PS 1-48
HOW DO WOMEN VALUE TRADE-OFFS IN MATERNAL-FETAL MORBIDITY AND MORTALITY?
Purpose: To calculate utilities to assess women's willingness to trade-off maternal morbidity for fetal benefit among a community-based sample of pregnant and non-pregnant women of reproductive age.
Method: We recruited English-speaking women aged 18-45 in clinical settings and at community-based events. Eight health states were selected for the study: 4 maternal (healthy, stroke, hysterectomy, death) and 4 neonatal (healthy, severe cerebral palsy (CP), severe mental retardation (MR), death).� Each participant's utilities were assessed on 9 pairs of �mom/baby' delivery outcomes comprised of maternal and neonatal health and death plus 1 randomly selected maternal and neonatal outcome (stroke or hysterectomy, CP or MR).� Participants ranked the 9 pairs of outcomes in order of preference; then Standard Gamble methods were used to measure utilities.�
Results: Utilities were assessed in a total of 485 participants (a recruitment rate of 85%). Twenty-one percent were pregnant; 63% were parents; and 54% were African American.� Twenty-seven percent ranked at least one health state pairing as worse than �mom death/baby death.' These were excluded from the analysis. Utilities (depicted in Table) only differed significantly between pregnant and non-pregnant women for �mom healthy/baby death' (0.62 vs 0.54, p=.04).
Mom | Baby | Mean |
Healthy | Healthy | 1.00 |
Hyst | Healthy | 0.86 |
Healthy | CP | 0.83 |
Healthy | MR | 0.79 |
Hyst | CP | 0.78 |
Stroke | Healthy | 0.75 |
Hyst | MR | 0.74 |
Death | Healthy | 0.72 |
Stroke | CP | 0.67 |
Stroke | MR | 0.67 |
Death | CP | 0.55 |
Healthy | Death | 0.54 |
Death | MR | 0.53 |
Stroke | Death | 0.45 |
Hyst | Death | 0.45 |
Death | Death | 0.00 |
Conclusion: When women were asked to valuate pairs of maternal/fetal outcomes that required a trade-off of morbidity and mortality, they tended to assign greatest value to conditions that limited maternal morbidity and lowest value to conditions that resulted in neonatal mortality.� These findings have clinical implications in that they highlight the importance of assessing individual patient's preferences and goals of care for high-risk obstetrical conditions wherein pregnancy prolongation threatens maternal morbidity or mortality (e.g. severe preeclampsia or preterm premature rupture of membranes).� Furthermore, as efforts to determine the optimal timing and mode of delivery in high-risk settings may best be achieved using decision analyses and comparative effectiveness models, our findings can aid future research efforts.� Utilities assessed among reproductive-aged women should be utilized to inform the practice and policy surrounding obstetrical decision-making.