Previous studies have reported cessation of cocaine use in pregnant women prior to treatment entry. This study examined the relative effectiveness of adjunctive contingency management interventions in maintaining abstinence and enhancing compliance with prenatal care in this unique population. Pregnant cocaine-dependent women who had used the drug during this pregnancy but had ceased use prior to study entry (N = 12) were randomly assigned to one of two treatment groups. All patients received a multifaceted treatment including behaviorally based drug counseling and weekly prenatal visits. Patients in the experimental condition also received contingent reinforcement for cocaine abstinence and attendance at prenatal visits. There was a high rate of retention and abstinence from cocaine in both groups. However, patients in the experimental group had a higher rate of attendance at prenatal visits, and none of the patients in this group experienced adverse perinatal outcome(s), compared to 80% of patients in the control group. This finding has important implications for cost-effective treatments and prevention of illness.