Financial Toxicity in Relation to Childbirth

Abstract

Objective: To measure change in financial toxicity from pregnancy to the postpartum period and to identify factors associated with this change.

Design: Longitudinal survey.

Setting: Obstetric clinics at an academic medical center in Massachusetts between May 2020 and May 2022.

Participants: Obstetric patients who were 18 years of age or older (N = 242).

Methods: Respondents completed surveys that included the COmprehensive Score for financial Toxicity tool during pregnancy and in the postpartum period. We collected additional medical record data, including gestational age, birth weight, and cesarean birth. We used paired t tests to assess changes in financial toxicity before and after childbirth and one-way analysis of variance to compare average change in financial toxicity by demographic and medical variables.

Results: The mean current financial toxicity score was significantly lower after childbirth (M = 19.0, SD = 4.6) than during pregnancy (M = 21.8, SD = 5.4), t(241) = 13.31, p < .001. Concern for future financial toxicity was not significantly different after childbirth (M = 8.5, SD = 2.9) compared to during pregnancy (M = 8.2, SD = 3.0), t(241) = -1.80, p = .07. Individual-level sociodemographic variables (e.g., racial/ethnic category, insurance, employment) and medical factors (e.g., cesarean birth, preterm birth) were not associated with change in financial toxicity.

Conclusion: Among respondents, financial toxicity worsened after childbirth, and patients are at risk regardless of their individual socioeconomic and medical conditions.

Keywords: financial stress; health expenditures; longitudinal studies; postpartum period; pregnancy; risk factors; socioeconomic factors.