a widespread impact on society.

“We show that the costs of maternal morbidity affect not only birthing people and their families but also all of us. Our findings highlight the need for more societal investments in maternal health, an area where the United States performs poorly in comparison to other developed nations, despite having the resources to prevent morbidity and mortality,” said So O’Neil, a senior researcher and director at Mathematica.

Interpreting the data

The study’s co-authors say that the costs associated with maternal morbidity are likely much higher than they have estimated.

“Our model estimated that nine common maternal morbidity conditions associated with births in a given year (2019) cost society $32.3 billion from the beginning of pregnancy through five years postpartum. The lack of comprehensive data for other conditions suggests that maternal morbidity has the potential to exact a much higher toll on society than what we have found, rivaling that of expensive chronic conditions like diabetes, whose costs run into the hundreds of billions of dollars,” they wrote.

In addition, the availability of data also likely underestimates the costs associated with maternal morbidity in the study, the co-authors wrote.

“Of the costs documented, medical costs made up the majority (58%). This preponderance of medical costs is likely driven by the relative availability of hospital discharge data compared with other cost information. The focus of these costs on the delivery period also implies our estimates might further miss costs associated with later and longer-term physical and mental health consequences of maternal morbidity for birthing people and their children, including consequences for subsequent pregnancies,” they wrote.

Nonmedical costs are also likely underestimated, the co-authors wrote.

“Nonmedical costs accounted for the other 42 percent of total costs, which mainly stemmed from maternal mental health conditions—the maternal morbidity for which we had the most complete information on outcomes and costs. While the literature contained fewer documented nonmedical costs for the eight remaining maternal conditions in this model, studies of other health conditions have found that nonmedical costs attributable to lost earnings, productivity loss, and other indirect costs can account for more than half of overall costs. Additional information on nonmedical costs related to maternal morbidity could raise our estimate of nonmedical and total costs,” they wrote.

The co-authors conclude that addressing maternal morbidity must be a healthcare system priority. “The cost of maternal morbidity has significant implications for delivery system leaders and policymakers. System failures that result in today’s severe maternal morbidity can result in tomorrow’s maternal death, which makes preventing morbidity even more critical to addressing the U.S. maternal health crisis,” they wrote.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.