Open Access Research article

Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: Results of an economic evaluation alongside a randomised controlled trial

Nicolette Oostdam1, Judith Bosmans2, Maurice GAJ Wouters3, Elisabeth MW Eekhoff4, Willem van Mechelen15 and Mireille NM van Poppel156*

Author Affiliations

1 Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands

2 Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands

3 Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands

4 Department of Endocrinology, VU University Medical Center, Amsterdam, the Netherlands

5 Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam and Hoofddorp, the Netherlands

6 Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, Room-C568, 1081 BT, Amsterdam, the Netherlands

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BMC Pregnancy and Childbirth 2012, 12:64  doi:10.1186/1471-2393-12-64

Published: 4 July 2012



The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care.


A randomised controlled trial (RCT) and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n = 62) or to standard care (n = 59). The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs) were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios.


There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204). The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs.


The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of GDM cannot be recommended.

Trial registration


Cost-effectiveness; Pregnancy; Exercise