Distinct black-white differences in pregnancy outcome and prenatal care utilization have been a persistent feature of U.S. natality-related statistics. Using South Carolina and North Carolina live birth-infant death cohort files for 1978-1982, this study examines the extent to which variations in prenatal care utilization may be associated with racial disparities in pregnancy outcome within maternal sociomedical risk groups. After taking indicators of maternal risk into account (age-parity, education, marital status, complications of pregnancy and previous pregnancy terminations), birth weight and gestational age distributions and birth weight- and gestational age-specific neonatal mortality rates of blacks and whites were compared by level of prenatal care utilization. Distinct racial differences in birth weight and gestational age distributions were observed within equivalent maternal risk and prenatal care categories, with whites having an approximately 200-gram mean birth weight and five-day mean gestational age advantage compared to blacks. In this analysis of more than 650,000 cases, low-risk blacks adequately utilizing prenatal care had a lower mean birth weight (3,266 grams) and a higher neonatal mortality rate (6.6) than low-risk, inadequate-care whites (3,302 grams; 6.1).