Food insecurity disproportionately affects women during their reproductive years. Food insecurity is associated with many negative health outcomes in the general population, including hypertension, diabetes, depression, anxiety, and obesity, particularly in women, yet it remains unclear whether it has negative implications for perinatal outcomes. We conducted a systematic scoping review using PubMed, Embase, and Scopus to identify studies of food insecurity and perinatal outcomes, including preterm birth, birth weight, gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and mental health outcomes during the perinatal and immediate postpartum periods, and breastfeeding initiation. Twenty-nine studies were included. There is consistent evidence that individuals experiencing food insecurity in the prenatal period are at greater risk for depression and anxiety during pregnancy and postpartum. The findings were inconclusive for preterm delivery, birth weight, and other pregnancy outcomes, including gestational diabetes, hypertensive disorders of pregnancy, and gestational weight gain. This review highlights important data gaps related to the assessment of food insecurity in pregnancy that must be addressed to draw conclusions about potential perinatal outcomes among those experiencing food insecurity. More research is needed to understand the impacts of food insecurity on pregnancy outcomes and assess whether efforts to alleviate food insecurity improve outcomes.