Adverse birth outcomes are the leading cause of death among infants globally, and the second leading cause of infant deaths in the United States. African-American women have disproportionately higher rates of preterm birth, low birth weight, and infant mortality compared to other racial groups. This is due in part to social inequities, as well as differential exposures to and experience of risk and protective factors before, during, and after pregnancy. The life course perspective framework posits that adverse birth outcomes are not primarily due to experiences during pregnancy, but experiences (environmental exposures, biological, social and behavioral factors, as well as life experiences) across the life course. These experiences negatively affect birth outcomes in current and future generations. Reducing the adverse birth outcome gap between African Americans and other racial groups requires not only increasing access to prenatal care, but also addressing the differential cumulative impact of social inequities and early life disadvantages experienced by the former. It is therefore critically important to focus on the life course perspective when framing solutions to bridge racial disparities in adverse birth outcomes.