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de Jersey S, Keramat SA, Chang A, Meloncelli N, Guthrie T, Eakin E, Comans T. A cost-effectiveness evaluation of a dietitian-delivered telephone coaching program during pregnancy for preventing gestational diabetes mellitus. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:18. [PMID: 38429805 PMCID: PMC10908067 DOI: 10.1186/s12962-024-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM. METHODS Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses. RESULTS The costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000. CONCLUSION Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.
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Affiliation(s)
- Susan de Jersey
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia.
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Angela Chang
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Taylor Guthrie
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Osman MM, Mullins E, Kleprlikova H, Wilkinson IB, Lees C. Beetroot juice, exercise, and cardiovascular function in women planning to conceive. J Hypertens 2024; 42:101-108. [PMID: 37728100 PMCID: PMC10713001 DOI: 10.1097/hjh.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Prepregnancy optimization of cardiovascular function may reduce the risk of pre-eclampsia. We aimed to assess the feasibility and effect of preconception cardiovascular monitoring, exercise, and beetroot juice on cardiovascular parameters in women planning to conceive. DESIGN AND METHOD Prospective single-site, open-label, randomized controlled trial. Thirty-two women, aged 18-45 years, were allocated into one of four arms (1 : 1 : 1 : 1): exercise, beetroot juice, exercise plus beetroot juice and no intervention for 12 weeks. Blood pressure (BP) was measured at home daily. Cardiac output ( CO ) and total peripheral resistance (TPR) were assessed via bio-impedance. RESULTS Twenty-nine out of 32 (91%) participants completed the study. Adherence to daily BP and weight measurements were 81% and 78%, respectively ( n = 29). Eight out of 15 (53%) of participants did not drink all the provided beetroot juice because of forgetfulness and taste. After 12 weeks, exercise was associated with a reduction in standing TPR (-278 ± 0.272 dynes s cm -5 , P < 0.05), and an increase in standing CO (+0.88 ± 0.71 l/min, P < 0.05). Exercise and beetroot juice together was associated with a reduction in standing DBP ( 7 ± 6 mmHg, P < 0.05), and an increase in standing CO (+0.49 ± 0.66 l/min, P < 0.05). The control group showed a reduction in standing TPR ( 313 ± 387 dynes s cm -5 ) and standing DBP ( 8 ± 5mmHg). All groups gained weight. CONCLUSION Exercise and beetroot juice in combination showed a signal towards improving cardiovascular parameters. The control group showed improvements, indicating that home measurement devices and regular recording of parameters are interventions in themselves. Nevertheless, interventions before pregnancy to improve cardiovascular parameters may alter the occurrence of hypertensive conditions during pregnancy and require further investigation in adequately powered studies.
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Affiliation(s)
| | - Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London
- The George Institute for Global Health
| | - Hana Kleprlikova
- Women's Health Research Centre, Queen Charlotte's and Chelsea Hospital, London
- NHS North West London Clinical Commissioning Group, UK
- Department of General Anthropology, Faculty of Humanities, Charles University in Prague, Czechia
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London
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Tsironikos GI, Potamianos P, Zakynthinos GE, Tsolaki V, Tatsioni A, Bargiota A. Effectiveness of Lifestyle Interventions during Pregnancy on Preventing Gestational Diabetes Mellitus in High-Risk Women: A Systematic Review and Meta-Analyses of Published RCTs. J Clin Med 2023; 12:7038. [PMID: 38002654 PMCID: PMC10672732 DOI: 10.3390/jcm12227038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Until now, it is uncertain whether lifestyle interventions during pregnancy can prevent gestational diabetes mellites (GDM) in high-risk pregnant women. OBJECTIVE This study aims at investigating the effectiveness of dietary interventions and/or exercise interventions during pregnancy for preventing GDM in high-risk pregnant women. MATERIALS AND METHODS Eligible randomized controlled trials (RCTs) were selected after a search in CENTRAL, Scopus, and PubMed. Synthesis was performed for the outcome of GDM in women with any identified GDM risk factor. Separate meta-analyses (MA) were performed to assess the efficacy of either nutrition or physical activity (PA) interventions or both combined compared with standard prenatal care for preventing GDM. Subgroup and sensitivity analyses, as well as meta-regressions against OR, were performed to assess