This study evaluates the association between prenatal RSV vaccination with the nonadjuvanted bivalent respiratory syncytial virus (RSV) prefusion F (RSVpref F) protein subunit vaccine and perinatal outcomes among pregnant individuals who delivered at 32 weeks' gestation or later during the 2023 to 2024 RSV season. The study was conducted at two New York City hospitals and included 2973 pregnant individuals. Prenatal RSV vaccination was captured from electronic health records. The primary outcome was preterm birth (PTB), defined as less than 37 weeks' gestation. Secondary outcomes included hypertensive disorders of pregnancy (HDP), stillbirth, small-for-gestational age (SGA) birth weight, and various neonatal conditions. The study found no significant association between prenatal RSV vaccination and an increased risk of PTB. However, there was an increased risk of HDP in the time-dependent model. The study supports the safety of prenatal RSVpref F vaccination but highlights the need for further investigation into the risk of HDP.This study evaluates the association between prenatal RSV vaccination with the nonadjuvanted bivalent respiratory syncytial virus (RSV) prefusion F (RSVpref F) protein subunit vaccine and perinatal outcomes among pregnant individuals who delivered at 32 weeks' gestation or later during the 2023 to 2024 RSV season. The study was conducted at two New York City hospitals and included 2973 pregnant individuals. Prenatal RSV vaccination was captured from electronic health records. The primary outcome was preterm birth (PTB), defined as less than 37 weeks' gestation. Secondary outcomes included hypertensive disorders of pregnancy (HDP), stillbirth, small-for-gestational age (SGA) birth weight, and various neonatal conditions. The study found no significant association between prenatal RSV vaccination and an increased risk of PTB. However, there was an increased risk of HDP in the time-dependent model. The study supports the safety of prenatal RSVpref F vaccination but highlights the need for further investigation into the risk of HDP.