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Prenatal health has been linked to a wide variety of negative outcomes including birth complications, low birth weight, cognitive deficits, externalizing problems, and poor school performance. A long line of research has found that low birth weight and cognitive deficits increase the risk for life-course-persistent offending (Moffitt, 1993), which is characterized by conduct disorder or oppositional defiant disorder during childhood, high levels of juvenile delinquency during adolescence, and persistent criminal behavior in adulthood. While previous research has found that low birth weight and child cognition are associated with life-course-persistent offending patterns, especially when coupled with environmental adversity, few studies have examined the influence of prenatal health factors on life-course-persistent offending. The present study analyzes over 30 years of self-report and cognitive data on a sample of youth to examine the longitudinal pathways between prenatal health, cognitive deficits, school performance, antisocial behavior in childhood, and criminal offending from early adolescence to adulthood. Findings offer support for Moffitt’s (1993) life-course-persistent offending hypothesis and suggest that incorporating prenatal information may help to better understand the developmental pathways that lead to life-course-persistent offending.