potentional heterogeneity. Overall quality, the quality of RCTs, and publication bias were also evaluated. RESULTS A total of 13,524 participants comprising high-risk pregnant women in 41 eligible RCTs were analyzed for GDM. Women receiving only a nutrition intervention during pregnancy were less likely to experience GDM compared with women following standard prenatal care. Among 3109 high-risk pregnant women undergoing only dietary intervention for preventing GDM, 553 (17.8%) developed GDM; however, the result of the MA was marginally not significant (OR 0.73, 95%CI 0.51, 1.03; p-value 0.07), (Q 21.29, p-value 0.01; I2 58% (95%CI 10, 78%)). Subgroup analyses demonstrated an effect for studies that were conducted in Great Britain (OR 0.65, 95%CI 0.49, 0.81; p-value 0.003), and in Spain (OR 0.50, 95%CI 0.27, 0.94; p-value 0.03), for studies with forms of the Mediterranean diet as the intervention's component (OR 0.61; 95%CI 0.46, 0.81; p-value 0.0005), and for studies including a motivation arm in the intervention (OR 0.71, 95%CI 0.58, 0.87; p-value 0.0008). Among 2742 high-risk pregnant women being analyzed for GDM outcome after receiving only an exercise intervention, 461 (16.8%) were diagnosed with GDM. Women after receiving PA intervention were less likely to develop GDM (OR 0.64, 95%CI 0.51, 0.80; p-value < 0.0001), (Q 11.27, p-value 0.51; I2 0% (95%CI 0, 99%)). Finally, 1308 (17%) cases of GDM were diagnosed among 7673 high-risk pregnant women undergoing both diet and PA intervention. Women in the group of mixed lifestyle intervention had a significant reduction in incidence of GDM (OR 0.70, 95%CI 0.55, 0.90; p-value 0.005), (Q 50.32, p-value < 0.0001, I2 66%, (95% CI 44, 79%)). CONCLUSIONS The results of this study support the efficacy of lifestyle interventions during pregnancy for preventing GDM in high-risk women if an exercise component is included in the intervention arm, either alone, or combined with diet. A combined lifestyle intervention including physical exercise and a Mediterranean diet accompanied by motivation support may be considered the most effective way to prevent GDM among high-risk women during pregnancy. Future research is needed to strengthen these findings.
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Affiliation(s)
- Georgios I. Tsironikos
- Department of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Petros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece
| | - Athina Tatsioni
- Department of Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
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Lloyd M, Morton J, Teede H, Marquina C, Abushanab D, Magliano DJ, Callander EJ, Ademi Z. Long-term cost-effectiveness of implementing a lifestyle intervention during pregnancy to reduce the incidence of gestational diabetes and type 2 diabetes. Diabetologia 2023; 66:1223-1234. [PMID: 36932207 PMCID: PMC10244289 DOI: 10.1007/s00125-023-05897-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/31/2023] [Indexed: 03/19/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine the long-term cost-effectiveness and return on investment of implementing a structured lifestyle intervention to reduce excessive gestational weight gain and associated incidence of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus. METHODS A decision-analytic Markov model was used to compare the health and cost-effectiveness outcomes for (1) a structured lifestyle intervention during pregnancy to prevent GDM and subsequent type 2 diabetes; and (2) current usual antenatal care. Life table modelling was used to capture type 2 diabetes morbidity, mortality and quality-adjusted life years over a lifetime horizon for all women giving birth in Australia. Costs incorporated both healthcare and societal perspectives. The intervention effect was derived from published meta-analyses. Deterministic and probabilistic sensitivity analyses were used to capture the impact of uncertainty in the model. RESULTS The model projected a 10% reduction in the number of women subsequently diagnosed with type 2 diabetes through implementation of the lifestyle intervention compared with current usual care. The total net incremental cost of intervention was approximately AU$70 million, and the cost savings from the reduction in costs of antenatal care for GDM, birth complications and type 2 diabetes management were approximately AU$85 million. The intervention was dominant (cost-saving) compared with usual care from a healthcare perspective, and returned AU$1.22 (95% CI 0.53, 2.13) per dollar invested. The results were robust to sensitivity analysis, and remained cost-saving or highly cost-effective in each of the scenarios explored. CONCLUSIONS/INTERPRETATION This study demonstrates significant cost savings from implementation of a structured lifestyle intervention during pregnancy, due to a reduction in adverse health outcomes for women during both the perinatal period and over their lifetime.
