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01.
arXiv (CS.LG) 2026-06-18

KEPLA: A Knowledge-Enhanced Deep Learning Framework for Accurate Protein-Ligand Binding Affinity Prediction

arXiv:2506.13196v5 Announce Type: replace Abstract: Accurate prediction of protein-ligand binding affinity is critical for drug discovery. While recent deep learning approaches have demonstrated promising results, they often rely solely on structural features of proteins and ligands, overlooking their valuable biochemical knowledge associated with binding affinity. To address this limitation, we propose KEPLA, a novel deep learning framework that explicitly integrates prior knowledge from Gene Ontology and ligand properties to enhance prediction performance. KEPLA takes protein sequences and ligand molecular graphs as input and optimizes two complementary objectives: (1) aligning global representations with knowledge graph relations to capture domain-specific biochemical insights, and (2) leveraging cross attention between local representations to construct fine-grained joint embeddings for prediction. Experiments on two benchmark datasets across both in-domain and cross-domain scenarios demonstrate that KEPLA consistently outperforms state-of-the-art baselines. Furthermore, interpretability analyses based on knowledge graph relations and cross attention maps provide valuable insights into the underlying predictive mechanisms.

02.
arXiv (CS.CV) 2026-06-17

Theoretical Grounding of Out-Of-Distribution Detection With Reinforcement Learning Optimizer

Out-of-distribution (OOD) detection in dynamic open-world environments requires a model to continually adapt to evolving data distributions while generalizing to covariate-shifted inputs and rejecting semantic-shifted OOD examples. Most existing OOD detection methods optimize only the current-step objective and do not explicitly account for how post-deployment environment changes affect future OOD behavior. In this paper, we establish a theoretical grounding for dynamic OOD detection using a reinforcement learning (RL)-guided optimizer that explicitly favors updates that reduce the semantic OOD false positive rate over time. We develop a novel augmented optimizer that uses an RL-guided correction term on top of standard gradient descent (GD) and show its improvement over both future-domain generalization and semantic-OOD rejection. We analyze temporal error decomposition in terms of model-change and environment-change generalization errors and develop a new theoretical framework for comparing the generalization errors under both GD and RL-guided optimizers.

03.
arXiv (CS.CL) 2026-06-15

When Plausible Is Not Realistic: Evaluating Human Mobility in LLM-Based Urban Simulation

LLM-based generative agents are increasingly used in urban simulators, yet it remains unclear whether they reproduce empirically realistic human mobility patterns or merely generate plausible mobility narratives. We introduce a validation framework for evaluating the mobility of generative agents of LLM-based urban simulators against real-world mobility data. For this, we use mobility laws, temporal rhythms, network motifs, semantic activity transitions, and behavioral mobility profiles. Using datasets from the Greater Paris region and Shanghai, we evaluate AgentSociety and CitySim across multiple dimensions of mobility realism. Our analysis reveals a substantial gap between narrative plausibility and empirical mobility realism. Although the simulators capture some high-level semantic activity distributions, they struggle to reproduce core spatial and temporal constraints, including realistic trip-length distributions, origin-destination flows, dwell times, and transition dynamics. We further observe that realistic mobility diversity is unstable across default prompting configurations and may require explicit profile-aware initialization. To support reproducible evaluation, we also contribute scalable and open LLM-driven infrastructure for regional-scale map generation, observability-enhanced simulation, mobility-metric computation, and traffic simulation. Our findings highlight the need for rigorous empirical validation of LLM-based urban simulators and provide practical tools for building more realistic and reproducible urban simulation systems.

