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Interventions to prevent excessive gestational weight gain (general population)

Health Care: Maternal and Infant Health
Benefit-cost methods last updated December 2023.  Literature review updated December 2016.
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A wide range of programs aim to prevent excessive gestational weight gain. We included programs that offer an exercise class and programs that offer counseling on recommended weight gain during pregnancy. Typically athletic trainers lead exercise programs in groups and counseling is delivered one-on-one in a clinical setting by a health educator, midwife, or obstetrician. Counseling ranged from one to nine sessions.
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $125 Benefits minus costs ($1,359)
Participants ($176) Benefit to cost ratio ($5.27)
Others $203 Chance the program will produce
Indirect ($1,295) benefits greater than the costs 34%
Total benefits ($1,142)
Net program cost ($217)
Benefits minus cost ($1,359)

^WSIPP’s benefit-cost model does not monetize this outcome.

***We report this outcome twice: once for mothers (designated as the primary participant) and once for infants (designated as the secondary participant). We do this because the outcome is associated with costs and benefits for both mothers and infants, and the amount of the cost or benefit is different for mothers than it is for infants.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
31 Primary 10 1172 -0.184 0.052 31 n/a n/a n/a -0.184 0.001
31 Primary 5 621 -0.256 0.120 31 n/a n/a n/a -0.256 0.033
31 Primary 5 1054 -0.081 0.102 31 0.000 0.000 32 -0.081 0.425
31 Primary 2 148 0.048 0.117 31 0.000 0.000 32 0.048 0.682
31 Primary 3 706 -0.009 0.136 31 n/a n/a n/a -0.009 0.945
31 Primary 2 468 -0.461 0.189 31 n/a n/a n/a -0.461 0.015
31 Primary 4 719 0.025 0.070 31 0.000 0.000 32 0.025 0.722
31 Primary 6 1247 0.070 0.066 31 0.000 0.000 32 0.070 0.287
1 Secondary 4 719 0.025 0.070 1 0.000 0.000 2 0.025 0.722
1 Secondary 6 1247 0.070 0.066 1 0.000 0.000 2 0.070 0.287
1 Secondary 7 1272 -0.131 0.111 1 n/a n/a n/a -0.131 0.239
1 Secondary 1 421 -0.135 0.327 1 0.000 0.000 2 -0.135 0.680
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1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Weight change Labor market earnings associated with diabetes ($5) ($11) $0 $0 ($16)
Mortality associated with diabetes $0 $0 $0 $0 $0
Cesarean sections Health care associated with Cesarean sections $50 $2 $50 $25 $127
Preterm birth Health care associated with preterm births ($13) ($1) ($13) ($6) ($33)
Subtotals $32 ($10) $37 $18 $78
From secondary participant
Preterm birth Infant mortality ($73) ($173) $0 ($1,288) ($1,534)
Health care associated with preterm births ($103) ($4) ($103) ($52) ($263)
NICU admission Health care associated with NICU admissions $270 $11 $270 $135 $685
Subtotals $93 ($166) $166 ($1,205) ($1,112)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($108) ($108)
Totals $125 ($176) $203 ($1,295) ($1,142)
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $182 2015 Present value of net program costs (in 2022 dollars) ($217)
Comparison costs $0 2015 Cost range (+ or -) 50%
The length of these interventions vary from a single session up to seven months. The average per-participant cost was calculated by multiplying the number of staff hours per participant by the average 2015 salary of the staff member as reported by the Bureau of Labor Statistics ( We multiplied the average salary by 1.441 to estimate the total staff costs including benefits.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Althuizen, E., Wijden, C.L.V.D., Mechelen, W.V., Seidell, J.C., & Poppel, M.N.M.V. (2012). The effect of a counseling intervention on weight changes during and after pregnancy: a randomised trial. BJOG: an International Journal of Obstetrics & Gynecology, 120(1), 92-99.

Barakat, R., Lucia, A., & Ruiz, J.R. (2009). Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial. International Journal of Obesity, 33(9), 1048-1057.

Barakat, R., Pelaez, M., Lopez, C., Lucia, A., & Ruiz, J.R. (2013). Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. British Journal of Sports Medicine, 47(10), 630-36.

Haakstad, L.A.H., & Bø, K. (2011). Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial. The European Journal of Contraception and Reproductive Health Care, 16(2), 116-125.

Hui, A.L., Ludwig, S.M., Gardiner, P., Sevenhuysen, G., Murray, R., Morris, M., & Shen, G.X. (2006). Community-based exercise and dietary intervention during pregnancy: A pilot study. Canadian Journal of Diabetes, 30(2), 169-175.

Hui, A.L., Back, L., Ludwig, S., Gardiner, P., Sevenhuysen, G., Dean, H.J., . . . Shen, G.X. (2014). Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different prepregnancy Body Mass Index in a randomized control trial. BMC Pregnancy and Childbirth, 14(1), 331-40.

Olson, C.M., Strawderman, M.S., & Reed, R.G. (2004). Efficacy of an intervention to prevent excessive gestational weight gain. American Journal of Obstetrics and Gynecology, 191(2), 530-536.

Polley, B.A., Wing, R.R., & Sims, C.J. (2002). Randomized controlled trial to prevent excessive weight gain in pregnant women. International Journal of Obesity, 26(11), 1494-1502.

Ronnberg, A.K., Ostlund, I., Fadl, H., Gottvall, T., & Nilsson, K. (2015). Intervention during pregnancy to reduce excessive gestational weight gain-a randomised controlled trial. BJOG: an International Journal of Obstetrics & Gynaecology, 122(4), 537-544.

Ruiz, J.R., Perales, M., Pelaez, M., Lopez, C., Lucia, A., & Barakat, R. (2013). Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clinic Proceedings, 88(12), 1388- 97.

Smith, K.M. (2014). The Blossom Project Online: Use of a behaviorally-based website to promote physical activity and prevent excessive gestational weight gain in previously sedentary pregnant women. Digital Repository @ Iowa State University.

Stafne, S.N., Salvesen, K.A., Romundstad, P.R., Eggebø, T.M., Carlsen, S.M., & Mørkved, S. (2012). Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial. Obstetrics and Gynecology, 119(1), 29- 36.