Investigation of the Effect of Maternal Weight on Pediatric Health Service Utilization

Abstract

Maternal weight during pregnancy has an important impact on multiple aspects of health for both mothers and their children. This dissertation investigated whether pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) independently impact a child’s health service utilization. Methods: This dissertation included four studies. The study population for the first three studies was all women who delivered a singleton, live infant in Ontario between 2012-2014 and have information contained in the Better Outcomes Registry and Network (BORN) Ontario registry. Health service data in the first 24 months following birth were collected via health administrative databases housed at ICES. I investigated whether there was an association of pre-pregnancy BMI (Chapter 2) or GWG (Chapter 3) with pediatric health service use. I then investigated whether adverse birth outcomes, specifically small for gestational age (SGA) or preterm birth (PTB), mediated this relationship (Chapter 4). Finally, I developed a cost effectiveness evaluation framework for the implementation of a maternal weight intervention program to limit the impact on the child (Chapter 5).Findings: Children born to women with pre-pregnancy obesity relative to normal weight experienced higher rates of hospitalization (adjusted incidence rate ratio [aIRR]: 1.20, 95% CI:1.17,1.24), physician visits (aIRR: 1.05, 95% CI: 1.04,1.05) and emergency department (ED)visits (aIRR: 1.27, 95% CI: 1.25,1.29). Children born to normal weight (aIRR: 1.07, 95% CI:1.05,1.09) or overweight (aIRR: 1.04, 95% CI: 1.01,1.07) mothers with above recommended (versus recommended) GWG had increased ED visits. Children born to underweight women with below recommended GWG had increased hospitalizations (aIRR: 1.31, 95% CI: 1.14,1.51) and physician visits (aIRR: 1.14, 95% CI: 1.10,1.17). PTB (56.74%), and SGA (6.83%)iv mediated the relationship of below recommended GWG and pediatric hospitalizations only. Adetailed cost effectiveness framework is outlined to investigate an intervention plan targeting GWG to limit adverse pediatric health outcomes. Discussion: The findings of this dissertation indicate that below or above optimal maternal weight is associated with pediatric health service use. This dissertation serves as a call to action to better inform clinical practice and impact health service policy related to maternal weight via early intervention.