Posttraumatic stress disorder (PTSD) affects 12% of women in the United States and could affect childbearing via behavioral and neuroendocrine mechanisms. This pilot study collected preliminary data about the extent to which the low cortisol profile found in patients with PTSD also occurs in the hormonal context of pregnancy, as well as the association between PTSD and less optimal processes and outcomes of pregnancy. Standardized psychiatric diagnostic telephone interviews, salivary cortisol assays, and medical records review were evaluated in a community sample of 25 women pregnant with their first child. Higher PTSD symptom counts correlated with worse overall perinatal outcomes summarized by an Optimality Index Score (n = 22; r = —.725; P < .001). The women whose symptoms met diagnostic criteria for PTSD or partial PTSD had lower peak basal salivary cortisol concentrations (n = 14; mean = .4584 versus .8123; P = .010). Further research on the effects of PTSD on pregnancy processes and outcomes is warranted. Differences in cortisol levels were consistent with the pattern seen in nonpregnant women with PTSD. This finding suggests that salivary cortisol would be a useful biological measure to include in perinatal research on PTSD and childbearing.