Preterm low birth weight is the major determinant of infant morbidity and mortality. Numerous studies have linked bacterial vaginosis (BV) with preterm birth and low birth weight (LBW), especially among black women. This article reviews the published literature to provide clear evidence that BV is an independent risk factor for preterm birth and LBW. Pregnant black women are especially at risk, having nearly three times the level of BV as pregnant white women. Compounding the problem is the fact that half the population of women with BV are asymptomatic, and current standard antenatal procedures do not provide for screening for BV. By reviewing BV treatment literature, this article also provides evidence that treatment for BV is effective and that the identification and treatment of BV in pregnant women can lead to substantial reduction in the high rates of preterm birth and LBW.