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Supplement: Nutrition as a Preventive Strategy against Adverse Pregnancy Outcomes

Potential Cost-Effectiveness of Nutrition Interventions to Prevent Adverse Pregnancy Outcomes in the Developing World ^{1 ,2}

Center for Research in Women's Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35249

³ To whom correspondence should be addressed. E-mail: drouse{at}uab.edu.

The potential cost-effectiveness of antenatal nutrition interventions to improve pregnancy outcomes in the developing world has not undergone formal evaluation. Furthermore, the effectiveness of antenatal care in improving maternal or fetal and neonatal health has been questioned. However, reasonably compelling evidence from randomized trials shows that nutrition interventions can prevent both infant (iodine supplementation) and maternal (vitamin A and ß-carotene supplementation) deaths, and informal analysis suggests that the cost-effectiveness of nutrition interventions would be comparable and, in some cases, markedly superior to several standard antenatal interventions. Future efforts to establish the cost-effectiveness of nutrition interventions in developing countries will depend on conducting large, pragmatic clinical trials that use region- and resource-appropriate interventions with mortality or valid, incontrovertibly severe morbidity endpoints. If such trials establish effectiveness, credible cost-effectiveness analyses can then be performed.

KEY WORDS: • cost-effectiveness • nutrition intervention • pregnancy outcomes • developing world

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