Objective: Unintended pregnancies are associated with poor prenatal care and increased risk for child maltreatment, which engenders other societal problems, including costly negative mental health outcomes. Our objective—by highlighting higher rates of unintended and problematic pregnancies in a Medicaid youth sample—is to help policy makers appreciate the need for realistic preventative and ameliorative mental health services in these vulnerable children. Method: Mothers of children on Medicaid, referred for outpatient neuropsychological testing, were interviewed about the quality of their pregnancies. To establish base rate estimates in this sample, mothers were asked (a) if the pregnancy was intended, (b) if they suffered abuse, and (c) if alcohol or cigarettes were used. Findings were compared to published based rates in the population. Results: Seventy-five percent (30/40) of the pregnancies were unplanned, compared with published rates of 37%, 49%, and 51%. Thirty-five percent (13/37) of Medicaid mothers were emotionally abused while pregnant, 16.32% (6/37) were physically abused, and 5.71% (2/35) were sexually abused. In contrast, published rates for any form of abuse hover between 4 and 8%. Twenty-nine percent (12/41) drank alcohol during pregnancy and 24% (10/41) smoked cigarettes. Meanwhile, published rates on mother alcohol consumption during pregnancy are between 37 and 50%, while cigarette use during pregnancy is at about 15%. Conclusion: Healthy nervous systems function better in real-world settings but the likelihood of a healthy brain is lower for those resulting from difficult pregnancies. These data argue for more mental health services in Medicaid youth.