The Maternal-Fetal Medicine (MFM) Division of the University of Alabama at Birmingham (UAB) submits this application to continue as a clinical center of the NICHD MFM Units (MFMU) Network. We present our center's attributes and longstanding record of exceptional performance in the Network. We remain committed to the Network's goals to improve obstetric care, pregnancy health, and outcomes for pregnant/lactating people and their babies. Our internationally-renowned, Center for Women's Reproductive Health (CWRH), the home of our MFMU center, has a research staff of >50 and extensive successful experience leading large clinical trials and observational studies to transform maternal and infant health both in and outside the Network. As an MFMU center for >30 years, UAB has consistently played a leadership role in providing stewardship for the Network at the Steering Committee and sub-committee levels, conducted Network trials with the highest efficiency of any center, and led all centers in the presentation and publication of data generated. Among 32 clinical centers in MFMU history, a UAB investigator first-authored >17% of Network publications (14.5% since 2016) and 18% of presentations at national meetings. Current members of our team have accumulated >250 MFMU person-years' experience of active participation supporting MFMU projects; our research staff similarly cumulate >275 MFMU person-years. Alan Tita, MD, PhD (CWRH Director) and Brian Casey, MD will continue as PI and Alternate PI, respectively. Our team includes 2 previous MFMU PI's and 7 members who have served or currently serve as Network protocol chairpersons or Subcommittee members. We continue to enroll and retain the highest number of participants in many network studies; adjusted for the available population, we enroll the highest of any MFMU site. Our enriched high-risk and diverse population (>50% black), strong culture of research support and collaboration, 24/7 research staff coverage and high proportion of screen-eligible patients successfully enrolled into network studies allow us to sustain and continue this high level of performance. If successful in this renewal, we will strengthen our collaboration with Ochsner Health System as a satellite site. We will deploy our extensive research resources - data management systems, recruitment resources including programming into electronic health records, transdisciplinary investigative team and experienced personnel - to conceive, design and implement new innovative and impactful studies. We will leverage the network to train future research leaders including our next PI. Our record of success extends to leadership of complementary large non-MFMU consortia conducting impactful clinical trials and follow-up studies towards similar goals, including the Chronic Hypertension and Pregnancy consortium and the American Heart Association Health Equity Research Network on Disparities in Maternal-Infant Health Outcomes. Since 2016 our core MFM ...