To examine whether the relationships among pregnancy health practices, maternal-fetal attachment, and prenatal depression differ between women living in the inner city and women living in a smaller urban community. Cross-sectional, descriptive survey. Clinics in inner-city and small urban communities in the Midwest. Fifty-five pregnant women living in the inner city and 197 pregnant women living in a smaller urban setting. Health Practices Questionnaire, a self-report instrument that measures pregnancy health practices. Women living in the inner city reported lower levels of health practices than women in urban settings, but this was moderated by maternal-fetal attachment. Inner-city women with lower levels of maternal-fetal attachment had poorer health practices than inner-city women with higher levels of maternal-fetal attachment; there was no relationship for women residing in the small urban area. Depression was negatively associated with health practices for all women; however, there was no difference by residence. Maternal-fetal attachment contributed differently to health practices in women from the inner city compared with women from small urban communities. Nurses can use this information to help identify women at risk for poor pregnancy health practices. More research is needed to identify the interventions that most effectively improve health practices.