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Affiliation(s)
- Melanie Lloyd
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jedidiah Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Clara Marquina
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Dina Abushanab
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Dianna J Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Lim S, Harrison C, Callander E, Walker R, Teede H, Moran L. Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature. Curr Obes Rep 2022; 11:405-414. [PMID: 36318371 PMCID: PMC9729313 DOI: 10.1007/s13679-022-00485-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Reproductive-aged women (aged 19 to 50 years) are a key population warranting focused research for the prevention of overweight and obesity. This review highlights the importance of addressing weight before, during and after pregnancy. RECENT FINDINGS Obesity decreases fertility during the preconception period; increases the risk of adverse pregnancy outcomes including gestational diabetes, pre-eclampsia and caesarean section and postpartum weight retention; and increases the long-term health risks for both the mother and offspring. Despite overwhelming efficacy evidence on solutions, there are significant implementation gaps in translating this evidence into pragmatic models of care and real-world solutions. Interventions during preconception, pregnancy and postpartum are likely to be cost-effective or cost-saving, with future investigation needed in the preconception and postpartum period. International clinical guidelines and public health policies are needed for a concerted effort to prevent unhealthy weight gain in these life stages and to reverse the significant adverse health outcomes for women and the next generation.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Boxhill, VIC, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.
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Lloyd M, Teede H, Bailey C, Callander E, Ademi Z. Projected Return on Investment From Implementation of a Lifestyle Intervention to Reduce Adverse Pregnancy Outcomes. JAMA Netw Open 2022; 5:e2230683. [PMID: 36066890 PMCID: PMC9449797 DOI: 10.1001/jamanetworkopen.2022.30683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Structured antenatal diet and physical activity interventions have been shown to be associated with reduced adverse pregnancy outcomes and recommended to be routinely offered to all pregnant women. The health cost implications of population-level implementation are unclear. OBJECTIVE To estimate the budget impact associated with integrating structured diet and physical activity interventions into routine antenatal care. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted from the perspective of Australian health funders. An open-source decision-tree model was constructed to compare the projected budget outcomes of implementing lifestyle intervention vs usual care. Scenario, deterministic, and probabilistic sensitivity analysis were completed. The study setting was Australian health services, and the study population was all Australian women projected to give birth in the years 2022 to 2026 (approximately 330 000 per year). INTERVENTIONS Structured diet and physical activity intervention provided by trained health professionals, integrated into routine antenatal care. Comparator was usual care, which currently in Australia does not include routine structured lifestyle interventions. MAIN OUTCOMES AND MEASURES Return on investment (ROI) ratio for lifestyle intervention (cost of intervention divided by cost savings attributable to reduced maternal and infant adverse events) from the perspective of Australian health care funders. Adverse events were obtained from a published meta-analysis and population data. Costs were estimated from aggregate trial data and clinical pathways and valued at the year incurred. RESULTS Intervention offered an ROI ratio of 4.75 over the 5-year program; hence every Australian dollar spent on implementation produced an estimated return of A$4.75. The projected total 5-year intervention cost was A$205 million ($151 million), with cost offsets (from reduced incidence of adverse pregnancy outcomes) of A$1022 million ($755 million), and health budget savings of A$807 million (95% CI, A$129 million to A$1639 million) ($596 million [95% CI, $95 million to $1211 million]); 93.3% of the 10 000 iterations were within cost saving, and results were robust to scenario and sensitivity analyses. CONCLUSIONS AND RELEVANCE This economic evaluation found that providing access to structured diet and physical activity lifestyle interventions for all pregnant Australian women was estimated to provide strong return on investment for health funders. The open-source model developed can be used by other jurisdictions and health services to explore cost implications of implementation within their patient population.