04.
medRxiv (Medicine) 2026-06-16

Higher Population Coverage with Typhoid Conjugate Vaccine is Needed to Induce Herd Protection: Evidence from a Cluster-Randomized Trial in Urban Bangladesh

Introduction: A cluster randomized trial (CRT) in Bangladesh found that Vi-tetanus toxoid (Vi-TT) vaccine conferred 85% protection to vaccinees at 18 months of follow-up; however, it failed to confer significant herd protection to non-vaccinees. Methods: In the CRT, children aged 9 months to

05.
arXiv (CS.CV) 2026-06-11

Spatially Selective Self-Training for Unsupervised Building Change Detection

Unsupervised building change detection aims to learn building-change masks from unlabeled bi-temporal remote sensing images. Existing label-free methods often follow a discrepancy-to-mask paradigm, directly using temporal differences, frozen foundation-model responses, prompt-based outputs, or post-processing results as final change maps. Although these strategies provide annotation-free cues, they do not learn a task-specific building-change detector and remain vulnerable to the gap between generic temporal discrepancies and building-defined structural changes. In practice, such discrepancies are often noisy and task-irrelevant, as appearance shifts, registration errors, and non-building modifications can produce strong but misleading responses. To address this problem, we propose SST-CD, a spatially selective self-training framework that reformulates fully label-free building change detection as end-to-end detector learning under noisy pseudo supervision. SST-CD uses temporal discrepancies as candidate pseudo labels and trains the detector only on spatially reliable pixels, whose reliability is estimated by a local consistency criterion that filters inconsistent regions from supervision. To further stabilize noisy self-training, a lightweight feature adapter recalibrates bi-temporal features, while a prototype-based decoder produces compact change and no-change representations. Experiments on LEVIR-CD, WHU-CD, and DSIFN-CD show that SST-CD achieves F1 scores of 83.08%, 91.69%, and 86.60%, respectively, outperforming existing unsupervised and label-free baselines.

06.
arXiv (CS.LG) 2026-06-18

Lifecycle-Aware Dynamic Analysis for Secure ML Model Execution

arXiv:2606.19023v1 Announce Type: cross Abstract: The growing reliance on pre-trained Machine Learning (ML) models has introduced new attack surfaces. Recent vulnerabilities demonstrate that malicious behavior can be embedded within model artifacts, often bypassing existing defenses. Current model-scanning solutions primarily rely on static, format-specific rules or known attack signatures, which limit their ability to generalize across frameworks and to detect novel exploitation paths. In contrast, we propose a solution that focuses on the effects an attack has on the host system executing the model and builds on foundational intuitions about ML model execution. In particular, we observe that ML models operate within well-defined lifecycle phases and that, within each phase, interactions with the host system are highly structured and predictable. We translate these intuitions into Moat, a dynamic lifecycle-aware approach for securing ML model execution, and instantiate this design in Re-Moat, our reference implementation. We evaluate Re-Moat across multiple ML frameworks using 77,974 real-world model artifacts from the Hugging Face Hub, 31 Proofs-of-Concept (PoCs) from CVEs, and 334 models from a state-of-the-art dataset, and compare it against state-of-the-art model-scanning solutions. Our results show that our approach detects all evaluated attack classes while maintaining a close-to-zero false-positive rate, validating our intuitions and motivating dynamic analysis for securing ML model execution.

07.
arXiv (CS.AI) 2026-06-19

Hard or Just Unreached? Diagnosing the Sampling Blind Spot in Math-Reasoning Difficulty Estimation

arXiv:2606.19636v1 Announce Type: cross Abstract: Math and science reasoning benchmarks rely on pass@k, the fraction of sampled chains that reach gold, as the canonical per-example difficulty signal. The same signal drives RL with verifiable rewards, math data curation, synthetic curricula, and verifier training. We show this proxy has a persistent blind spot on its hardest stratum: on the eight free-form math cells we test (GSM8K and MATH across four open-weight models), 10.3-22.9% of the examples that no sampling seed solves in six tries are instead solved at matched compute by a six-chain deterministic regime. These are greedy decoding plus five cheap residual-stream perturbations applied via activation grafting, while greedy alone solves at most 6% on these math cells. Recovery scales with the additional budget, across perturbations whose mechanistic distinctness we verify across all twelve cells (cross-kind fix-set Jaccard

