In the US, Black women experience two to three times higher rates of adverse pregnancy outcomes and pregnancy-related mortality compared to their White counterparts. This disparity persists despite adjustments for socio-economic factors like education and income, showcasing the impact of structural racism and discrimination. These factors may have biological implications, leading to an elevated risk of adverse pregnancy outcomes driven by placental dysfunction. Placental dysfunction occurs when the placenta fails to deliver sufficient oxygen and nutrients to the fetus, linked to outcomes such as preeclampsia and preterm birth. Our lab previously identified significant placental differences in metabolic and transcriptional factors of healthy Black women versus White women, indicating reduced resilience to additional stress. The current projet uses extracellular vesicles (EVs) to understand metabolic and placental differences between first-trimester Black women with adverse vs non-adverse outcomes. EVs are a heterogeneous population ranging from small (30-200 nm) to large (200-1000 nm) that are released into the extracellular environment by all cell types. EVs transport RNAs, proteins, and mitochondrial components between maternal and placental cells, influencing cellular functions in recipient cells and reflecting the pathological states of their cells of origin. This projeced assessesd the potential of circulating plasma-derived EV from first-trimester Black women as early indicators of adverse outcomes. Using the mtDNA content of EVs as a marker of cellular stress, we hypothesize that small EVs from women with adverse outcomes will exhibit elevated mtDNA levels, indicative of increased stress.