Advances in preconception and prenatal care have been successful in reducing risk in a number of areas. Folic acid supplementation, abstinence from alcohol, tight glycemic control in pre-gestational diabetics, and the administration of rhogham all have been successful in reducing individual risks. Unfortunately, overall perinatal morbidity and mortality has not decreased in the past two decades. In light of this, clinicians must remain abreast of the latest research and technological advances, and adopt those practices that improve outcomes. Continued critical appraisal of persistent racial and ethnic disparities may be useful in understanding and reversing current trends. Additionally we must continue to creatively develop instruments of quantifying those aspects of high quality prenatal care, which are unmeasurable. Furthermore, we must advocate on a local, state, and national level for improved services for our prenatal patients not just in the office and the hospital, but in their homes and communities.