Introduction <p>Evidence regarding the impact of prenatal depression and other psychosocial factors, such as coping, on perinatal outcomes is limited. We examined whether depressive symptoms during pregnancy were associated with the rate of having a small-for-gestational-age (SGA) infant and whether women’s coping styles modified the relationship.</p> Methods <p>Data were obtained from a cohort of 1410 Black/African American women in Metropolitan Detroit, MI, using a structured maternal interview and medical record abstraction. Depressive symptomology was measured using the Center for Epidemiologic Studies Depression (CES-D) Scale. Women’s coping efforts (confronting, distancing, and internalizing) were assessed using the Ways of Coping (WOC) questionnaire. Modified-Poisson regression models assessed direct and moderated associations.</p> Results <p>About 20% of women had severe depressive symptoms (CES-D &gt; 23). Severe depressive symptoms were associated with having an SGA infant (adjusted PR [aPR] = 1.39, 95% CI = 1.02–1.89). Among women who frequently utilized confrontive coping efforts, severe depressive symptoms were marginally associated with SGA (PR = 1.43, 95% CI = 0.98–2.09), but not among women using confrontive coping less frequently. Regarding distance coping, severe depressive symptoms were not associated with SGA among women who frequently used distancing. However, severe depressive symptoms were associated with SGA (PR = 1.52, 95% CI = 1.03–2.24) among women who use distancing coping less frequently.</p> Conclusions <p>/Implications.</p> <p>Our findings suggest the use of confrontive and distancing coping moderates the relationship between depressive symptoms and SGA. In addition to screening for depressive symptomology during pregnancy, clinicians may want to assess coping styles as they drive women’s response to stress and may be amenable to intervention.</p>