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Objective To compare obstetric and neonatal outcomes between human immunodeficiency virus (HIV) positive (HIV+) and HIV negative (HIV-) women and to determine if racial disparities exist among pregnancies complicated by HIV infection. Study Design This was a retrospective analysis of data from the Consortium of Safe Labor between 2002 and 2008. Comparisons of obstetric morbidity, neonatal morbidity, and indications for cesarean delivery were examined. Included were singletons with documented HIV status, race, and antepartum admission. Chi-square, Fisher exact tests, and logistic regression were used for statistical analysis. Results Included were 178,972 patients (178,210 HIV-, 762 HIV+, 464 HIV+ black, 298 HIV+ nonblack). HIV+ women were more likely to have a cesarean delivery, preterm premature rupture of membranes, another sexually transmitted infection, and delivery at an earlier gestational age. Obstetric outcomes were similar between HIV+ black and HIV+ nonblack women. Neonates of HIV+ mothers had lower birth weights and higher rates of neonatal intensive care admissions. HIV+ black women had lower birth weight neonates than HIV+ nonblack women. Conclusion HIV+ women have higher rates of obstetric complications and deliver at an earlier gestational age than HIV- mothers. Lower birth weight was the only notable complication among HIV+ black women compared with HIV+ nonblack women. [ABSTRACT FROM AUTHOR]