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

Bray, George ; Maksym, Kasia ; Dilipkumar, Maurvi ; Spencer, Rebecca N. ; Ginsberg, Yuval ; Weissbach, Tal ; Peebles, Donald M. ; Marlow, Neil ; Huertas-Ceballos, Angela and Buquis, Gina , et al. (2026) In BJOG: An International Journal of Obstetrics and Gynaecology 133(1). p.61-70
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... (More)

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.

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type
Contribution to journal
publication status
published
subject
keywords
economic burden, economic evaluation, foetal growth restriction, healthcare costs, neonatal intensive care, preterm birth
in
BJOG: An International Journal of Obstetrics and Gynaecology
volume
133
issue
1
pages
10 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:105008779799
  • pmid:40552422
ISSN
1470-0328
DOI
10.1111/1471-0528.18266
language
English
LU publication?
yes
id
4112a2c3-6559-4bef-836f-d6b225d03c7f
date added to LUP
2026-01-20 11:23:31
date last changed
2026-02-03 12:33:19
@article{4112a2c3-6559-4bef-836f-d6b225d03c7f,
  abstract     = {{<p>Objective: Foetal growth restriction (FGR) affects 10% of pregnancies, contributing to 30% of stillbirths. Current management of early-onset FGR (&lt; 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 &lt; 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, &lt; 28 + 0 weeks), 23% very preterm (VPT, 28 + 0–&lt; 32 + 0 weeks), 16% late/moderate preterm (MLPT, 32 + 0–&lt; 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 &lt; 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.</p>}},
  author       = {{Bray, George and Maksym, Kasia and Dilipkumar, Maurvi and Spencer, Rebecca N. and Ginsberg, Yuval and Weissbach, Tal and Peebles, Donald M. and Marlow, Neil and Huertas-Ceballos, Angela and Buquis, Gina and Okell, Jade and Hecher, Kurt and Diemert, Anke and Singer, Dominique and Hansson, Stefan R. and Ley, David and Figueras, Francesc and Gratacós, Eduard and Crispi, Fatima and David, Anna L. and Hunter, Rachael}},
  issn         = {{1470-0328}},
  keywords     = {{economic burden; economic evaluation; foetal growth restriction; healthcare costs; neonatal intensive care; preterm birth}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{61--70}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJOG: An International Journal of Obstetrics and Gynaecology}},
  title        = {{Economic Impact of Severe Early-Onset Foetal Growth Restriction : A Multicentre Prospective Cohort Study}},
  url          = {{http://dx.doi.org/10.1111/1471-0528.18266}},
  doi          = {{10.1111/1471-0528.18266}},
  volume       = {{133}},
  year         = {{2026}},
}