Maternal and Child Health Journal

, Volume 24, Issue 1, pp 30–38 | Cite as

Costs of Severe Maternal Morbidity During Pregnancy in US Commercially Insured and Medicaid Populations: An Observational Study

  • Kimberly K. Vesco
  • Shannon Ferrante
  • Yong Chen
  • Thomas Rhodes
  • Christopher M. BlackEmail author
  • Felicia Allen-Ramey



To estimate the maternity-related cost of health care services in women with and without severe maternal morbidity (SMM).


Women with a live inpatient birth in the calendar year 2013 were identified in the MarketScan® Commercial and Medicaid health insurance claims databases. Costs were defined as the amounts paid by insurers plus out-of-pocket and third-party payments. Costs were calculated as total maternity-related costs and categorized as prenatal, delivery, and postpartum costs. SMM was identified using the CDC algorithm of 25 ICD-9 diagnostic and procedural codes. Variables associated with higher delivery costs were determined by multivariable linear regression analysis.


A total of 750 women met the criteria for SMM in the Commercial population. The total, per-patient mean costs of care for women without and with SMM were $14,840 and $20,380, respectively. Delivery hospitalization costs were 76-77% of total mean costs for women without and with SMM. A total of 99 women met the criteria for SMM in the Medicaid population. The total, per-patient mean costs of care for women without and with SMM were $6894 and $10,134, respectively. Delivery costs were 71–72% of total costs. Variables independently predictive of increased delivery costs in both Commercial and Medicaid populations were delivery by cesarean section, multifetal gestation, gestational hypertension/preeclampsia, and obstetric infection.


The occurrence of SMM was associated with an increase in maternity-related costs of 37% in the Commercial and 47% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs may be prevented.


Comorbidity Health care costs Hospitalization Insurance claim review Pregnancy complications United States 



The authors thank Michelle Fox, MD, MPH, and Michelle Vichnin, MD, for their contributions to this project. Anna Kaufman, MPH and Melissa Stauffer, PhD, in collaboration with ScribCo, provided medical writing assistance.


Funding for this study was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Compliance with Ethical Standards

Conflict of interest

KKV reports no conflict of interest. At the time of the study, SF, YC, TR, CMB, and FAR were employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Supplementary material

10995_2019_2819_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 37 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Kaiser Permanente Center for Health ResearchPortlandUSA
  2. 2.Merck & Co., Inc.KenilworthUSA
  3. 3.GlaxoSmithKlineWarrenUSA

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