Pre-birth risk assessment is a process by which circumstances affecting an unborn child can be identified and support for mother and infant embedded. This mixed methods study describes a community-based pre-birth assessment and care pathway that utilised the Parents Under Pressure (PuP) programme to assess parenting capacity and provide support pre-and post-birth for 'at risk' women. Sixty-eight pregnant women referred to children's social care services were allocated to the pre-birth assessment and care pathway (n = 35) or to routine care (n = 33). Standardised measures of psychological distress, social support and alcohol measured change for the women in the assessment and care pathway. Twenty women who provided pre-and post-data reported significant improvements on all measures except alcohol use. Safeguarding outcomes at 12 months were obtained for both groups using administrative data. Forty-two per cent of the infants whose mothers received the pre-birth assessment and care pathway showed an improvement in child protection status compared to 14 per cent of the routine care infants. Safeguarding status deteriorated or stayed the same in 52 per cent of the routine cases compared to 26 per cent of those receiving the pathway. Qualitative data revealed that the pathway was acceptable and helpful to service users and service providers. Copyright © 2017 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES:• The current project found that a community-based pre-birth assessment and care pathway with high-risk pregnant women was feasible and acceptable for practitioners and service users.• The pathway began mid-pregnancy and support was provided following the birth of the infant for up to 12 months.• Over 40 per cent of infants whose mothers were allocated to the pre-birth risk assessment pathway showed improvements in child safeguarding status at 12 months.