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The primary goal of the current study was to examine the association between maternal distress during pregnancy, conceptualized as stress, anxiety, and depression, and infant reproductive outcomes. It was hypothesized that women who report high levels of distress during pregnancy would be more likely to experience adverse reproductive outcomes. An additional goal of the study was to examine the hypothesis that social support and coping style moderate the association between prenatal maternal distress and birth outcomes. This study utilized a prospective, longitudinal design. Pregnant women (N = 257) completed self-report questionnaires and clinical interviews at two time points during pregnancy. Following delivery, birth weight, week of delivery, head circumference, and Apgar score were extracted from medical records. Results suggested that women who were clinically depressed during pregnancy were more likely to experience adverse birth outcomes. In addition, maternal stress, anxiety, and depression were best conceptualized as one general "distress" factor, which did not predict variance in birth outcomes over and above demographic variables. However, when self-report measures were considered individually, they decreased over the course of pregnancy, and were associated with birth outcomes, particularly at time 2. Significant interactions between maternal distress and social support, as well as maternal distress and coping emerged as predictors of birth outcomes. Results suggest that women with high levels of stress, who also have small support networks, are at higher risk of adverse birth outcomes than women with large networks, who were relatively insulated from effects of higher distress. This study points to the need for ongoing assessment of maternal distress and resources throughout pregnancy, such that women at risk for adverse birth outcomes can be identified and supported as soon as possible.