Objective To investigate the incidence of preterm delivery, low birth weight low birth weight (LBW), and small for gestational age (SGA) in pregnant women with hepatitis B virus (HBV) infection in Hunan Province and to explore the related factors. Methods The pregnant women with HBV infection who delivered from January to December, 2021 in various midwifery institutions in Hunan Province and reported to the communication system of mother-to-child transmission of hepatitis B were investigated. Their demographic characteristics, pregnancy, hepatitis B virus-related detection, and treatment were analyzed. The incidences of preterm delivery, LBW, and SGA were calculated respectively. Multivariate logistic regression was used to analyze the influencing factors. Results A total of 28 100 pregnant women with HBV infection were included, with a premature delivery rate of 6.8% (1 899/28 100), LBW rate of 4.4% (1 224/28 100), and SGA rate of 6.9% (1 931/28 100). Risk factors for preterm delivery in pregnant women with HBV infection included maternal age of 30 to 34 years and 3 35 years (compared with 25 to 29 years old), gestational age of the first antenatal examination 3 28 weeks (compared with 1 to 12 weeks), and antiviral therapy during pregnancy. The adjusted odds ratios (aOR) were 1.40 (95%CI: 1.23-1.60》 1.97 (95%CI: 1.70-2.28), 1.15 (95%CI: 1.03-1.28), and 1.36 (95%CI: 1.16-1.59), respectively. Maternal age < 20 years old, 30 to 34 years old, and 3 35 years old, and antiviral therapy during pregnancy were risk factors for LBW, and their aOR values were 1.75 (95%CI: 1.08-3.16), 132 (95%CI: 1,13-1.54) and 1.88 (95%CI: 1.57-2.25): 135 (95%CI: 1.12-1.63), respectively. Maternal age < 20 years old, 20 to 24 years old, and antiviral therapy during pregnancy were risk factors for SGA, and their aOR values were 1.92 (95%CZ: 1.24-2.97) and 134 (95%CI: 1.14-1.56), and 1.26 (95%CI: 1.07-1.48), respectively. Birth experience was a common protective factor for preterm delivery, LBW, and SGA, and their aOR values were 0.75 (95%CI: 0.67-0.85), 0.68 (95%CI: 0.59-0.78), and 0.82 (95%CI: 0.73-0,92), respectively. Conclusion The incidence of preterm delivery, LBW\and SGA in pregnant women with HBV infection in Hunan Province is not high, and it is affected by maternal age, parity, the time of the first antenatal examination, and antiviral therapy during pregnancy. [ABSTRACT FROM AUTHOR]