Obesity is a major public health problem. Children of women who were obese before or during pregnancy are at increased risk for neurobehavioral developmental problems. Whether a maternal lifestyle intervention conducted before and during pregnancy in obese women affects child neurobehavioral development is unknown. This study reports on the follow‐up of a subsample of two randomized controlled trials, the Finnish RADIEL (n = 216) and Dutch LIFEstyle (n = 305) trial. Women with a pre‐pregnancy BMI ≥29 kg/m² wishing to conceive or who were already pregnant (<20 weeks) were allocated to a lifestyle intervention or to care as usual. Child neurodevelopment was measured with the Ages and Stages Questionnaire and child behavioral problems were measured with the Childhood Behavior Checklist (RADIEL) or the Strengths and Difficulties Questionnaire (LIFEstyle) at age 3‐6 years. We used linear and binary logistic regression analyses to assess the effects of the lifestyle interventions on children's neurobehavioral developmental scores. Follow‐up data was available from 161(38%) RADIEL and 96(32%) LIFEstyle children. Child neurodevelopmental scores did not differ significantly between children in the intervention and the control group (RADIEL:median = 275 vs. 280; LIFEstyle:median = 270 vs 267). Child behavioral problem scores did not differ significantly between children in the intervention and the control group (RADIEL:median = 22 vs. 21; LIFEstyle:median = 8 vs. 8). We did not observe considerable effects of the lifestyle interventions before or during pregnancy in obese women on child neurobehavioral development. With our sample sizes, we were not able to detect subtle differences in neurobehavioral development however.

Introduction: The care for many patients with diabetes mellitus type 2 in the Netherlands, is contracted by a local care group. The healthcare providers, who collectively shape a care group, provide protocolled diabetes care. Differences exist between care groups in terms of their organizational and financial arrangements. These differences may result in variation in outcomes. The aim of this study is to assess whether variation in healthcare costs, diabetes complications and related hospital admissions on the level of care groups exist. Methods: A quantitative cohort study was conducted. Patients who used diabetes medication (more than 180 days of defined daily doses per year) for the first time between the years 2014 and 2019 were included. Data were extracted from health insurance claims between 2014 and 2019. Generalized linear mixed models were used to analyse patient variation in healthcare costs (two and six years follow-up), diabetes-related complications and hospital admission days. Intraclass correlation coefficients were calculated to estimate the amount of variation that was attributable to the care groups. Results: A large variation in outcome variables was observed between patients and a small variation between care groups. The intraclass correlation coefficient for long-term costs was 0.4%; for short-term costs between 0.1% and 0.3%; for complications 1% and for hospital days 4%. Discussion: A large variation between patients with diabetes mellitus type 2 exists in terms of their healthcare costs and complications. In our study, care groups accounted minimally for this variation. A generalized linear mixed model in combination with year cohorts is a tool to study variations in the long-term outcomes of integrated care initiatives.