Objective: To study the association between the risk of severe maternal morbidity and adequacy of prenatal care in teenage pregnancies. Design: Population-based retrospective cohort study. Setting: National Health Insurance Service National Delivery Cohort in Korea Population: A total of 23,202 delivery cases including pregnant teenagers aged 13 to 19 years and gestational age ≥ 37 weeks between 2003 and 2018. Methods: We used a generalized estimating equation model with adjustment for all covariates to determine the adjusted relative risk (RR) associated with severe maternal morbidity. Main Outcome Measures: severe maternal morbidity, Kessner Adequacy of Prenatal Care Index Results: Severe maternal morbidity occurred in 723 (3.1%) of the 23,202 delivery cases investigated, over a 16-year period. The risk of severe maternal morbidity was 1.8-fold higher in teenagers with inadequate prenatal care (RR 1.81, 95% confidence interval [CI] 1.39– 2.37) and 1.6-fold higher in those with intermediate prenatal care (RR 1.59, 95% CI 1.33–1.87) than in those with adequate prenatal care. Synergistic effects of inadequate prenatal care and maternal comorbidity were observed on severe maternal morbidity. Conclusion: This study confirmed that inadequate prenatal care was associated with the risk of severe maternal morbidity among pregnant teenagers. Notably, maternal comorbidity and inadequate prenatal care produced synergistic effects on severe maternal morbidity. Therefore, public health policy makers should focus on the development and implementation of programs to ensure adequate prenatal care and support financial accessibility of healthcare to improve teenage mothers’ health.

Background: The number of cancer survivors, including childhood cancer survivors, is increasing as a consequence of improved therapeutic options. However, the medical costs associated with therapy are high and many families are suffering from the resultant financial burden. Objective: Our study aims to determine the total medical cost for 5 years after the initial diagnosis of childhood cancers. Methods: A customized dataset from the Korean National Health Insurance Claims Database was requested for this study. A total of 7,317 patients were selected to determine the total medical cost related to their treatment. The costs are presented as the 2% trimmed mean value to exclude extreme costs. The medical costs were further classified according to cancer type, treatment phase, and socioeconomic status. Multiple linear regression analyses were performed. Results: The average total medical cost per patient is 36.8 million Korean Wons (KRW) or 30,665 United States Dollars (USD). Among childhood cancers, leukemia was associated with the highest cost at 53.5 million KRW (USD 44,556). Analysis of socioeconomic status revealed that the higher income group demonstrated higher medical expenditure when compared to other groups. Analysis of the treatment phase showed that costs associated with the early phase of treatment are the highest, especially in the first 3 months after initial diagnosis. Conclusion: Cancer treatments are expensive and are a source of significant financial stress to patients’ families. To alleviate the financial burden and reduce the socioeconomic disparities associated with medical care and costs, a better understanding of the current experience of patients and their families is required.