Over 10,000 women were recruited from 7 different sites: two within Cape Town, South Africa; and five within South and North Dakota, United States of America. These areas were selected due to high rates of sudden infant death syndrome (SIDS) and prenatal alcohol use. If recruited early in their pregnancy, women completed three prenatal visits at 20 to 24, 28 to 32, and 34+ weeks, and all women were then assessed at delivery, one month, and one year post delivery. Around 15% of the women enrolled had more than one child within the study period, and around 1% of all births were of twins. Additionally, the PASS-ECHO sub-study builds on this infrastructure, continuing follow-up of 6,647 mother-child pairs while expanding the cohort with 1,650 new prenatal participants and a preconception group. It focuses on how prenatal stress and lifestyle factors, such as nutrition, can affect childhood obesity and neurodevelopment, while also enhancing community engagement and increasing representation of rural and American Indian populations within the broader ECHO program.