OBJECTIVES: Anemia in pregnancy has been a topic of interest for researchers due to its potential impact on various adverse pregnancy outcomes. This study aims to explore the relationship between anemia and adverse pregnancy outcomes such as preterm birth, low birth weight, and maternal mortality. METHODS: We conducted both a systematic review and a meta-analysis on the associations between anemia during pregnancy and adverse pregnancy outcomes. We searched Chinese databases (CNKI, Wanfang, CBM, VIP) and English ones (Cochrane Library, PubMed, Embase, Web of Science). Two researcher-authors independently assessed study quality with the Newcastle-Ottawa Scale. After extracting data, we analyzed heterogeneity and used a random-effects model for higher heterogeneity and a fixed-effects model for low heterogeneity in the meta-analysis while also systematically synthesizing and narratively describing findings in the systematic review. RESULTS: A total of 31 cohort studies were included. Meta-analysis showed that the risk of postpartum hemorrhage [RR [95% CI], 2.76 [1.63, 4.66]], premature rupture of membranes (PROM) [1.94 (1.26, 3.00)], preterm delivery [1.51 (1.33, 1.72)], low birth weight (LBW) [1.40 (1.19, 1.63)], cesarean section[1.33 (1.02, 1.74)], gestational hypertension[1.28 (1.14, 1.44)] and neonatal asphyxia[1.21 (1.07, 1.37)] was higher in the group of anemia in pregnancy than in the control group. CONCLUSION: Maternal anemia is associated with an increased risk of seven adverse pregnancy outcomes: postpartum hemorrhage, PROM, preterm delivery, LBW, cesarean section, gestational hypertension and neonatal asphyxia. Appropriate nutritional supplementation and screening for anemia before and during pregnancy are recommended to improve maternal health and manage adverse pregnancy outcomes.