PROJECT SUMMARY/ABSTRACT The University of Utah has been one of the most productive sites in the NICHD Maternal-Fetal Medicine Units (MFMU) Network over the past 27 years, contributing numerous concepts and protocols, large numbers of well-characterized study participants, high-quality data, and multiple important secondary analyses resulting in national presentations and high impact publications. The specific aim of this application is a successful competitive renewal for the existing Utah Clinical Center as a member of the MFMU Network. The Utah Center is consistently among the leading Network centers for screening, recruitment and data quality. Torri Metz MD has served as the Utah center PI since early 2019. She has worked to ensure that the University of Utah – Intermountain Healthcare (IHC) collaboration continues to be mutually beneficial, and given her long-standing collaboration with the University of Colorado, was able to add them as a satellite site of the Utah Center in early 2022. The 6 participating hospitals represent over ~20,000 deliveries per year in the Intermountain West with a catchment area that includes Utah, Colorado, Idaho, Nevada, New Mexico, Wyoming, Arizona, and Montana. Importantly, Utah provides geographic diversity with potential participants from rural and frontier locations who are at increased risk of maternal morbidity and mortality. Utah investigators have established partnerships with leaders in our Native Hawaiian/Pacific Islander and Native American communities to help increase enrollment in clinical studies and further diversify our participants. We have a collaborative relationship with the Utah Neonatal Research Network, which has contributed to our success in long-term follow-up studies. Overall, 21 perinatal research personnel at UUHSC and IHC, and an additional 4 research staff in Colorado, are specifically dedicated to MFMU studies. Coverage is available 24/7. Our staff are dedicated clinical researchers, with a low turnover rate. The Utah center contributes to the science of the MFMU and has submitted 28 proposals to the Network Steering Committee, of which 16 have been advanced to full protocol status. Dr. Torri Metz (Utah Center PI) is the PI for two active MFMU protocols (GRAVID and PASC-PREG), has numerous Network committee responsibilities, and has developed collaborations between the MFMU Network and other NIH-funded clinical research networks. The addition of Dr. Kevin Watt (co-I) brings expertise in obstetric pharmacology and pharmacokinetics in pregnant and lactating people. The University of Utah is enthusiastically committed to continued participation in the NICHD MFMU Network, as confirmed by multiple letters of support. The proven and continuing ability of Drs. Metz and Esplin to enlist wide-spread participation by community obstetric providers and to attract/retain an excellent clinical research staff are major factors in the success of the Utah site and will continue through the complet...