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Background  Maternal body mass index is linked to short- and long-term unfavorable health outcomes both for child and mother. We conducted a systematic review and meta-analysis of population-based cohort studies to evaluate maternal BMI and the risk of harmful neonatal outcomes in China.    Methods  Six databases identified 2454 articles; 46 met the inclusion criteria for this study. The dichotomous data on maternal BMI and harmful neonatal outcomes were extracted. Pooled statistics (odds ratios, ORs) were derived from Stata/SE, ver. 12.0. Sensitivity analyses assessed the robustness of the results. Meta-regression and subgroup meta-analyses explored heterogeneity.    Results  The meta-analysis revealed that compared with normal BMI, high maternal BMI is associated with fetal overgrowth, defined as macrosomia ≥4000 g ( OR  1.91, 95% CI 1.75–2.09); birth weight ≥ 90% for gestational age ( OR  1.88, 95% CI 1.64–2.15); and increased risk of premature birth ( OR  1.38, 95% CI 1.25–2.52) and neonatal asphyxia ( OR  1.74, 95% CI 1.39–2.17). Maternal underweight increased the risk of low birth weight ( OR  1.61, 95% CI 1.33–1.93) and small for gestational age ( OR  1.75, 95% CI 1.51–2.02).    Conclusions  Raised as well as low pre-pregnancy BMI is associated with adverse neonatal outcomes. Management of weight during pregnancy might help reduce their adverse neonatal outcomes in future intervention studies or programmes.    Electronic supplementary material  The online version of this article (10.1186/s12884-019-2249-z) contains supplementary material, which is available to authorized users.

Maternal body mass index and risk of neonatal adverse outcomes in China: a systematic review and meta-analysis