Inadequate nutrition during pregnancy can lead to adverse birth outcomes, and more importantly for pregnant adolescents as they require nutrients to meet their needs for their growth and the fetus. The study examined the relationship between  and birth outcomes among Ghanaian pregnant adolescents in selected districts of the Ashanti Region, Ghana. In this , we followed 416 pregnant teenagers recruited at health centers during antenatal care until delivery. We measured weight and height to calculate  (BMI), and Mid-Upper  (MUAC), and nutrient intakes using a repeated 24 hr dietary recall were collected. Hemoglobin (Hb),ÌýÌý´Ç´ÚÌý,Ìý,Ìý, Total  (TAC), C-reactive protein (CRP), and  (ZPP) were analyzed. Birth outcome data of interest were low birth weight (LBW) and  (PTB). About 15.2 % had LBW, 12.5 % had PTB, and 3.1 % . The majority of the pregnant adolescents consumed below Estimated Average Requirements (EAR) for  (75.7 %),Ìý (84.6 %),Ìý (82.9 %),Ìý (87.3 %), iron (93.5 %), zinc (83.7 %), and calcium (96.9 %) intakes, while energy (96.6 %), protein (84.6 %), and dietary fiber (74.4 %) were below the  (RDA). Anemia and wasting prevalences were 57.1 % and 27.8 %. The mean intakes for carbohydrates (p = 0.042) and dietary fiber (p = 0.012) were significantly higher among adolescent mothers with term birth (276.7 ± 111.2 g, 23.7 ± 11.2 g) than those with PTB (237.3 ± 83.7 g, 19.4 ± 9.0 g), respectively. Preterm birth proportions were higher in severely wasted (18.8 %) adolescents than moderately wasted (6.2 %) and normal MUAC (14.0 %) adolescents (p = 0.184). LBW proportions were higher among anemic (18.1 %) than the non-anemic (12.1 %), among low (30 %) compared with normal (14.9 %) , among low (15.7 %) compared with normal (0 %) serum , and among low (16.2 %) compared with normal (11.1 %)  A status pregnant adolescents. Pregnant adolescents with moderate wasting had lower odds (Adjusted odds ratio = 0.2,Ìýp = 0.017, 95 % confidence interval = 0.1–0.8) of having LBW infants compared with those with normal MUAC. The odds of  were significantly higher among pregnant adolescents with dietary fiber intake below the RDA (Unadjusted OR = 2.8,Ìýp = 0.042, 95 % CI = 1.0–7.3). In conclusion, adverse birth outcomes were associated with poor nutritional status among pregnant adolescents studied.