PROJECT SUMMARY Meeting the Sustainable Development Goals' 2030 targets for maternal and child morbidity and mortality will require sustained and effective public health interventions for the most vulnerable populations. The broad goal of this application is to continue to participate in all collaborative activities relevant to the mission of the Global Network (GN), which aims to develop and test potential sustainable interventions through collaborative, large- scale, high-impact, multi-site common research protocols. The primary objective of our research unit (RU), which represents a partnership between the University of Colorado and Guatemala, is to develop and implement nutrition-specific interventions to mitigate the effects of pre- and post-natal malnutrition and thereby to improve maternal and infant health outcomes. This objective will be met through the following specific aims: 1) continue to maintain a strong research record and productivity as GN members; 2) continue to foster a progressively stronger research partnership with our colleagues in Guatemala and other GN sites; and 3) continue to develop nutrition-specific interventions as GN common protocols. During the past 5-yr cycle, this RU has built a strong research record, as evidenced by having led two major nutrition-specific common protocols, including the preconception maternal nutrition intervention trial; having strengthened the research capacity in Guatemala; participation in the development and implementation of all GN-initiated common protocols with contribution of a high percentage of cluster/participant numbers to each study; strong productivity in publications (total of 60 with GN co-authors) that report findings of GN supported trials; and having successfully obtained major external funding to support common protocol implementation. Major contributions to the GN by this RU include co-chairing the Protocol Review Sub-committee and the oversight committee for the ongoing Maternal Newborn Health Registry. Successful mentoring and capacity building for the RU is evidenced from invitation by NICHD for the Sr. Foreign Investigator to be site lead for a multi-country observational study of Zika virus exposure during pregnancy. The positive impact of our continued participation in the GN will be to strengthen the multi-disciplinary capacity of the Global Network by identifying nutrition- specific interventions to improve maternal and infant health. Such collaborative research will accelerate the development of evidence-based policies to reduce the global burden of malnutrition and other adverse health outcomes.

PROJECT NARRATIVE Identification of effective nutrition-specific interventions to improve maternal and infant health is critical to mitigate the enormous loss of human potential in low resource settings due to both pre- and post-natal malnutrition. Our expertise in maternal, infant, and young child nutrition will strengthen the multi-disciplinary capacity of the Global Network to develop effective common protocols. Such collaborative research will accelerate the development of evidence-based policies to reduce the global burden of malnutrition and adverse health outcomes.