The epidemiological associations between the prenatal perfluoroalkyl substances ( PFASs ) exposure and the reproductive outcomes remain controversial. A continuous evaluation is needed to combine the inconsistent results. In this study, we explored the associations between PFASs exposure and the low birth weight ( LBW) , preterm birth and small for gestational age ( SGA ) . The quality of selected literature, quantitative estimates, publication bias and subgroup analysis were performed on the basis of 17 retrieved articles published before December 2020. The results showed a significant positive association between the perfluorooctane sulfonate ( PFOS) exposure and the risk of LBW [ Odds ratio ( OR )= 1. 17; 95％ confidence interval ( CI):1. 01, 1. 36; heterogeneity: P=0. 30, I2=17％] . The positive association was also observed between the PFOS and the risk of preterm birth (OR=1.19; 95％CI: 1.01, 1.39, P= 0. 007; I2 = 62％) . There was a paucity of evidence regarding the negative effects of perfluorooctanoic acid ( PFOA ) , perfluorohexanesulfonic acid ( PFHxS ) and perfluorononanoic acid ( PFNA ) on the pregnancy outcomes. The findings from the subgroup analysis ( the sampling period, the birth gender and biologic specimens) did not substantially altered the results of the overall pooled estimate ORs. The increased prevalence of negative birth outcomes with gestational PFASs exposure warrants further explorations from biological process perspective.