INTRODUCTION: In large urban cities, fast food restaurants and convenient stores dominate the food sector leaving limited access to quality healthy foods. Food insecurity is a modifiable risk factor of social drivers of health. We hypothesize that low-access food environment is associated with gestational diabetes, preterm deliveries, hypertensive disorders, and other comorbidities. METHODS: A retrospective cohort study was performed to determine the effects of food environment on pregnancy outcome using geographic data from 3,898 patients who delivered after 20 weeks of gestation in a large inner-city hospital between 2014 and 2019. The USDA Food Access Research Atlas was used to extrapolate census tract data from neighborhoods that have been previously identified as low-access areas. Demographics were obtained by chart abstraction. Chi-squared tests were used for analysis. RESULTS: Of the 3,684 patients, 1,377 (37.4%) of the population lived in low-access food environments. There is a higher rate of neonatal intensive care unit (NICU) admission in low-access food environments compared to high access (8.6% versus 7.5%; P<.001). Contrarily, there is a lower rate of gestational diabetes mellitus (11.3% versus 13.6%; P=.0381) and preterm delivery (13.2% versus 16.7%; P=.0043) in women living in low-access food environments. There was no significant difference between hypertensive disorders (P=.0874) and fetal growth restriction (P=.8465). CONCLUSION: This study demonstrates that low-access food environment is associated with statistically significant higher rates of NICU admission. Unlike other risk factors, food environment is a modifiable risk factor, and as women's health providers, it is important to address all social drivers of health, including food insecurity.