08.
arXiv (CS.AI) 2026-06-18

A Taxonomy of Mental Health and Technology Needs for Alzheimer's and Dementia Caregivers

arXiv:2606.19247v1 Announce Type: cross Abstract: Family members caring for individuals with Alzheimer's disease and related dementias (AD/ADRD) provide the foundation of long-term care worldwide. In 2023, more than 11 million U.S. family and friends contributed 18 billion hours of unpaid care, often at the cost of their own physical and mental health. These informal caregivers – also referred as the "invisible second patients" – experience elevated rates of mental health problems. Yet research commonly reduces their complex psychosocial experiences to a single construct of caregiver burden, obscuring which specific needs are unmet or effectively supported. At the same time, digital and AI-enabled technologies are rapidly expanding, from smartphone apps and videoconferencing to sensor platforms and AI chatbots. However, the absence of shared frameworks across medicine, psychology, and technology research limits cumulative progress. This study introduces a Caregiver Mental Health and Technology Taxonomy that systematically links AD/ADRD caregiver needs with corresponding classes of technology-based interventions. Drawing from an interdisciplinary literature review and two qualitative studies with caregivers, the taxonomy identifies mismatches between caregiver priorities and existing technological support, highlights under-served domains such as relational strain and compassion fatigue, and proposes design directions for adaptive, responsive systems. The framework offers a shared vocabulary to guide clinicians, researchers, and technology designers in developing more person-centered and clinically grounded innovation in dementia care.

09.
arXiv (CS.CL) 2026-06-17

VoidPadding: Let [VOID] Handle Padding in Masked Diffusion Language Models so that [EOS] Can Focus on Semantic Termination

MDLMs generate text by denoising a preallocated masked response canvas, making response-length modeling central to instruction tuning. Existing MDLMs often inherit the autoregressive convention of using repeated \texttt{[EOS]} tokens for padding during instruction tuning, giving \texttt{[EOS]} a dual role as both a semantic terminator and a padding token. We show that this dual role is a root cause of \texttt{[EOS]} overflow under large-block decoding. To decouple these roles, we propose VoidPadding, which introduces \texttt{[VOID]} for padding and reserves \texttt{[EOS]} for termination. During inference, the learned \texttt{[EOS]} signal enables early stopping, while the learned \texttt{[VOID]} signal guides adaptive response canvas expansion. On Dream-7B-Instruct, VoidPadding improves the block-size-averaged four-task mean across mathematical reasoning and code generation benchmarks by \(+17.84\) points over the original model and \(+6.95\) points over RainbowPadding, while reducing decoding NFE by 55.7\% on average. Code is available at https://github.com/Haru-LCY/VoidPadding.

10.
arXiv (CS.LG) 2026-06-15

A Statistical and Machine Learning Framework for Operational Threshold Detection and Deployable Dispatch Controller Development in Hydrogen Multi-Energy Systems

arXiv:2606.14601v1 Announce Type: new Abstract: This study presents a statistical and machine learning framework for characterizing a hydrogen-based multi-energy system (H-MES) using one year of high-resolution operational data. Statistical analysis revealed a binary operation driven by renewable surplus, with solar irradiance explaining 45.7% of rank-based variance in hydrogen production, a large effect by conventional standards. Only high-irradiance periods triggered meaningful electrolyzer engagement, while electricity demand exerted a weaker inverse suppression effect ($\epsilon^2 = 0.126$). Multiple regression confirmed electrolyzer power as the dominant linear predictor, with a synergistic solar-wind interaction. Notably, Random Forest analysis ranked wind output first in predictive importance despite its weak bivariate correlation (r = 0.167), revealing non-linear dynamics invisible to parametric methods. A sequence model exploited strong 24-hour autocorrelation (r = 0.845) for operational forecasting, while a reinforcement learning agent optimized hydrogen revenue dispatch. The core contribution is demonstrating that statistical and machine learning approaches are complementary for H-MES modeling and control.

