The prenatal period represents an opportunity to buffer the intergenerational transmission of adversity through integrated, comprehensive perinatal health services for women experiencing high levels of adversity and clinical symptoms. This article presents preliminary descriptive data, drawn from an ongoing clinical research study, on prenatal clinical symptomatology and service usage and needs in 101 pregnant women who have experienced lifetime adversity. The women gave birth at a university-affiliated county hospital that serves low-income, ethnically diverse, medically uninsured families. Results highlight the need for improved identification of unmet mental health service needs during pregnancy. The authors provide recommendations for strategies to more comprehensively understand how to support low-income pregnant women via tailored, trauma-informed services for maternal health and infant well-being.