This study examines a case management intervention for first-time pregnant and parenting adolescents. It compares a sample of 1,260 first-time adolescent mothers in the Adolescent Parenting Program (APP) in North Carolina with 1,260 first-time adolescent mothers who did not participate in the program (non-APP). Using birth certificate data, logistic regression and survival analyses were used to compare prenatal care use, birth outcomes, and subsequent births, adjusting for age, race, marital status, and tobacco use during pregnancy. The groups had similar rates of prenatal care use. Participation in APP, however, was associated with an increased likelihood of normal birthweight (more than 2,500 grams [5.5 pounds]) and full-term birth (at or more than 37 weeks). Adolescents ages 12 to 16 in the APP group also delayed second births significantly longer than the non-APP group. Study implications point to case management and direct services provided by social workers and health service professionals as instrumental to helping adolescent mothers achieve favorable birth outcomes and postpone subsequent births during adolescence.