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During the adult reproductive years, women have higher medical expenditures than men. The difference in medical expenditures between women and men is largely related to pregnancy care, childbirth and its complications. The costs of preterm and postpartum maternal hospitalization and the costs of hospital care for infants with adverse outcomes are major sources of increased cost. Because the cost of outcomes is large and the time to outcomes is short, treatments that are effective in preventing adverse outcomes of pregnancy are often cost-effective or even cost saving. Such interventions include folic acid fortification of grain to prevent NTD and smoking cessation programs to prevent low birthweight infants.