OBJECTIVES: Preterm labor (PTL) is associated with adverse maternal and neonatal outcomes and results in half of all preterm births. This review aimed to synthesize contemporary real-world estimates of the economic burden of PTL for both mothers and infants.

METHODS: A systematic review was conducted using MEDLINE and EMBASE to identify observational studies reporting PTL-related costs or healthcare resource use (HCRU) in select high-income countries (EU4, UK, US, Canada, Australia, Japan) and published in the English language between 01/2012 and 07/2022. Estimates of direct costs, indirect costs, and HCRU were tabulated by country, gestational age, birth plurality, and race/ethnicity where available.

RESULTS: Of 662 records identified, 7 studies were included describing direct costs (n=1) and HCRU (n=7); no studies reported indirect costs. Sample sizes ranged from 22 to 29,553 and mean maternal age ranged from 24.5 to 29.3 years. The study reporting direct costs analyzed Medicaid-related HCRU claims from Texas: mean total all-cause costs during the 5 months before delivery were $14,112 per woman with PTL (2015 US$). Three studies reported HCRU among infants born following PTL, primarily related to neonatal intensive care unit (NICU) stays (n=2) and ventilation (n=2). Studies reported that 13.3% of infants were transferred to the NICU and mean (standard deviation [SD]) length-of-stay was 9 (7.3) days. Five studies reported HCRU among mothers with PTL, largely due to hospitalizations (n=5). Women presenting with PTL had a mean initial length-of-hospitalization of 2.1 (2.9) days with 1.5 (2.1) readmissions during pregnancy. None of the articles stratified by race/ethnicity; and HCRU estimates were difficult to compare due to variability in samples, designs, and healthcare systems.

CONCLUSIONS: This review highlights that few studies have examined the economic burden of PTL; and available estimates are variable. Additional data are needed to understand the short- and long-term economic consequences of PTL.