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Affiliation(s)
- Melanie Lloyd
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily Callander
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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Harrison CL, Brammall BR, Garad R, Teede H. OptimalMe Intervention for Healthy Preconception, Pregnancy, and Postpartum Lifestyles: Protocol for a Randomized Controlled Implementation Effectiveness Feasibility Trial. JMIR Res Protoc 2022; 11:e33625. [PMID: 35679115 PMCID: PMC9227652 DOI: 10.2196/33625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/15/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reproductive-aged women are a high-risk population group for accelerated weight gain and obesity development, with pregnancy recognized as a critical contributory life-phase. Healthy lifestyle interventions during the antenatal period improve maternal and infant health outcomes, yet translation and implementation of such interventions into real-world health care settings remains limited. Objective We aim to generate key implementation learnings to inform the feasibility of future scale up and determine the effectiveness of intervention delivery methods on engagement, experience, acceptability, knowledge, risk perception, health literacy, and modifiable weight-related health behaviors in women during preconception, pregnancy, and postpartum periods. Methods This randomized hybrid implementation effectiveness study will evaluate the penetration, reach, feasibility, acceptability, adoption, and fidelity of a healthy lifestyle intervention (OptimalMe) implemented into, and in partnership with, private health care. Individual health outcomes associated with implementation delivery mode, including knowledge, risk perception, health literacy, self-management, and health behaviors, are secondary outcomes. A total of 300 women aged 18 to 44 years, who are not pregnant but wish to conceive within the next 12 months, and with access to the internet will be recruited. All participants will receive the same digital lifestyle intervention, OptimalMe, which is supported by health coaching and text messages during preconception, pregnancy, and postpartum periods. We will use a parallel 2-arm design to compare telephone with videoconference remote delivery methods for health coaching. Methods are theoretically underpinned by the Consolidated Framework for Implementation Research and outcomes based on the Reach, Engagement, Adaptation, Implementation and Maintenance framework. Results The study was approved on August 16, 2019 and has been registered. Recruitment commenced in July 2020, and data collection is ongoing. Results are expected to be published in 2022. Conclusions The study’s design aligns with best practice implementation research. Results will inform translation of evidence from randomized controlled trials on healthy lifestyle interventions into practice targeting women across preconception, pregnancy, and postpartum periods. Learnings will target consumers, program facilitators, health professionals, services, and policy makers to inform future scale up to ultimately benefit the health of women across these life-phases. Trial Registration Australian and New Zealand Clinical Trial Registry ACTRN12620001053910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378243&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/33625
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Affiliation(s)
- Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia.,Endocrine and Diabetes Unit, Monash Health, Clayton, Australia
| | - Bonnie R Brammall
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia.,Endocrine and Diabetes Unit, Monash Health, Clayton, Australia
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Health-promoting behaviors and intermediary social determinants of health in low and high-risk pregnant women: an unmatched case-control study. BMC Pregnancy Childbirth 2022; 22:445. [PMID: 35643433 PMCID: PMC9145513 DOI: 10.1186/s12884-022-04784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/24/2022] [Indexed: 12/05/2022] Open
Abstract
Background High-risk pregnancies require increased health and care resources to reduce the severe perinatal consequences. The adoption of a health-promoting lifestyle and social determinants is an important strategy for achieving the desired outcomes of pregnancy. This study aimed to compare intermediate determinants of social health in low and high-risk pregnant women. Methods This unmatched case-control study was performed with a ratio of 1: 2 and 300 pregnant women including 200 healthy and 100 pregnant women with gestational hypertension were included using the available sampling technique. Data were collected using socio-demographic and obstetrics, Health-promoting behaviors, Self-efficacy, Perceived stress, and Social support questionnaires by the self-report method. Results There was no significant difference in the demographic characteristics between the two groups, except for the spouse's education status. The total score of health-promoting behaviors and social