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Objective: This study aimed to describe the obstacles and solutions in developing and implementing a prospective obstetric database registry that collects biopsychosocial data on women during pregnancy and postpartum. The clinical goals of the registry were to improve both diagnosis of mental health and substance use problems and access to mental health care during pregnancy. The research goals were to examine the impact of psychiatric illness and substance use on birth outcomes., Study Setting and Registry Design: A questionnaire that contained validated instruments for mental health, substance use and psychosocial stressors was developed and administered to all pregnant women in an academic medical center obstetric clinic. Results were incorporated with reminder and decision support systems to ensure active follow-up of patients with mental health needs. Automated medical record information was collected for future analysis of outcomes., Program Implementation: Barriers to program implementation were overcome by a multifaceted intervention that included educational outreach to patients, providers and staff; integration of the registry into preexisting clinical protocols; reminder systems at workstations; provision of mental health decision support through perinatal social work and psychiatric consultation; and utilization of a "stepped-care" model to delivering mental health services., Conclusion: A mental health registry that merges clinical and research needs can be successfully integrated into the obstetric clinic setting.