11.
arXiv (CS.LG) 2026-06-19

Compositionality Emerges in a Narrow Depth-Connectivity Regime: Architecture Constraints and Solution Manifolds

arXiv:2606.19941v1 Announce Type: new Abstract: Compositionality is believed to be the foundation for generalization, enabling models to reuse meaningful primitives in novel combinations. Yet, models trained with standard gradient-based optimization rarely, and often only weakly, exhibit compositional internal structure, and it remains unclear how or why such compositionality forms. In this work, we show that compositionality emerges in a narrow connectivity-depth sweet spot. Along the connectivity axis, compositionality only appears in some specifically sparse networks, heavily depends on which connections remain rather than on weights' sparsity alone. Along the depth axis, compositionality emerges within a narrow, target-dependent regime, peaking at specific depths, while both shallower and deeper networks fail. When either the depth or connectivity condition is violated, gradient descent silently converges to fractured solutions rather than compositional ones. To discover and exploit this emergence, we introduce (i) similarity-based pruning (SP) to recover compositional connectivity and (ii) a heuristic depth predictor to estimate where compositionality is most likely to appear. Finally, we support these empirical findings with a theoretical framework based on compositional sparsity, volume-ratio arguments, and feature-interference bounds, explaining why compositional solutions are reachable only in a narrow depth-connectivity regime.

12.
medRxiv (Medicine) 2026-06-10

Towards the Virtual Amyotrophic Lateral Sclerosis Patient: Inferring Cortical Excitability through Whole-Brain Dynamical Modeling

Amyotrophic lateral sclerosis (ALS) is increasingly recognized as a multisystem neurodegenerative disorder in which motor-neuron degeneration is accompanied by widespread alterations in cortical dynamics. Among its most reproducible neurophysiological signatures is cortical hyperexcitability, yet how this local excitability imbalance shapes distributed whole-brain activity remains poorly understood. Here, we combined source-reconstructed resting-state MEG data, tractography-informed whole-brain modeling, and simulation-based inference to investigate whether ALS-related alterations in large-scale brain dynamics can be mechanistically explained by changes in cortical excitability. First, we characterized empirical brain dynamics using complementary features spanning regional activity amplitude and variability, functional connectivity, and avalanche-based metrics. These analyses revealed significant alterations in ALS patients relative to healthy controls, as well as associations with clinical impairment and disease staging. To mechanistically interpret these changes, we employed a reduced Wong-Wang whole-brain model in which local recurrent excitation modulates emergent large-scale neural dynamics. Simulations showed that increasing excitability systematically reproduced the empirical dynamical signatures observed in ALS. We then applied a simulation-based inference framework to estimate latent excitability parameters directly from empirical observations. Whole-brain model inversion revealed increased excitability in ALS patients compared with controls. The recovered excitability parameter was associated with disease staging, supporting its clinical relevance as a model-derived descriptor of ALS progression. Finally, by extending the model to estimate frontal and non-frontal excitability separately, we found that ALS-related alterations were predominantly associated with increased frontal excitability, whereas non-frontal regions appeared comparatively less affected. The recovered parameters related to disease staging. Together, these findings provide a mechanistic framework linking altered large-scale brain dynamics in ALS to selective cortical hyperexcitability, explaining how local excitability changes can give rise to global network reorganization. More broadly, they show how computational model inversion can recover latent multiscale pathophysiological processes from empirical neural recordings, offering a non-perturbative alternative to complex experimental paradigms typically required to causally probe local-to-global mechanisms.

13.
arXiv (quant-ph) 2026-06-16

Quantum learning with a single-atom sensor

arXiv:2606.15071v1 Announce Type: new Abstract: The ability to gather information and to act upon it is at the core of every learning agent. But what is the impact of quantum mechanics on an agent's ability to sense external inputs and to translate them into actions? Here we address the question for a prototype task of learning agency at the quantum scale: rotating a single spin based on information gathered by a single atom. We determine the ultimate performance limit for this task, revealing a fundamental tradeoff between entanglement at the sensing stage and coherence at the action stage: if the single-atom sensor is not entangled with the quantum system serving as the agent's internal memory, then the best learning strategy requires a coherent transfer of quantum information from the sensor to the system that controls the agent's actions. In contrast, if the sensor is initially entangled with the agent's memory, then the transfer of quantum information is no longer necessary. Our results indicate that the quantum properties of the sensor radically affect the optimal way to convert external stimuli into actions, revealing a link between quantum sensing and the behavior of quantum agents.

