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Rates of adverse pregnancy outcomes (APOs) are increasing among Black and Latina Americans. Whether health-related social needs (HRSNs) are prospectively associated with APOs among racial and ethnic minoritized groups is unclear. Black and Latina pregnant individuals completed a Centers for Medicare & Medicaid Services-endorsed screening tool encompassing 13 domains of HRSNs. We tested the association of cumulative HRSN scores with APOs, adjusted for age, prior APO history, and parity. Among 320 participants, 119 (37.2%) had at least one APO. Each 1-point increase in a composite HRSN score was associated with 11.0% higher odds of developing an APO. An HRSN score of 7 or higher, compared with 0-4, was associated with 2.34-fold odds of APOs (95% CI, 1.26-4.34, P =.007). Pregnancy may provide an opportunity to identify and address HRSNs that place Black and Latina Americans at risk for APOs.