In spite of technological advances in healthcare, poor maternal and infant birth outcomes remain at unacceptably high levels in Western countries. Therefore, governmental and healthcare institutions, particularly in North America, have implemented various models of expanded prenatal-care programs focused on improving birth outcomes of high-risk pregnant women. This article presents an overview of recent studies that evaluated the quality and cost (if available) of programs (case management, home care, nurse specialist care, or augmented prenatal care) for the management of high-risk pregnancy. The findings suggest that enhanced prenatal programs (particularly with expert nurses) improve birth outcomes while controlling costs. These enhanced programs provide early and continuing psychosocial assessment, psychosocial interventions to mediate the effects of the risk factors, and health promotion education.