Inclusion Criteria:

• Prenatal sequencing group
• 1. Fetus identified by ultrasound and/or MRI with at least one of the following:
• 1. One or more major structural anomalies (Appendix A)
• 2. A nuchal translucency measurement of ≥ 3.5 mm
• 3. A fetus less than 24 weeks 0 days gestation with normal anatomy and sonographically estimated fetal weight \<5th %ile without maternal hypertension, type I diabetes, or other maternal disorders known to alter fetal growth.
• 2. Negative prenatal CMA (or those with CMA findings not related to the ultrasound finding)
• 3. Singleton or twin gestation
• 4. Gestational age less than 36 weeks, 0 days to allow for availability of sequencing results before delivery
• Unsequenced Group
• 1. Fetus identified by ultrasound and/or MRI with at least one of the following:
• 1. One or more major structural anomalies (Appendix A)
• 2. A nuchal translucency measurement of ≥ 3.5 mm
• 3. A fetus less than 24 weeks 0 days gestation with normal anatomy and sonographically estimated fetal weight \<5th %ile without maternal hypertension, type I diabetes, or other maternal disorders known to alter fetal growth
• 2. Negative prenatal or postnatal CMA (or those with CMA findings not related to the ultrasound finding)
• 3. Declined prenatal sequencing
• 4. Singleton gestation

Exclusion Criteria:

• Prenatal Sequencing Group
• 1. Prenatal sequencing or planned prenatal sequencing performed outside of the study, including gene panels
• 2. Maternal or paternal age less than 18 years old
• 3. Proven infectious or teratogenic cause of fetal anomaly
• 4. Planned termination of the pregnancy
• 5. Unavailable blood or saliva samples from both biologic parents prior to sequencing
• 6. Parental unwillingness to participate in 1 year postnatal follow-up
• 7. Language barrier (non-English or Spanish speaking)
• 8. Previous consent to the unsequenced prenatal group or enrollment in a previous pregnancy
• Unsequenced Group
• 1. Maternal or paternal age less than 18 years old
• 2. Proven infectious or teratogenic cause of fetal anomaly
• 3. Positive prenatal NIPT screening for trisomy 21,18 or 13. Positive 22q11.2 prenatal NIPT testing with consistent ultrasound findings is also an exclusion.
• 4. Planned termination of the pregnancy
• 5. Parental unwillingness to participate in 1 year postnatal follow-up
• 6. Language barrier (non-English or Spanish speaking)