Adverse obstetric outcomes, such as hypertensive disorders, preterm birth, and depression, disproportionately affect marginalized populations in the US and contribute to long-term health risks like cardiovascular disease (CVD). Racism and chronic stress are drivers of these inequities, yet the biological pathways linking them to perinatal health are underexplored. Allostatic load (AL), a cumulative measure of biological wear and tear from chronic stress, offers a potential tool for exploring these relationships and informing clinical care. We synthesized existing studies that measured AL in pregnancy, explored the feasibility of identifying AL biomarkers in clinical data, and examined the association between a biomarker-based index, modeled after AL, and adverse obstetric outcomes that impact CVD risk. We also incorporated iterative feedback from a working group of perinatal professionals. The scoping review identified 22 biomarkers and a refined index was developed using a subset. The most common combination for an index included six biomarkers, which included blood pressure and albumin. While the refined index was not significantly associated with adverse obstetric outcomes, the results highlighted stable partnerships as a protective factor. Exploring the relationship between AL and health inequities in perinatal populations is complex, especially using retrospective clinical data. Challenges include missing data and the inconsistency in how data is documented for clinical care compared to research. Despite these limitations, there is a need to refine AL indices further and explore systematic inequities and the biological pathways that may impact perinatal outcomes. These findings may inform the development of helpful interventions.