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• Hepatitis E virus infection has become a global concern, especially in pregnant women. • A large cohort of pregnant women (n=19,762) were investigated for HEV prevalence. • Adverse pregnancy outcomes were found in genotype 4 HEV-infected pregnant women. • Age, gravidity and parity are associated with the prevalence of HEV during pregnancy. Hepatitis E virus (HEV) infection has become a global concern, especially in pregnant women. However, the association between HEV prevalence and age, gravidity and parity of pregnant women remains unclear. Pregnant women (n=19,762) were enrolled for HEV prevalence and associated adverse pregnancy outcomes investigation in Qujing City, Yunnan Province of China from May 2019 to December 2020. The seroprevalence of HEV was 11.6% (2,297/19,762; 95% CI:11.2%–12.1%). About 11.4% (2,247/19,762; 95% CI:10.9%–11.8%) were positive for anti-HEV IgG antibody, 0.1% (22/19,762; 95% CI:0.1%–0.2%) were positive for anti-HEV IgM antibody, and 0.1% (28/19,762; 95% CI:0.1%–0.2%) were positive for both anti-HEV IgM and IgG antibodies. Sixty-one out of 2,297 anti-HEV-antibodies-positive pregnant women were positive for HEV RNA. Phylogenetic analysis revealed that all HEV isolates from pregnant women belong to genotype 4. Age, gravidity and parity are associated with increased prevalence of HEV. Pregnant women positive for HEV-IgG antibody bear a higher risk for an adverse pregnancy history and liver injury with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels than anti-HEV-negative pregnant women. Furthermore, seropositive pregnant women suffered a higher adverse maternal outcomes risk (crude odds ratio [cOR]=1.29; 95% CI: 1.16–1.43; adjusted odds ratio [aOR]=1.40, 95% CI: 1.25–1.55 for anti-HEV-IgG-positive pregnant women and cOR=1.38, 95% CI: 1.02–1.86; aOR=1.43, 95% CI: 1.05–1.95 for anti-HEV-IgM-positive pregnant women) and fetal outcomes risk (cOR=1.80, 95% CI: 1.61–2.01; aOR=1.77, 95% CI: 1.57–1.99) than anti-HEV-negative pregnant women. Adverse pregnancy outcomes of HEV infection are aggravated by age, gravidity and parity. In this study, we demonstrated high prevalence of HEV in pregnancy women in China, and HEV infection can cause various adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]