PROJECT SUMMARY/ABSTRACT Maternal prenatal stress and nutrition influences fetal growth and long-term child outcomes. Maternal psychological stress and undernutrition frequently co-occur and affect overlapping biological stress axes involved in fetal growth and neuroendocrine development. Still, little is known about the interactive effects of maternal prenatal stress and nutrition on fetal and long-term child outcomes. The proposed K99/R00 research will leverage data from the ongoing “Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health” (ENAT) trial in rural Ethiopia to examine interactive effects of maternal prenatal stress and nutrition intervention on fetal and child outcomes. ENAT randomized 2390 pregnant women to receive an “enhanced nutrition” package or “standard care” and collected data on maternal prenatal stress (Cohen's Perceived Stress Scale) throughout pregnancy. Existing ENAT data will be used to determine independent and interactive effects of maternal prenatal stress and nutrition intervention on birthweight-for-age (Aim 1, K99). During the R00 I will conduct a new follow up study with ENAT mother-child dyads at 36 months postpartum to assess children's stress-sensitive outcomes (Aim 2, R00). Specifically, the developmental follow-up study will assess child outcomes related to attention, stress reactivity, memory, and socio-emotional functioning. I will also use biospecimens from ENAT to examine whether maternal and newborn telomere lengths can serve as biomarkers of in- utero programming of BWAZ and child outcomes in relation to maternal prenatal stress and nutrition (Aim 3, R00). I hypothesize that maternal prenatal stress and nutrition intervention will have main and interactive effects on newborn and childhood outcomes. I also hypothesize that maternal and newborn telomere length will serve as biomarkers for prenatal programing effects of maternal stress and nutrition. My long-term career goal is to lead independent multi-disciplinary research delineating the complex ways in which biological and psychosocial factors influence fetal and child development in low resource environments. This award would allow me to acquire basic science knowledge of maternal-fetal nutrition and telomere biology, technical skills in advanced neurodevelopmental assessments including eye-tracking and electrocardiography, and practical skills in primary data collection and research management in a low-income country. During the R00 I will independently lead an innovative child development research study in rural Ethiopia. The proposed research aligns with NICHD's goal to improve pregnancy outcomes to maximize the lifelong health of women and children and to help all children thrive. The proposed study will generate epidemiologic and biologic evidence linking maternal prenatal nutrition and stress with newborn and childhood outcomes that are sensitive to prenatal stress and predict long-term outcomes related to school a...