The Agency for Health Care Policy and Research (AHCPR) holds the main responsibility at the federal level for examining the relationship between how health care is organized, financed, and delivered and the care outcomes and health of those it is intended to serve. Since its inception, AHCPR has struggled to balance the need for rigorous research that addresses the question of what works with the impatience of all stakeholders in the health care system for solutions rather than ever more refined questions. Increased demands by public policy makers, health systems leaders, and even patients for better evidence to inform decisions at all levels of health care delivery is exciting – but also creates an unprecedented opportunity and challenge to the research community, and underscores the lacunae in the knowledge base supporting many areas of health care delivery. It was in recognition of this opportunity that AHCPR supported the conference that formed the basis for this book on the practice and the potential of prenatal care.

Research on effectiveness and cost-effectiveness can and does affect health policy. In 1985, the Institute of Medicine published Preventing Low Birthweight, a work often cited as the prime example of the impact research can have. The finding that every dollar spent on providing more adequate prenatal care for low-income, poorly educated women could reduce medical expenditures by $3.38 in the first year of the baby's life was a potent stimulus for subsequent policies that expanded Medicaid benefits for pregnant women and children.