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Study Objective: To describe the number of admissions of pregnant adolescents to US juvenile residential systems (JRS) and the outcomes of pregnancies that ended while in custody., Design: Prospective study., Setting: Three nonrandomly selected JRS in 3 US states., Participants: Designated reporter at each JRS reporting aggregate data on various pregnant admissions, outcomes, and systems' policies., Interventions: None., Main Outcome Measures: Monthly number of pregnant people admitted, pregnant people at the end of the month, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, maternal and newborn deaths, and administrative policies., Results: There were 71 admissions of pregnant adolescents reported over 12 months from participating JRS. At the time of the census, 6 of the 183 female adolescents (3.3%) were pregnant. Eight pregnancies ended while in custody. Of these, 1 pregnancy was a live full-term birth, 4 were miscarriages, and 3 were induced abortions. There were no newborn deaths or maternal deaths. Administrative policies and services varied among the JRS. For example, all JRS had a prenatal care provider on-site, whereas 2 JRS helped cover the costs of abortions., Conclusion: To our knowledge, this study is the first to report the estimates of pregnancy and pregnancy outcomes among justice-involved youth in JRS. Our findings indicate that there are pregnant adolescents in JRS and most return to their communities while pregnant, highlighting the importance of continuity of care. More work is needed to understand the complexities of health care needs of justice-involved pregnant youth during and after their incarceration., (Copyright © 2021 Elsevier Ltd. All rights reserved.)