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Prior studies have demonstrated that a cardiovascular exercise intervention during pregnancy can reduce the risk of developing preeclampsia and gestational diabetes (GDM). Our study evaluated the cost-effectiveness of using an exercise-based intervention to reduce the risk of both preeclampsia and GDM in obese women.
A decision-analytic model was built using TreeAge 2016 software to examine whether an exercise intervention would be a cost-effective intervention in decreasing the risk of developing preeclampsia and GDM in women who start pregnancy at a BMI ≥30. The effect of the intervention as well as other probabilities, outcomes, utilities, and life expectancies were abstracted from the literature including a randomized trial that examined the effect of exercise on preeclampsia if performed from weeks 9-38 of pregnancy. Outcomes analyzed included preeclampsia, GDM, preterm delivery, method of delivery, permanent brachial plexus injury, cerebral palsy, and maternal and neonatal mortality. A cost-effectiveness threshold was set at $100,000 per quality adjusted life year (QALY). Univariate sensitivity analyses were used to investigate the impact of interventions with varying effectiveness.
Exercise results in 74,824 fewer cases of preeclampsia, 109,980 fewer cases of GDM, and 14,136 fewer preterm births per 1,000,000 women treated as well as the negative outcomes associated with both preeclampsia and GDM. Exercise also decreased the rates of neonatal mortality and maternal mortality by 137 deaths and 20 deaths respectively. The intervention was cost-effective leading to both lower total costs and better outcomes (a dominant strategy). Using sensitivity analyses, exercise is cost saving up to a cost of the intervention of $2,934, and cost-effective up to a cost of $4,005.
A prenatal exercise-based intervention leads to decreased costs and improved outcomes among obese women. How to fund and incorporate greater access to exercise during pregnancy should be examined from a public health standpoint.