14.
arXiv (CS.LG) 2026-06-16

The Algebra of Units: From Buckingham's Pi-grec Theorem to Latent-Variable Learning

arXiv:2606.16737v1 Announce Type: cross Abstract: Engineers often measure many quantities-speed, pressure, temperature, length-expressed in different physical units. The Buckingham Pi-grec theorem states that these variables can always be combined into a smaller set of dimensionless numbers whose values fully determine the system's behaviour. Identifying the appropriate dimensionless groups has traditionally required expert knowledge and physical insight. This paper shows that they can instead be discovered automatically from data, without prior knowledge of the governing physics. The key observation is that, after logarithmic transformation, measurements collected under different scalings of the same system lie on a low-dimensional manifold whose geometry is determined by the underlying dimensionless groups. Singular value decomposition (SVD) identifies this manifold directly from data. A subsequent search over integer-exponent combinations recovers candidate dimensionless quantities, while a repeating-variable filter retains only those constructed from the machine's characteristic scales. This procedure recovers familiar engineering groups, including the flow coefficient, head coefficient, and Mach number, while excluding equivalent but less interpretable alternatives. The method is demonstrated on a synthetic compressor dataset containing 16,000 measurements. Starting from raw dimensional variables and no physics input, it recovers the correct dimensionless groups to numerical precision and reproduces the compressor performance map with an error below 0.01%. More broadly, the work reveals a close connection between classical dimensional analysis and modern data-driven learning. Both rely on the same underlying algebraic structure, suggesting new approaches for building physical models that are simultaneously interpretable, scalable, and data-efficient.

17.
arXiv (CS.AI) 2026-06-11

Embodied-R1.5: Evolving Physical Intelligence via Embodied Foundation Models

arXiv:2606.11324v1 Announce Type: cross Abstract: We introduce Embodied-R1.5, a unified Embodied Foundation Model (EFM) that integrates comprehensive embodied reasoning capabilities, spanning embodied cognition, task planning, correction, and pointing, within a single architecture toward general physical intelligence. Leveraging three automated data construction pipelines to significantly expand the data coverage of critical capabilities, we build a large-scale data system of over 15B tokens, and design a multi-task balanced RL recipe to alleviate heterogeneous task conflicts. We further introduce a Planner-Grounder-Corrector (PGC) closed-loop framework that enables a single model to autonomously execute and self-correct over long-horizon tasks. With only 8B parameters, Embodied-R1.5 achieves SOTA on 16 out of 24 embodied VLM benchmarks, surpassing leading models like Gemini-Robotics-ER-1.5 and GPT-5.4. Benefiting from the internalized embodied capabilities, Embodied-R1.5 can be fine-tuned into a VLA with only a small amount of data, outperforming leading VLA models like $\pi_{0.5}$ across 4 popular manipulation benchmark suites. We further conduct extensive zero-shot real-robot experiments, validating performance in instruction following, affordance grounding, articulated object manipulation, and long-horizon complex tasks, demonstrating strong generalization to the physical world. We open-source model weights, datasets, training code, and EmbodiedEvalKit, an evaluation framework tailored for embodied tasks, to facilitate future research in EFMs.

