ABSTRACT Objective To determine accurate estimates of risks of maternal and neonatal complications in pregnancies with fetal macrosomia by performing a systematic review of the literature and meta-analysis. Methods A search of MEDLINE, EMBASE, CINAHL and The Cochrane Library was performed to identify relevant studies reporting on maternal and/or neonatal complications in pregnancies with macrosomia having a birth weight (BW) > 4000 g and/or those with birth weight > 4500 g. Prospective and retrospective cohort and population-based studies that provided data regarding both cases and controls were included. Maternal outcomes assessed were emergency Cesarean section (CS), postpartum hemorrhage (PPH) and obstetric anal sphincter injury (OASIS). Neonatal outcomes assessed were shoulder dystocia, obstetric brachial plexus injury (OBPI) and birth fractures. Meta-analysis using a random-effects model was used to estimate weighted pooled estimates of summary statistics (odds ratio (OR) and 95%CI) for each complication, according to birth weight. Heterogeneity between studies was estimated using Cochran’s Q, I2 statistic and funnel plots. Results Seventeen studies reporting data on maternal and/or neonatal complications in pregnancy with macro- somia were included. In pregnancies with macrosomia having a BW > 4000 g, there was an increased risk of the maternal complications: emergency CS, PPH and OASIS, which had OR (95% CI) of 1.98 (1.80 – 2.18), 2.05 (1.90 – 2.22) and 1.91 (1.56 – 2.33), respectively. The corresponding values for pregnancies with BW > 4500 g were: 2.55 (2.33 – 2.78), 3.15 (2.14 – 4.63) and 2.56 (1.97 – 3.32). Similarly, in pregnancies with a BW > 4000 g, there was an increased risk of the neonatal complications: shoulder dystocia, OBPI and birth fractures, which had OR (95%CI) of 9.54 (6.76–13.46), 11.03 (7.06 – 17.23) and 6.43 (3.67 – 11.28), respec- tively. The corresponding values for pregnancies with a BW > 4500 g were: 15.64 (11.31 – 21.64), 19.87 (12.19–32.40) and 8.16 (2.75–24.23). Conclusion Macrosomiaisassociatedwithseriousmater- nal and neonatal adverse outcomes. This study provides accurate estimates of these risks, which can be used for decisions on pregnancy management.