Objectives. To examine the association between the psychosocial construct of race-related stress and smoking among pregnant African-American women. Design. Inferential statistical analyses were performed. Setting. Participants were recruited primarily at a medical clinic as well as through word-of-mouth consistent with the snowball sampling technique. Population. Seventy pregnant self-identified African-American women (32 smokers and 38 non-smokers) 18 years or older participated in the study. Methods. Participants completed self-report measures of the Index of Race-Related Stress and an investigator-developed demographic and smoking questionnaire. Main outcome measures. Smoking status of each participant was established through self-report. Results. Significant associations were found between the smoking status of pregnant African-American women and the frequency and perceptions of overall race-related stress (p < 0.03 and 0.02, respectively), the frequency and perceptions of both individual and cultural race-related stress (p < 0.01, 0.03, 0.05, and 0.03, respectively). No associations were found between institutional race-related stress and smoking status. Conclusions. The findings suggest that integrating race-related stress relieving and coping activities into smoking cessation intervention programs for pregnant African-American women may reduce smoking and subsequent smoking-related reproductive health disparities in the population.