Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy

Bailey, Cate; Skouteris, Helen; Harrison, Cheryce L.; Boyle, Jacqueline; Bartlett, Rebeccah; Hill, Briony; Thangaratinam, Shakila; Teede, Helena; Ademi, Zanfina

doi:10.1007/s41669-020-00197-9

Cited by 30 publications

(28 citation statements)

References 41 publications

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“…1,2 Dietary interventions in pregnancy are also likely to be cost-effective. 3 Despite this, diet is not universally addressed by obstetricians and gynecologists as a routine part of maternity care. 4,5 Many women do not meet dietary recommendations during pregnancy, despite identifying healthy eating as a personal priority.…”

Section: Introductionmentioning

confidence: 99%

Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: multistakeholder feedback to implementation

Killeen

Callaghan

Jacob

et al. 2020

Intl J Gynecology & Obste

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Objective To gain insights from pregnant women and obstetricians on the utility of the FIGO Nutrition Checklist in antenatal practice. Methods Women were recruited from the antenatal department of a large tertiary‐level university maternity hospital in Dublin, Ireland, between October and December 2019. Participants completed the FIGO Nutrition Checklist before their routine antenatal appointment. Obstetricians and women were encouraged to discuss the FIGO Nutrition Checklist during the clinical visit. Completed FIGO Nutrition Checklists were collected after appointments. Acceptability was assessed through questionnaires. Results The majority (80.0%) of women answered “No” to at least one diet quality question, indicating a potential nutritional risk. While none of the participating obstetricians routinely discussed nutrition with women, all agreed that using the Checklist encouraged them to address nutrition with pregnant women. Nearly every woman (99.0%) found the Checklist quick to complete; however, all participating obstetricians felt there was not enough time to discuss it in routine practice. Despite this, most obstetricians and pregnant women recommended the FIGO Nutrition Checklist for use. Conclusion The FIGO Nutrition Checklist is acceptable for use in routine antenatal practice in tertiary care settings. It helped identify potentially at‐risk women during early pregnancy and facilitated conversations related to optimum diet.

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Section: Introductionmentioning

confidence: 99%

Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: multistakeholder feedback to implementation

Killeen

Callaghan

Jacob

et al. 2020

Intl J Gynecology & Obste

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“…This has also been discussed in a recent health economic evaluation of interventions to reduce gestational weight gain as part of decreasing gestational diabetes, in which the decided threshold was found to affect the cost effectiveness of said interventions [49]. The same applies to acceptable costs for reducing adverse maternal outcomes, such as gestational diabetes or hypertensive disease in pregnancy [50]. Thus, more research is needed on the long-term effects of decreasing gestational weight gain through antenatal care interventions, including their potential effects on health-related quality of life, to enable comparisons of cost effectiveness with other healthcare interventions.…”

Section: Discussionmentioning

confidence: 97%

Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity

Gyllensten

Haby

Berg

et al. 2021

BMC Pregnancy Childbirth

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Background The Mighty Mums antenatal lifestyle intervention is a person-centered behavioral intervention focusing on nutrition and physical activity for pregnant women with obesity (body mass index [BMI] ≥30). The aim of this study was to evaluate the costs and clinical outcomes of adding the Mighty Mums intervention to standard antenatal care. Methods Participants in the intervention group (n = 434) received motivational talks with their midwife and a selection of physical and/or nutritional activities in addition to antenatal care. Control participants (n = 867) from adjacent geographic areas received standard antenatal care. Costs for staff, unit costs for specific activities, and registered costs for specialized antenatal care were analyzed for associations with gestational weight gain and self-reported health. Results are reported for the intention-to-treat (ITT) population and a per protocol (PP) population identified by participation in the intervention. Analyses included bootstrapped linear regressions adjusted for background characteristics that differed significantly between groups. Results The average costs were SEK 9727 higher (95% confidence interval [CI]: 6677 to 12,777) among participants in the intervention group than in the control ITT population and SEK 8655 (95% CI 4586 to 12,724) higher than in the PP population. The cost increase per 1 kg reduction in gestational weight gain was SEK 12,369 in the ITT population and SEK 7209 for the PP population. Conclusion Participation in the Mighty Mums intervention was associated with higher costs, but also reduced gestational weight gain. The cost per kilogram reduction in gestational weight gain was low, particularly in the PP population. A future decision to implement this behavioral intervention in standard care should take into account society’s willingness to pay per unit reduction in gestational weight gain. Trial registration The study is registered at ClinicalTrials.gov, Identifier: NCT03147079.

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“…The investment required to improve maternal diet quality is unknown [ 10 ]. Further investigation is required, given that poor dietary patterns are common among this population [ 39 ] and that current systematic review indicate interventions to improve maternal BMI and pregnancy outcome show inconsistent finding in regard to cost-effectiveness [ 40 , 41 ]. This study found no significant association between pre-pregnancy BMI and maternal length of stay or midwifery-in-the-home care visits.…”

Section: Discussionmentioning

confidence: 99%

Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study

et al. 2020

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The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women’s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m2 (range: 14.7 kg/m2–64 kg/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0–39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or “midwifery-in-the-home-visits”.

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Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy

Cited by 30 publications

References 41 publications

Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: multistakeholder feedback to implementation

Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: multistakeholder feedback to implementation

Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity

Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study

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