Objectives: Motor-vehicle injuries are the leading cause of death and hospitalized trauma during pregnancy. The study objectives were to report the prevalence of seat belt counseling by prenatal care providers during pregnancy, seat belt use during the last trimester, and self-reported motor-vehicle injury during pregnancy. Differences were examined by age, race and education. Methods: A cross-sectional study design using self-reported 22 state data from the Centers for Disease Control and Prevention's 2001 Pregnancy Risk Assessment Monitoring System (PRAMS) were used (n = 37,081). Estimates were computed using logistic regression from weighted counts. Results: On average, reported prenatal care provider counseling for seat belt use occurred in 48.7% (38.2-58.8%) of prenatal visits. Women most likely to report being counseled were aged 20-29, non-White, Hispanic ethnicity, and less educated. Women 30 years of age or greater and that had a greater than high school education were more likely to report always wearing seat belts in the last trimester. On average, 2.3% (1.2-4.7%) of respondents reported being hurt in a "car accident" during pregnancy. Women less than 20 years old (3.0%), Black (3.9%), and less educated (3.2%) were the most likely to report being hurt in a crash during pregnancy. Conclusions: Based on PRAMS, it is estimated that about 92,500 pregnant women are hurt annually in motor-vehicle crashes in the United States. Despite this reported risk and the proven efficacy of restraint use, most pregnant women do not report being counseled about seat belt use during prenatal visits. Limitations of PRAMS methodology make it difficult to determine the association of prenatal counseling with seat belt use.