(551) Economic Implications of Stillbirth to Families and the Health Care System

Objective:
To evaluate the medical health care expenditure and healthcare utilization in pregnancies affected by stillbirth.

Study Design:
We conducted a population-based case-control study using the 1978 to 2021 Utah state fetal death and live birth records linked to the state’s All-Payers Claims Database. Cases were stillbirths (≥20 weeks’ gestation, Apgar 0/0), and controls were live births without prior pregnancy loss. Controls were 2:1 matched to cases by birth/death month and year. Maternal health care expenditure was assessed across antenatal, delivery, and postpartum periods, and stratified by insurance payer vs. out-of-pocket (deductible, coinsurance, and copay). Generalized linear models were used to estimate mean differences in per-person costs adjusted for inflation to reflect 2025 U.S. dollars.

Results:
Among 1,948 stillbirths and 4,136 controls with medical claims, the mean total direct medical expenditure reimbursed by payers was $121,359 in stillbirths cases and $83,370 in controls, representing a 45.5% (p-value< 0.001) higher expenditure for cases than controls. In the post-partum period, the mean expenditure reimbursed by payers was 2.7 times higher in stillbirths group than controls (p-value< 0.001). The mean total out-of-pocket expenditure was $18,938 in stillbirths group and $17,429 in controls, representing an 8.7% (p-value=0.2) higher out-of-pocket expenditure in cases than controls. Higher direct medical expenditures associated with stillbirth post-partum may reflect the complex medical and psychosocial needs for affected families.

Conclusion:
Stillbirth imposes significant economic implications on both families and the health care system. The observed increased health care expenditures for stillbirth-affected pregnancies in our data represent the health system’s response to higher clinical acuity and care needs during and after a stillbirth. Further investigations are warranted to determine areas where health systems can better support affected individuals through tailored care delivery.