The lifetime prevalence of serious mental illness (SMI) for women in the United States is nearly 6% (NIMH, 2012). Women in this group often have lifestyle and socioeconomic characteristics that lead to poor health status and delays in seeking heath care. While women with SMI are just as likely to have children as their non-mentally ill counterparts, they are more likely to experience pregnancy complications and negative birth outcomes. Prenatal care must take into consideration the unique needs of these women and the challenges they face. Recommendations for improving practice include increasing pregnancy screening, using multidisciplinary teams to provide holistic care, and involving the patient in shared decision-making. This care should be continuous throughout the woman’s childbearing years. Further research is needed to test the effectiveness of models of prenatal care tailored to women with SMI.