PMID- 27936083
OWN - NLM
STAT- MEDLINE
DCOM- 20170710
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 12
DP  - 2016
TI  - Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle 
      Counseling Trial: A Seven-Year Follow-Up.
PG  - e0167759
LID - 10.1371/journal.pone.0167759 [doi]
LID - e0167759
AB  - There is a link between the pregnancy and its long-term influence on health and 
      susceptibility to future chronic disease both in mother and offspring. The 
      objective was to determine whether individual counseling on physical activity and 
      diet and weight gain at five antenatal visits can prevent type 2 diabetes 
      mellitus (T2DM) and overweight or improve glycemic parameters, among all 
      at-risk-mothers and their children. Another objective was to evaluate whether 
      gestational lifestyle intervention was cost-effective as measured with mother's 
      sickness absence and quality-adjusted life years (QALY). This study was a 
      seven-year follow-up study for women, who were enrolled to the antenatal 
      cluster-randomized controlled trial (RCT). Analysis of the outcome included all 
      women whose outcome was available, in addition with subgroup analysis including 
      women adherent to all lifestyle aims. A total of 173 women with their children 
      participated to the study, representing 43% (173/399) of the women who finished 
      the original RCT. Main outcome measures were: T2DM based on medication use or 
      fasting blood glucose or oral glucose tolerance test (OGTT), body mass index 
      (BMI), glycosylated hemoglobin (HbA1c). None of the women were diagnosed to have 
      T2DM. HbA1c or fasting blood glucose differences were not found among mothers or 
      children. Differences in BMI were non-significant among mothers (Intervention 
      27.3, Usual care 28.1 kg/m2, p = 0.33) and children (I 21.3 vs U 22.5 kg/m2, p = 
      0.07). Children's BMI was significantly lower among adherent group (I 20.5 vs U 
      22.5, p = 0.04). The mean total cost per person was 30.6% lower in the 
      intervention group than in the usual care group (I euro2,944 vs. U euro4,243; p = 
      0.74). Intervention was cost-effective in terms of sickness absence but not in 
      QALY gained i.e. if society is willing to pay additional euro100 per one avoided 
      sickness absence day; there is a 90% probability of the intervention arm to be 
      cost-effective. Long-term effectiveness of antenatal lifestyle counseling was not 
      shown, in spite of possible effect on children's BMI. Cost-effectiveness of the 
      intervention in terms of sickness absence may have larger societal impact.
FAU - Kolu, Paivi
AU  - Kolu P
AD  - UKK Institute for Health Promotion, Tampere, Finland.
FAU - Raitanen, Jani
AU  - Raitanen J
AD  - UKK Institute for Health Promotion, Tampere, Finland.
AD  - School of Health Sciences, University of Tampere, Tampere, Finland.
FAU - Puhkala, Jatta
AU  - Puhkala J
AD  - UKK Institute for Health Promotion, Tampere, Finland.
FAU - Tuominen, Pipsa
AU  - Tuominen P
AD  - UKK Institute for Health Promotion, Tampere, Finland.
FAU - Husu, Pauliina
AU  - Husu P
AD  - UKK Institute for Health Promotion, Tampere, Finland.
FAU - Luoto, Riitta
AU  - Luoto R
AD  - School of Health Sciences, University of Tampere, Tampere, Finland.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20161209
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - Body Mass Index
MH  - Child
MH  - Cost-Benefit Analysis
MH  - *Counseling/economics
MH  - Diabetes Mellitus, Type 2/economics/epidemiology/*prevention & control
MH  - Diabetes, Gestational/economics/epidemiology/*prevention & control
MH  - Diet
MH  - Female
MH  - Follow-Up Studies
MH  - Health Care Costs
MH  - Humans
MH  - *Life Style
MH  - *Maternal Health Services/economics
MH  - Pregnancy
MH  - Prenatal Care/economics
MH  - Quality-Adjusted Life Years
MH  - Weight Gain
PMC - PMC5147978
COIS- The authors have declared that no competing interests exist.
EDAT- 2016/12/10 06:00
MHDA- 2017/07/14 06:00
PMCR- 2016/12/09
CRDT- 2016/12/10 06:00
PHST- 2016/08/08 00:00 [received]
PHST- 2016/11/18 00:00 [accepted]
PHST- 2016/12/10 06:00 [entrez]
PHST- 2016/12/10 06:00 [pubmed]
PHST- 2017/07/14 06:00 [medline]
PHST- 2016/12/09 00:00 [pmc-release]
AID - PONE-D-16-31676 [pii]
AID - 10.1371/journal.pone.0167759 [doi]
PST - epublish
SO  - PLoS One. 2016 Dec 9;11(12):e0167759. doi: 10.1371/journal.pone.0167759. 
      eCollection 2016.