A Behavioral Weight Gain Intervention in Pregnancy: A Cost-Benefit Analysis

OBJECTIVE: Prior studies have demonstrated that behavioral interventions during pregnancy could prevent excessive gestational weight gain. This study investigates the cost of such interventions, taking into account the costs and benefits associated with outcomes of gestational weight gain according to the 2009 Institute of Medicine (IOM) weight gain recommendations. STUDY DESIGN: A decision analytic model was built using TreeAge software that compared routine prenatal care vs. routine prenatal care plus a behavioral intervention to prevent excessive gestational weight gain in the 1,528,000 normal weight women who are pregnant each year in the U.S. The Fit for Delivery Study protocol was used to estimate the effect of treatment on gestational weight gain and the costs of intervention. Outcomes included: gestational diabetes, preeclampsia, macrosomia (\u3e4500g), small-for-gestational age, postterm delivery, cesarean delivery, postpartum weight retention, and child obesity. RESULTS: In addition to reducing gestational weight gain among normal weight women, the intervention was cheaper, $15,965 versus$16,122 without intervention. With lower costs and better outcomes, such a behavioral intervention is a dominant strategy. In addition, it would lead to 7,579 fewer cesareans each year, 6,830 fewer cases of macrosomia, and 10,925 fewer cases of postpartum weight retention at 1 year (see table). CONCLUSION: A behavioral intervention added to routine prenatal care is cost-beneficial (leads to lower costs and more than recovers the cost of intervention) as compared to routine prenatal care alone among normal weight women. A proven intervention may have even greater impact in overweight and obese women. Further research in this area could lead to both better outcomes and economic benefits at a societal level

The Economic Impact of Gestational Weight Gain According to IOM Guidelines

OBJECTIVE: We sought to estimate the costs and outcomes associated with keeping gestational weight gain within the 2009 Institute of Medicine (IOM) recommendations. STUDY DESIGN: A decision analytic model was built using TreeAge software that compared the cost of gestational weight gain categorized by staying within versus exceeding the IOM guidelines in normal weight and obese women. We assumed the obesity prevalence from the most recent data in 2008 and applied to the estimated 4,000,000 million births per year. Outcomes included: gestational diabetes, preeclampsia, macrosomia (\u3e4500g), small-forgestational age, postterm delivery, cesarean delivery, postpartum weight retention, and child obesity. RESULTS: Normal weight women who gained within the IOM recommendations incurred $2,502 less costs than normal weight women who exceeded the IOM recommendations. Obese women who gained within the IOM recommendations incurred$6,501 less costs than obese women who exceeded the IOM recommendations. With lower costs and better outcomes adhering to IOM guidelines for gestational weight gain is a dominant strategy. When applied to the U.S. population, gaining within IOM guidelines could lead to $12.7 billion dollars of savings. In addition, staying within the IOM guidelines would result in 76,400 fewer cesarean deliveries for normal weight women and 408,000 for obese women (see table). CONCLUSION: From a societal standpoint, there is economic benefit to staying within the IOM guidelines for gestational weight gain. With such an enormous potential impact on economic and clinical outcomes, further research into accomplishing these guidelines should be widespread