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Epidemiological studies have suggested that there is an association between dietary acid load (DAL) with complications and outcomes of pregnancy. The current study aimed to explore the impact of DAL on theses parameters through a prospective cohort of Iranian pregnant women. In this prospective cohort study, 812 singleton pregnant women without any medical condition, use of medications, and without following a specific diet were included. Dietary intake of participants was examined using a 117-item semiquantitative food-frequency questionnaire (FFQ). Net endogenous acid production (NEAP) and potential renal acid load (PRAL) parameters were used to explore potential DAL using the suggested formula. Multinomial logistic regression analysis was used and odds ratio (OR) and 95% corresponding confidence interval (CI) were reported. DAL (NEAP and PRAL) was not associated with pregnancy outcomes including birth weight, birth height and birth head circumference (all P values > .05). NEAP was associated with preeclampsia (Model 3: OR = 0.48, 95%CI (0.25, 0.94); Ptrend = 0.05), systolic blood pressure (SBP) (Model 2: OR = 3.99, 95%CI (1.09, 14.53); Ptrend = 0.04), diastolic blood pressure (DBP) (Model 3: OR = 2.45, 95%CI (1.05, 5.72); Ptrend = 0.03), and intra-uterine growth restriction (IUGR) (Model 3: OR = 2.82, 95%CI (1.02, 7.78); Ptrend = 0.01). Moreover, PRAL was related with risk of pre-eclampsia (Model 3: OR = 0.41, 95%CI (0.19, 0.86); Ptrend = 0.003), SBP (Model 2: OR = 6.07, 95%CI (1.23, 29.94); Ptrend = 0.03), DBP (Model 3: OR = 3.62, 95% CI (1.23, 10.65); Ptrend = 0.03), and IUGR (Model 2: OR = 2.63, 95%CI (0.93, 7.44); Ptrend = 0.02). Our study focused on DAL which showed a significant association with pregnancy-related complications including higher SBP, DBP, IUGR, and pre-eclampsia. Further research with larger sample sizes in different populations might be required to evaluate the compatibility of DAL during pregnancy [ABSTRACT FROM AUTHOR]