PROJECT SUMMARY/ABSTRACT Life-saving advances in medical care in recent decades have reduced global mortality rates but have underperformed in addressing maternal mortality, stillbirth, and neonatal mortality. A key reason for these disparities in both low- and high-income settings is the lack of systematic screening with appropriate and affordable) technology for high priority conditions such as maternal hypertension and preeclampsia and fetal growth restriction. The development of new low-cost diagnostic tools to improve access to detection of these conditions by front-line workers would change outcomes for the most underserved populations, which is our long-term goal. In an NICHD-funded study, we collected point of care Doppler ultrasound recordings and developed a preliminary machine learning approach for detecting intrauterine growth restriction (IUGR) and maternal hypertension. The overall objective of this proposal is to prospectively validate these findings in two large underserved pregnancy cohorts in rural Guatemala and urban Georgia. Our general hypothesis is that our low-cost artificial intelligence will perform as well in detecting maternal hypertension, preeclampsia, and IUGR as standard-of-care high-cost diagnostic approaches. In Aim 1, we will validate our ultrasound-based IUGR detection algorithm against the standard of care (2-dimensional fetal imaging). In Aim 2, we will validate maternal hypertension and preeclampsia algorithms against gold-standard blood pressure devices and clinical risk prediction tools. In Aim 3, we will implement real-time versions of the algorithms validated in Aims 1 and 2 and implement them on an edge-computing system for field testing. Successful completion of this proposal will result in a novel and cost-effective approach to screening for maternal hypertension, preeclampsia, and IUGR using point-of-care Doppler connected to a low-cost, AI-enabled edge-computing system, suitable for wide use in low-resource settings. This proposal is innovative because it uses an artificial intelligence approach and widely-available point-of-care Doppler devices to provide new approaches to timely detection of high-impact maternal-fetal conditions. Our results will provide a strong basis for wide-scale deployment of new maternal and fetal screening technology which is expected to have a significant impact on maternal and fetal morbidity by improving access to timely screening. This research aligns with the NICHD's mission to advance knowledge of pregnancy, fetal development, and birth by promoting strategies that prevent maternal, infant, and childhood mortality and morbidity through lost-cost high-impact screening technology.