PROJECT SUMMARY One in 3 pregnant women with chronic hypertension (CHTN) deliver preterm from complications of superimposed preeclampsia or fetal growth restriction (FGR). The specific aims are: 1) prospectively evaluate the placental longitudinally via functional magnetic resonance imaging (MRI) in healthy pregnant women and pregnant women with CHTN; 2) extract radiomics texture features in normal and hypertensive placentas and 3) execute technical refinement toward automated segmentation for regions of interest to delineate patterns in placental abnormalities. We will study 20 normal pregnant women and 40 pregnant women with CHTN across gestation. MRI will be performed in the early and late second trimester to assess perfusion via arterial spin labeling (ASL), diffusion via intra-voxel incoherent motion (IVIM) diffusion weighted imaging (DWI) and DWI- derived apparent diffusion coefficient (ADC) mapping, and oxygenation via T2* from blood-oxygen level dependent (BOLD) MRI. Radiomics texture features also be extracted from MR imaging and automated segmentation applied for more subjective placental assessment. This career development award will establish Dr. Herrera as a clinical investigator focused on non-invasive imaging assessment of placental development and dysfunction. The award will provide her with the support needed to develop expertise in 3 areas: 1) clinical research 2) application and interpretation of advanced imaging modalities, and 3) technical skills of post- processing and deep learning. To achieve these goals, Dr. Herrera has assembled an interdisciplinary team with expertise in clinical investigation, placental imaging, and post-processing and automated segmentation techniques. Her primary mentor, Dr. Catherine Spong, has a long track record of successful clinical, translational, and basic science research including over 270 peer review publications and mentoring faculty to become independent investigators. The focus of this proposal is on the human placenta. Despite 150+ years of placental research, the role of the placenta in the pathology of pregnancy-related disease remains poorly understood. Understanding normal placental development and changes present in placental disease will provide a foundation to facilitate clinical prediction of pathologic conditions during pregnancy and provide an opportunity to test interventions. In this study, we will address the unmet clinical need to characterize both normal placental development and placental dysfunction in vivo. We have chosen to compare normal pregnant women with pregnant women with chronic hypertension as these women are increased risk for placental- mediated disease. Successful completion of this project will allow for better understanding of the placenta in normal pregnancy and pregnancy affected by chronic hypertension. We will also correlate our results with clinical outcomes of preeclampsia and FGR. Given the increased risk of superimposed preeclampsia and FGR in pre...