support in the healthy group was significantly higher than women with gestational hypertension. However, the perceived stress in women with gestational hypertension was significantly higher than in the healthy group. In the multivariate analysis, those women with high stress [AOR 1.13, 95% CI (1.08–1.18)] and whose Spouse’s Educational status was low [AOR 4.94, 95% CI (1.54–15.81)] had higher odds of gestational hypertension than women who haven’t respectively. The development of gestational hypertension was decreased by increasing the score of social support [AOR 0.96, 95% CI (0.93–0.98)]. The results showed that the two variables of social support (β=0.331) and self-efficacy (β=0.215) have the greatest impact on the score of health-promotion behaviors, respectively. Based on regression analysis, 21.2% of the health-promotion behaviors changes could be explained by three independent variables. Conclusion Women with gestational hypertension have unhealthier lifestyles. Having a high level of stress is a risk factor for gestational hypertension but Social support has a protective effect on it. Recognizing the risk factors of gestational hypertension could help the determination of high-risk cases and it is important to pay attention to women's psychosocial to create appropriate sources of social support and provide the necessary action to reduce stress.
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de Jersey S, Meloncelli N, Guthrie T, Powlesland H, Callaway L, Chang AT, Wilkinson S, Comans T, Eakin E. Outcomes from a hybrid implementation-effectiveness study of the living well during pregnancy Tele-coaching program for women at high risk of excessive gestational weight gain. BMC Health Serv Res 2022; 22:589. [PMID: 35501807 PMCID: PMC9063237 DOI: 10.1186/s12913-022-08002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. Methods The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity. Results The LWdP intervention group (n = 142) were compared with women in the historical comparison group (n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p < 0.05). Conclusion The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08002-5.
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Affiliation(s)
- Susan de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. .,The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.
| | - Nina Meloncelli
- The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Hilary Powlesland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Leonie Callaway
- The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Angela T Chang
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Shelley Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Mothers, Babies and Women's Theme, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia
| | - Tracy Comans
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Bailey C, Skouteris H, Harrison CL, Hill B, Thangaratinam S, Teede H, Ademi Z. A Comparison of the Cost-Effectiveness of Lifestyle Interventions in Pregnancy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:194-202. [PMID: 35094792 DOI: 10.1016/j.jval.2021.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Lifestyle interventions during pregnancy improve maternal and infant outcomes. We aimed to compare the cost-effectiveness of 4 antenatal lifestyle intervention types with standard care. METHODS A decision tree model was constructed to compare lifestyle intervention effects from a novel meta-analysis. The target population was women with singleton pregnancies and births at more than 20 weeks' gestation. Interventions were categorized as diet, diet with physical activity, physical activity, and mixed (lacking structured diet and, or, physical activity components). The outcome of interest was cost per case prevented (gestational diabetes, hypertensive disorders in pregnancy, cesarean birth) expressed as an incremental cost-effectiveness ratio (ICER) from the Australian public healthcare perspective. Scenario analyses were included for all structured interventions combined and by adding neonatal intensive care unit costs. Costs were estimated from published data and consultations with experts and updated to 2019 values. Discounting was not applied owing to the short time horizon. RESULTS Physical activity interventions reduced adverse maternal events by 4.2% in the intervention group compared with standard care and could be cost saving. Diet and diet with physical activity interventions reduced events by 3.5% (ICER = A$4882) and 2.9% (ICER = A$2020), respectively. Mixed interventions did not reduce events and were dominated by standard care. In scenario analysis, all structured interventions combined and all interventions when including neonatal intensive care unit costs (except mixed) may be cost saving. Probabilistic sensitivity analysis showed that for physical activity and all structured interventions combined, the probability of being cost saving was 58% and 41%, respectively. CONCLUSIONS Governments can expect a good return on investment and cost savings when implementing effective lifestyle interventions population-wide.
