This report presents data for the nation's 50 largest cities for every year from 1990-98 on eight measures of a healthy start to life (teen births, repeat teen births, births to unmarried women, low maternal education, late or no prenatal care, smoking during pregnancy, low-birthweight births, and preterm births). It identifies cities that have seen notable improvements in specific measures and those that are performing much better than average. It expands on a 1999 report by updating data through 1998, providing annual data for each year back to 1990, offering a one-page narrative description of how each city fared during 1990-98, and publishing a companion book with state-level data. Findings reveal consistent disparity between birth outcomes in the 50 cities and those for the nation. Birth outcomes in the cities are not as good as those elsewhere. Children in the cities are more likely to experience each of five risks associated with negative child outcomes. While racial differences in birth outcomes exist, many actually reflect differences in income, education, and availability of effective services. Three appendixes include: cities ranked by indicator, 1998; definitions, data sources, and reporting issues; and primary contacts for state KIDS COUNT projects. (SM)