PROJECT SUMMARY The overall maternal and infant health outcomes in rural areas of the United States depict a constant and growing health need. Continued technological advances are needed to improve health care services and outcomes for the most vulnerable populations. The long-term objective of this multidisciplinary team is to transition an engineering prototype to a self-monitoring clinical prototype. The objective of this proposal is to develop the functionality of a wireless, non-invasive skin-wearable fetal electrocardiogram (fECG) monitoring device based on an accurate fECG extraction algorithm and cloud-based remote health monitoring to improve clinical care among low-risk pregnant women in a rural community that is acceptable to prenatal healthcare services consumers. To achieve the proposal objective, the study will focus on two specific aims: Aim 1 - development of a wearable fECG monitoring device prototype via human subject-based testing in a rural based healthcare setting; and Aim 2 - examining the acceptability of wireless wearable monitoring health devices among females using community-based participatory research to understand the needs, perceptions, and preferences among women who have previously been pregnant. The expected outcomes upon completion of this study are the demonstrated functionality of the wearable fECG device and multiple sources of patient-centered data to support the future use of the device. In the future, widespread use of the wearable device is likely to improve obstetrical care for pregnant women through the ability to increase maternal mobility during labor and improved birth outcomes for both women and infants. Future studies could enhance rural health care access by using the wearable device remotely. These efforts align with the fifth NICHD theme to advance safe and effective devices for pregnant women and the efforts include a multidisciplinary collaboration with researchers in fields from engineering, nursing, and public health. Additionally, the research is community-based and includes a rural underrepresented population.