A recent front-page story in the New York Times reported a significant escalation in the number of African American babies in the southern United States who die as a consequence of preterm delivery and low birthweight. Having seen some marginal improvements in the rates of preterm delivery and low birthweight, health care professionals for mothers and their infants had been hopeful that further progress would be made. However, the current precipitous rise in poor birth outcomes undermines successes to date and raises major questions about what can be done to quell an escalating epidemic. Explanations for the increasingly poor birth outcomes among African American women are complex, involving a number of biological, psychological, social, and economic factors that surround pregnancy and birth. Diabetes, hypertension, and obesity are being scrutinized as major risks for adverse birth outcomes. However, more attention must be given to psychosocial risk factors, which may directly or indirectly trigger physiological responses, leading to premature births and low birthweights. This report examines the impact of stress and stress mediators on pregnancy outcomes for African American women.