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Are Lifestyle Interventions to Reduce Excessive Gestational Weight Gain Cost Effective? A Systematic Review


Purpose of Review

Lifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the common currencies of Australia and the United Kingdom by adjusting for resource utilization, healthcare purchase price and changes in costs over time. Included studies were economic analyses of lifestyle interventions aiming to limit weight-gain during pregnancy and/or reduce risk of gestational diabetes, for women with a BMI of 25 or greater in pre- or early-pregnancy.

Recent Findings

Of the 538 articles identified, six were retained for review: one modelling study and five studies in which an economic analysis was performed alongside a randomized-controlled trial. Outcome measures included infant birth-weight, fasting glucose, insulin resistance, gestational weight-gain, infant respiratory distress syndrome, perceived health, cost per case of adverse outcome avoided and quality-adjusted life years (QALYs). Interventions were cost-effective in only one study.


Although many studies have investigated the efficacy of lifestyle interventions in pregnancy, few have included cost-effectiveness analyses. Where cost-effectiveness studies were undertaken, results were inconsistent. Secondary meta-analysis, taxonomy and framework research is now required to determine the effective components of lifestyle interventions and to guide future cost-effectiveness analyses.

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CB acknowledges funding support from the Australian Prevention Partnership Centre. BdC is a recipient of the National Heart Foundation (NHF future leader fellowship 100864). HT is a recipient of NHMRC Practitioner fellowship. BH is funded by an NHMRC Early Career Fellowship (GNT1120477).

Author information

CB developed the search strategy, led the data collection and analysis and wrote the initial draft of the manuscript. ZA contributed in the design and scope of search strategy, advised on all aspects of the methodology and contributed expertise to the revision and editing of the manuscript. HS contributed to the conceptualization of the study, the design and scope of the search strategy and revised and edited the manuscript. BH contributed to reviewing data collection and revised and edited the manuscript. HT and BdC contributed to conceptualization of the study and revised and edited the manuscript. DL, RW and ST revised and edited the manuscript.

Correspondence to Cate Bailey.

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Conflict of Interest

Cate Bailey, Helen Skouteris, Helena Teede, Briony Hill, Barbora De Courten, Ruth Walker, Danny Liew, Shakila Thangaratinam and Zanfina Ademi each declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Bailey, C., Skouteris, H., Teede, H. et al. Are Lifestyle Interventions to Reduce Excessive Gestational Weight Gain Cost Effective? A Systematic Review. Curr Diab Rep 20, 6 (2020).

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  • Economic evaluation
  • Gestational weight gain
  • Gestational diabetes
  • Systematic review