Recently, we developed an immunoglobulin G (IgG)-capture BED-enzyme immunoassay (BED-CEIA) to identify recent HIV-1 infections. We estimated HIV-1 incidence among inner-city pregnant women in Atlanta, Georgia (1991-1998) using this assay. The annual cumulative incidence was estimated at 2.4/1000 (95% CI = 2.0-2.9). Incidence declined from 3.1/1000 in 1991-1994 to 1.4/1000 in 1995-1998 (risk ratio = 2.3, 95% CI = 1.5-3.4). Women with recent HIV-1 infection more often reported a previous negative antibody test (p = 0.018) and sexual relations with men other than the father during the past year (p = 0.046). Fewer seroconverters in 1995-1998 used crack cocaine than in the earlier time period. A high but declining HIV-1 incidence was found among inner-city pregnant women in Atlanta.