18.
arXiv (CS.AI) 2026-06-16

Haiku to Opus in Just 10 bits: LLMs Unlock Large Compression Gains

arXiv:2604.02343v2 Announce Type: replace-cross Abstract: We study the compression of LLM-generated text across lossless and lossy regimes, characterizing a compression-compute frontier where more compression is possible at the cost of more compute. For lossless compression, domain-adapted LoRA adapters can improve LLM-based arithmetic coding by 2x over compression with the base LLM alone. For lossy compression, prompting a model for a succinct rewrite then applying arithmetic coding can achieve compression ratios of approximately 0.03, a 2x improvement over compressing the original response. We further introduce Question-Asking compression (QA), an interactive lossy protocol inspired by the game 'Twenty Questions'. A small model iteratively refines its response by asking yes/no questions to a stronger model, transferring exactly one bit per answer. On 8 benchmarks spanning math, science, and code, 10 binary questions recover 23% to 72% of the capability gap between a small and large model on standard benchmarks and 7% to 38% on harder benchmarks, achieving compression ratios of 0.0006 to 0.004. This is over 100x smaller than prior LLM-based compression (Deletang et al., 2024), suggesting that interactive protocols can transfer knowledge far more efficiently than transmitting full responses.

19.
arXiv (quant-ph) 2026-06-11

Fisher geometry reshapes the effect of incompatibility in multiparameter quantum estimation

arXiv:2606.11343v1 Announce Type: new Abstract: Multiparameter quantum estimation faces two fundamental obstacles: sloppiness, i.e., anisotropy of the quantum Fisher information matrix (QFIM) that renders some parameter directions insensitive, and incompatibility, the non-commutativity of optimal measurements for different parameters. The trade-off bound $C_T$ captures their joint impact on precision, but it has remained unclear how the distribution of incompatibility across parameter planes affects its overall cost. Here we separate the total amount of incompatibility from its location. We introduce a dimensionless quantity $G_n^{(F)}$ that measures the alignment between the incompatibility distribution and the eigenvalues of the QFIM, and show how the Frobenius scale of the incompatibility contribution factorizes. We obtain a bound and prove the incompatibility cost lies between this bound and a rank-dependent multiple thereof. We also prove that at fixed sloppiness, or equivalently fixed Fisher volume, concentrating incompatibility into a single parameter plane reduces the optimized trade-off cost because the Fisher geometry can then be reshaped to allocate more Fisher area to that plane. A qutrit $SU(2)$ encoding numerically confirms that states with larger incompatibility strength can nevertheless incur a smaller cost if the matching factor $G$ is sufficiently small. Our results establish that the distribution of incompatibility relative to the Fisher eigenbasis is a central diagnostic for multiparameter estimation, beyond the total incompatibility strength.

20.
arXiv (CS.CL) 2026-06-17

Perceptual compensation for tonal context in self-supervised speech models

This study examines the extent to which the wav2vec2.0 architecture exhibits evidence of compensation for phonological context. We conducted a pseudo-replication of a perceptional compensation experiment on Mandarin Chinese tones, and compared the embedding similarities and probing classifier outputs between a purely self-supervised pre-trained model and a model fine-tuned for Mandarin ASR. No evidence of compensation was found in the embedding similarities of the purely pre-trained model. Probing classifiers showed some evidence of compensation in addition to the expected layer-wise improvements in categorization, but failed to replicate human performance on isolated test syllables. Our findings contrast with previous reports of sensitivity to phonological structure emerging through pre-training alone, and suggest that supervised objectives may be necessary to encourage the abstraction of at least some types of phonological regularities.

22.
arXiv (CS.CV) 2026-06-16

Contrastive Learning for Seismic Horizon Tracking with Domain-Specific Priors

Unsupervised 3D seismic horizon tracking faces a key limitation: signal-based propagators provide accurate trace-level alignment but often fail near faults, whereas texture-driven deep models are more robust to discontinuities, typically at the cost of labeled data requirements and reduced trace-level precision. We propose a self-supervised fusion of both paradigms in which signal-derived local horizon correspondences act as domain-specific priors to train a texture-based deep learning model. Specifically, we estimate reliable trace-to-trace flows from reflector slopes and use them to form positive pairs in a contrastive objective, while restricting training to high-confidence neighborhoods, optionally augmented with a fault mask. The objective is not to infer ambiguous correspondences close to discontinuities, but to preserve horizon identity across them. As a result, the network learns voxel-wise embeddings that preserve local signal continuity while enabling horizon propagation beyond discontinuities through similarity search. Experiments on the public F3 dataset and a faulted synthetic dataset achieve lower mean absolute error (MAE) than unsupervised baselines and competitive performance against a semi-supervised method using a single labeled slice.