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Affiliation(s)
- Cate Bailey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Warwick Business School, Warwick University, Coventry, England, UK
| | - Cheryce L Harrison
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shakila Thangaratinam
- World Health Organization Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England, UK
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health Endocrine and Diabetes Units, Monash Health, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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11
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Gyllensten H, Haby K, Berg M, Premberg Å. Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity. BMC Pregnancy Childbirth 2021; 21:639. [PMID: 34548038 PMCID: PMC8456662 DOI: 10.1186/s12884-021-04098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/29/2021] [Indexed: 11/30/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04098-5.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden. .,Centre for Person-Centred Care - GPCC, University of Gothenburg, Gothenburg, Sweden. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Haby
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.,Centre for Person-Centred Care - GPCC, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics, Gothenburg, Sweden
| | - Åsa Premberg
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
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12
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Goldstein RF, Boyle JA, Lo C, Teede HJ, Harrison CL. Facilitators and barriers to behaviour change within a lifestyle program for women with obesity to prevent excess gestational weight gain: a mixed methods evaluation. BMC Pregnancy Childbirth 2021; 21:569. [PMID: 34407775 PMCID: PMC8375116 DOI: 10.1186/s12884-021-04034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background Maternal obesity is associated with health risks for women and their babies and is exacerbated by excess gestational weight gain. The aim of this study was to describe women’s experiences and perspectives in attending a Healthy Pregnancy Service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Methods An explanatory sequential mixed methods study design utilised two questionnaires (completed in early and late pregnancy) to quantify feelings, motivation and satisfaction with the service, followed by semi-structured interviews that explored barriers and enablers of behaviour change. Data were analysed separately and then interpreted together. Results Overall, 49 women attending the service completed either questionnaire 1, 2 or both and were included in the analysis. Fourteen women were interviewed. Prior to pregnancy, many women had gained weight and attempted to lose weight independently, and reported they were highly motivated to achieve a healthy lifestyle. During pregnancy, diet changes were reported as easier to make and sustain than exercise changes. Satisfaction with the service was high. Key factors identified in qualitative analysis were: service support enabled change; motivation to change behaviour, social support, barriers to making change (intrinsic, extrinsic and clinic-related), post-partum lifestyle and needs. On integration of data, qualitative and quantitative findings aligned. Conclusions The Healthy Pregnancy service was valued by women. Barriers and enablers to the delivery of an integrated model of maternity care that supported healthy lifestyle and recommended gestational weight gain were identified. These findings have informed and improved implementation and further scale up of this successful service model, integrating healthy lifestyle into routine antenatal care of women with obesity. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (no.12620000985987). Registration date 30/09/2020, retrospectively registered. http://www.anzctr.org.au/ Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04034-7.
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Affiliation(s)
- Rebecca F Goldstein
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Gve, Clayton, 3168, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Gve, Clayton, 3168, Australia.,Monash Women's, Monash Health, Clayton, 3168, Australia
| | - Clement Lo
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Gve, Clayton, 3168, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Gve, Clayton, 3168, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Gve, Clayton, 3168, Australia. .,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Australia.
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13
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Bahri Khomami M, Walker R, Kilpatrick M, de Jersey S, Skouteris H, Moran LJ. The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy. Ther Adv Reprod Health 2021; 15:26334941211031866. [PMID: 34396131 PMCID: PMC8361518 DOI: 10.1177/26334941211031866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Women with maternal obesity, an unhealthy lifestyle before and during pregnancy
and excess gestational weight gain have an increased risk of adverse pregnancy
and birth outcomes that can also increase the risk of long-term poor health for
them and their children. Pregnant women have frequent medical appointments and
are highly receptive to health advice. Healthcare professionals who interact
with women during pregnancy are in a privileged position to support women to
make lasting healthy lifestyle changes that can improve gestational weight gain
and pregnancy outcomes and halt the intergenerational nature of obesity.
