Abstract: The goal of the Multilevel Interventions for Maternal Health Disparities (MIRACLE) Center is to reduce pregnancy-related and pregnancy-associated maternal morbidity and mortality (PRAMM) and health disparities among populations disproportionately affected through innovative community-partnered effectiveness and implementation research. This Center will address the need for multilevel, community-centered interventions developed and tested with an emphasis on scalability and sustainment to address PRAMM and health disparities. The MIRACLE Center is innovative because it: (1) tests complementary, multilevel pregnancy-to-postpartum interventions operating across multiple health systems and settings; (2) addresses and measures a wide range of PRAMM conditions (including non-severe morbidity and pregnancy-associated mortality, which are less commonly measured), as well as severe maternal morbidity (SMM) and pregnancy-related mortality; (3) analyzes main effects within each project and synergistic effects across projects, which target different levels and sources of disparities; (4) uses a statewide linked Medicaid dataset (claims, vital records, screening data) to evaluate common outcomes, allowing for data harmonization across projects and with other Centers nationally; and (5) focuses on the understudied implementation science concepts of scale-up and sustainment. The Center is significant because it: (1) develops and tests novel approaches to addressing determinants of maternal health and disparities at multiple levels and in multiple systems, (2) tests these population-level interventions in 20 Michigan counties, covering a population of >7 million; and (3) uses a fairly partnered Center structure, with academic and health system or community PIs of the Center and of each component. All these features enhance utility and impact of the proposed work. Through three R01-scope projects implementing and testing multilevel interventions, and Community Partnership and Training Components the Center will accomplish the following Aims: (1) Evaluate effectiveness, cost-effectiveness, implementation, and population-wide impact of innovative and culturally relevant multilevel interventions to reduce PRAMM and health disparities; (2) Generate and scale innovative approaches & partnerships to reduce PRAMM and health disparities; (3) Maximize scalability, sustainability, community relevance, and broad dissemination of identified approaches; (4) Increase research, practice, and policy capacity for reducing PRAMM and health disparities. This Center is rooted in a multi-disciplinary Research Community with involvement of longstanding community, health, and policy partners in all phases of the Center’s work, and partnership with Medicaid-eligible mothers and their families in urban and rural settings. With in-kind financial support from academic and health institutions, the Center will generate scalable and sustainable approaches for saving maternal live...