24.
arXiv (math.PR) 2026-06-12

Dimension-free Markov–Bernstein inequalities for product measures

Authors:

arXiv:2606.13575v1 Announce Type: cross Abstract: We study dimension-free Markov–Bernstein inequalities for polynomials with respect to product probability measures. In the Gaussian case, for $p\ge4$, we prove that \[ \|\nabla f\|_{L^p(\gamma^n)} \le C(p)d^{\frac12+\theta_p} \|f\|_{L^p(\gamma^n)} \] for every polynomial $f$ of degree at most $d$, where $\theta_p\le \frac{2}{3p}$ and $\theta_p=0$ whenever $p$ is an even integer. Thus, for even integer exponents, we establish the sharp dependence on the degree conjectured by Eskenazis–Ivanisvili. For general $p\ge4$, the estimate improves upon their dimension-free inequality. We also obtain dimension-free Markov–Bernstein inequalities with sharp dependence on the degree for even integer exponents beyond the Gaussian setting. We first prove such estimates for the uniform distribution on the unit cube and then extend them to products of absolutely continuous measures with unimodal densities. Finally, we treat products of one-dimensional Freud measures with densities proportional to $e^{-|t|^{2m}}$.

25.
PLOS Medicine 2026-05-20

Associations between hematologic dynamics during pregnancy and obstetric complications: A retrospective observational study

by Veronica Tozzo, Rachel Petherbridge, Kaitlyn James, Sarah Hsu, Deepti Pant, Chloe Michalopoulos, Brody H. Foy, Tanayott Thaweethai, Christopher Mow, Jacqueline Maya, Carolina Batlle Camero, Lydia Shook, Kathryn J. Gray, Logan Mauney, John M. Higgins, Camille E. Powe Background Pregnancy alters hematologic state as measured by complete blood count (CBC), but the longitudinal changes in CBC indices that define healthy pregnancies are not well established. In a large cohort based at an academic health system in the United States, we aimed to define reference intervals and typical longitudinal changes in CBC indices during pregnancy. We then tested for associations between extreme CBC values for gestational age or extreme longitudinal changes in CBC indices and obstetric complications. Methods and findings We studied nine CBC indices in individuals with singleton pregnancies who delivered after 30 weeks’ gestation and presented for prenatal care prior to 20 weeks. The electronic health record (EHR)-based Maternal Health Cohort (Massachusetts General Hospital; 1998–2016) formed our discovery cohort of 45,992 pregnancies, 18% of which had relevant complications. We developed a validation cohort of 48,868, 27% with complications from EHR data in the Mass General Brigham healthcare system from 2016 to 2024. In pregnancies without complications in the discovery cohort, we derived gestational-age-specific reference intervals (2.5th–97.5th percentile) and established typical intra-pregnancy longitudinal changes. In the validation cohort, we then tested CBC values outside of the 26–29 weeks’ gestation reference interval and CBC rare changes (uncommon changes in magnitude and direction) between 7–14 and 26–29 weeks’ gestation for association with a composite outcome (hypertensive disorders of pregnancy, small for gestational age birthweight, preterm birth) and its individual components using generalized estimating equations. Derived reference intervals differed from those in the literature for mean red cell volume, mean red cell hemoglobin, red cell count, and mean red cell hemoglobin concentration; reference intervals for other indices were similar to those previously published. In validation, hematocrit, hemoglobin, and red cell count values above their gestational-age specific reference intervals were associated with increased risk of the composite obstetric outcome: odds ratios (ORs) of 1.4 (95% CI [1.2, 1.5] p