Project Summary: Category 5 Hurricane Irma passed Puerto Rico on September 6, 2017, causing an estimated $1 billion in damage and 3 confirmed fatalities in Puerto Rico. Two weeks later, on September 20, Hurricane Maria made direct landfall with sustained 175 mile per hour winds. Although the evidence is limited, natural disasters have been shown to have consequences on infant health outcomes. Based on perinatal health findings following previous natural disasters, expectant and new mothers in Puerto Rico face many challenges including access to adequate prenatal care, increased likelihood of stress, depression and anxiety, lack access to nutrition, pregnancy-induced hypertension and gestational diabetes, and increase contact to environmental toxins and exposures. The overarching goal of this proposed research is to examine associations between hurricane exposure and recovery, and preterm birth and other infant health outcomes. Specifically, our proposed research intends to collect information on expectant mothers? hurricane and recovery experiences, including an inventory of disaster related traumatic events, measures traumatic exposures, and frequencies of severe experiences. We will compare these exposures to birth outcomes in their infants including preterm birth, low birth weight, pre-eclampsia, fetal death, gestational diabetes and small and large for gestational age. We will utilize current research infrastructure that is in place in Puerto Rico that recruits pregnant mothers early in pregnancy and follows them throughout pregnancy until birth. Puerto Rico Test site for Exploring Contamination Threats (PROTECT) and Zika in infants and Pregnancy (ZIP) studies have establish cohorts of pregnant women in Puerto Rico through collaborations with several Federally Qualified Health Centers and private clinics. Our research team?s long-standing rapport with these clinics allow for a unique opportunity for this research. By utilizing the PROTECT and ZIP cohorts we will be able to take advantage of a strong baseline in which we can compare out results to. Expectant and new mothers are a vulnerable part of the population and need special consideration in preparing for future natural disasters in order to help protect the public?s health from weather events. This study, although conducted in Puerto Rico, has implications for populations in all hurricane prone areas in the United States the Atlantic and Pacific regions.