Abstract
Background: Pregnancy is a normal physiological process usually resulting in the delivery of a healthy baby after 38 weeks of gestation. This is considered a full-term pregnancy and in instances where delivery occurs either spontaneously or electively prior to full term, it is considered preterm. Preterm birth is often accompanied by many medical complications resulting in an increase in healthcare needs as well as healthcare costs. In many circumstances preterm birth may be prevented with adequate antenatal care and support. This study aims to investigate risk factors and costs related to preterm labour in patients using private medical insurance in South Africa.
Method: This is a cross-sectional quantitative analysis of data extracted from a medical scheme’s databases on all pregnant women delivering prior to 37 weeks of gestation from January 2021 to December 2024. A descriptive analysis was conducted on all records (N=10142) extracted during this time period, comparing prevalence data on normal and preterm deliveries, cost of care during the antenatal, delivery and post-partum phases of pregnancy for both normal and preterm birth as well as identifying possible clinical factors associated with preterm delivery. The analytical plan included both descriptive and inferential analyses. Data was described using means, standard deviations, medians, ranges for continuous variables and counts and percentages for categorical variables. Inferential analysis included a Chi-square test or Fischer exact test for the variable age, antenatal visits, previous pregnancy admissions and admissions in the current pregnancy in relation to preterm delivery. A Mann Whitney test was conducted to assess the differences in the cost of pregnancy in relation to preterm delivery compared to term deliveries.
Results: A total of 10142 pregnancy cases were identified through a medical scheme’s claims database over a four-year period. Term deliveries occurred in 10069 of these pregnancies (99.3%), whilst the other 73 pregnancies (0.7%) resulted in preterm deliveries.
The average age across both cohorts was similar (31.73 versus 31.23), with the majority of pregnancies lying within the 20 – 34-year age group (69% term and 67% preterm). Within the term cohort, an average of 5.56 antenatal visits were claimed for, whereas in the preterm cohort an average of 4.75 antenatal visits was noted. The number of antenatal visits appeared to correlate with the outcome of preterm labour (p=0.027). No statistically significant conclusions could be drawn from the data regarding age or chronic conditions and preterm labour, with 93% of preterm cases having no chronic conditions reported (p=0.362).
The overall rate of Caesarean sections was 79% and this was slightly higher in the preterm cohort at 81%. The number of admissions during the current pregnancy showed a statistically significant...