This application, in response to CDC-RFA-DD-23 (“Pregnant People–Infant Linked Longitudinal Surveillance”), describes how we will 1) develop a data platform to collect linked pregnant-people and infant data for antenatal exposure to opiate use disorder (OUD) and 2) analyze and disseminate these findings to inform care that promotes patient-centered care and health outcomes for pregnant-patients and their infants. The University of Rochester Medical Center’s (URMC) status as a regional center of excellence with integrated care systems that serve a large, diverse, and well-characterized population positions us to track sufficient numbers of pregnant patients and their infants with health exposures targeted in this RFA. The URMC infrastructure is combined with highly developed and specialized services for providing optimal care for pregnant women and infants. For this RFA, we will capitalize on our ongoing work with CDC/Public Health Informatics Institute (PHII) on Opioid Use Disorder during pregnancy and expand this focus to include polysubstance abuse (PSA) and prenatal infections, including CMV, HIV, syphilis, group B Streptococcus (GBS), COVID-19, and mpox. The data obtained will aid in assessing the impact of these exposures and outcomes and inform clinical recommendations, collaborations, and public health policies.