Midwives and obstetrical nurses are key healthcare professionals responsible for
providing antenatal care in most countries. Therefore, it is crucial for them to
build and enhance their ability to promote healthy lifestyles in pregnant women.
Undergraduate midwifery curricula usually lack sufficient lifestyle content to
provide emerging midwives and obstetrical nurses with the knowledge, skills, and
confidence to effectively assess and support healthy lifestyle behaviours in
pregnant women. Consequently, registered midwives and obstetrical nurses may not
recognise their role in healthy lifestyle promotion specific to healthy eating
and physical activity in practice. In addition, practising midwives and
obstetrical nurses do not consistently have access to healthy lifestyle
promotion training in the workplace. Therefore, many midwives and obstetrical
nurses may not have the confidence and/or skills to support pregnant women to
improve their lifestyles. This narrative review summarises the role of midwives
and obstetrical nurses in the promotion of healthy lifestyles relating to
healthy eating and physical activity and optimising weight in pregnancy, the
barriers that they face to deliver optimal care and an overview of what we know
works when supporting midwives and obstetrical nurses in their role to support
women in achieving a healthy lifestyle.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation (MCHRI), Level 1, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michelle Kilpatrick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Susan de Jersey
- Perinatal Research Centre, Centre for Clinical Research and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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14
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Li R, Kuklina EV, Ailes EC, Shrestha SS, Grosse SD, Fang J, Wang G, Leung J, Barfield WD, Cox S. Medical expenditures for hypertensive disorders during pregnancy that resulted in a live birth among privately insured women. Pregnancy Hypertens 2021; 23:155-162. [PMID: 33418425 PMCID: PMC10423979 DOI: 10.1016/j.preghy.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/17/2020] [Accepted: 12/08/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate the excess maternal health services utilization and direct maternal medical expenditures associated with hypertensive disorders during pregnancy and one year postpartum among women with private insurance in the United States. STUDY DESIGN We used 2008-2014 IBM MarketScan® Commercial Databases to identify women aged 15-44 who had a pregnancy resulting in live birth during 1/1/09-12/31/13 and were continuously enrolled with non-capitated or partially capitated coverage from 12 months before pregnancy through 12 months after delivery. Hypertensive disorders identified by diagnosis codes were categorized into three mutually exclusive types: preeclampsia and eclampsia, chronic hypertension, and gestational hypertension. Multivariate negative binomial and generalized linear models were used to estimate service utilization and expenditures, respectively. MAIN OUTCOME MEASURES Per person excess health services utilization and medical expenditures during pregnancy and one year postpartum associated with hypertensive disorders (in 2014 US dollars). RESULTS Women with preeclampsia and eclampsia, chronic hypertension, and gestational hypertension had $9,389, $6,041, and $2,237 higher mean medical expenditures compared to women without hypertensive disorders ($20,252), respectively (ps < 0.001). One-third (36%) of excess expenditure associated with hypertensive disorders during pregnancy was attributable to outpatient services. CONCLUSIONS Hypertensive disorders during pregnancy were associated with significantly higher health services utilization and medical expenditures among privately insured women with hypertensive disorders. Medical expenditures varied by types of hypertensive disorders. Stakeholders can use this information to assess the potential economic benefits of interventions that prevent these conditions or their complications.
