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This paper evaluates the Nutrition Intervention Project (NIP) implemented statewide in the State of Virginia to determine the effectiveness of nutritional intervention in decreasing pre‐term births and low birth weight (LBW) babies to at‐risk pregnant women in urban and rural areas. Sample size was 1,284. Majority of the respondents were white, primiparae, between 20‐29 years of age, and underweight (BMI < 19.8). Twenty‐one per cent of the of the births were pre‐term, and 13.3 per cent were in the LBW category. Regression analysis indicated that number of visits to the nutritionist was positively associated with birth weight and gestational age of the baby. Nutrition intervention (NI) decreased the smoking behaviour and improved the intake of iron supplements, both of which improved the weight gain and pregnancy outcomes. Effects analysis indicated that the causal effect operated both via intervening variables as well as directly between nutritional intervention and pregnancy outcomes. The path from NI to birth outcomes via weight gain was the strongest. Respondents in urban areas had a higher risk of pre‐term births than rural areas.