Racial disparities in adverse pregnancy outcomes remain a persistent public health challenge in the United States. Black, Hispanic, and Native American women experience significantly higher rates of maternal mortality, preterm birth, hypertensive disorders, and other complications compared to White women. These disparities are not solely attributable to socioeconomic status or healthcare access but are shaped by complex interactions among social determinants of health, systemic racism, and differences in cardiometabolic health. This chapter explores the multifaceted drivers of racial inequities in maternal and neonatal outcomes, with a focus on the prenatal period as a critical window for intervention. Cardiometabolic conditions—such as hypertension, diabetes, and obesity—are disproportionately prevalent among minority women and are major contributors to pregnancy complications and future chronic disease. The chapter highlights how early identification and management of these conditions, alongside culturally competent care, can reduce disparities. Evidence from recent clinical trials and population studies is examined to demonstrate the effectiveness of lifestyle interventions, continuous postpartum care, and interpregnancy management in mitigating risk. The role of implicit bias and structural barriers in perpetuating inequities is also discussed. By viewing pregnancy as a sentinel event and an opportunity for long-term cardiovascular prevention, obstetric providers can contribute meaningfully to closing the racial gap in maternal health outcomes. Targeted, equitable interventions during and between pregnancies are essential for improving both immediate and lifelong health for at-risk populations.