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Affiliation(s)
- Rui Li
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Elena V Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Elizabeth C Ailes
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, United States
| | - Sundar S Shrestha
- Office on Smoking Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Scott D Grosse
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, United States
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
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15
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Whitaker KM, Becker C, Healy H, Wilcox S, Liu J. Women's Report of Health Care Provider Advice and Gestational Weight Gain: A Systematic Review. J Womens Health (Larchmt) 2021; 30:73-89. [DOI: 10.1089/jwh.2019.8223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kara M. Whitaker
- Department of Health and Human Physiology and University of Iowa, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Courtney Becker
- Department of Health and Human Physiology and University of Iowa, Iowa City, Iowa, USA
| | - Heather Healy
- Hardin Library for the Health Sciences, University of Iowa Libraries, Iowa City, Iowa, USA
| | - Sara Wilcox
- Department of Exercise Science and University of South Carolina, Columbia, South Carolina, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
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16
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Killeen SL, Callaghan SL, Jacob CM, Hanson MA, McAuliffe FM. Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: multistakeholder feedback to implementation. Int J Gynaecol Obstet 2020; 151 Suppl 1:51-56. [PMID: 32894589 PMCID: PMC7589336 DOI: 10.1002/ijgo.13323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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. The FIGO Nutrition Checklist is acceptable to pregnant women and may capture high‐risk weight or dietary practices in pregnancy that would otherwise go untreated.
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Affiliation(s)
- Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Shauna L Callaghan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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17
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Szewczyk Z, Weaver N, Rollo M, Deeming S, Holliday E, Reeves P, Collins C. Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study. Nutrients 2020; 12:nu12113532. [PMID: 33213030 PMCID: PMC7698580 DOI: 10.3390/nu12113532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Zoe Szewczyk
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Correspondence: (Z.S.); (C.C.)
| | - Natasha Weaver
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Megan Rollo
- School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Simon Deeming
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Elizabeth Holliday
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Penny Reeves
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Clare Collins
- School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Correspondence: (Z.S.); (C.C.)
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18
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Goldstein RF, Harrison CL, Teede HJ. Editorial: The importance of gestational weight gain. Obes Rev 2020; 21:e13073. [PMID: 32608189 DOI: 10.1111/obr.13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Rebecca F Goldstein
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Centre for Research Excellence in Healthy Lifestyle in Preconception and Pregnancy (HiPP), Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Centre for Research Excellence in Healthy Lifestyle in Preconception and Pregnancy (HiPP), Monash University, Melbourne, Victoria, Australia
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19
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Thangaratinam S, Cooray SD, Sukumar N, Huda MSB, Devlieger R, Benhalima K, McAuliffe F, Saravanan P, Teede HJ. ENDOCRINOLOGY IN THE TIME OF COVID-19: Diagnosis and management of gestational diabetes mellitus. Eur J Endocrinol 2020; 183:G49-G56. [PMID: 32454456 PMCID: PMC7938017 DOI: 10.1530/eje-20-0401] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has required rapid transformation and adaptation of healthcare services. Women with gestational diabetes mellitus (GDM) are one of the largest high-risk groups accessing antenatal care. In reformulating the care offered to those with GDM, there is a need to balance the sometimes competing requirement of lowering the risk of direct viral transmission against the potential adverse impact of service changes. We suggest pragmatic options for screening of GDM in a pandemic setting based on blood tests, and risk calculators applied to underlying risk factors. Alternative models for antenatal care provision for women with GDM, including targeting high-risk groups, early lifestyle interventions and remote monitoring are provided. Testing options and their timing for postpartum screening in women who had GDM are also considered. Our suggestions are only applicable in a pandemic scenario, and usual guidelines and care pathways should be re-implemented as soon as possible and appropriate.
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Affiliation(s)
- Shakila Thangaratinam
- WHO Collaborating Centre for Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's, NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to S Thangaratinam;
| | - Shamil D Cooray
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes Unit, Monash Health, Clayton, Australia
| | - Nithya Sukumar
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Mohammed S B Huda
- Department of Diabetes & Metabolism, St Bartholomew's and Royal London Hospitals, Barts Health NHS Trust, London, UK
| | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Unit Woman and Child, Department of Development and Regeneration KU Leuven, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ponnusamy Saravanan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Diabetes and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes Unit, Monash Health, Clayton, Australia
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