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Objectives To explore the levels of health-related functioning during pregnancy and postpartum and its association with non-severe maternal morbidities.Design An observational longitudinal study.Setting A tertiary women’s hospital in urban China.Participants Pregnant women in late pregnancy were recruited via consecutive sampling. The Chinese version of the Women’s Outcome Instrument for maternal healthCarE instrument was applied to measure health-related functioning and maternal morbidities at 28–41.6 weeks of gestation and at 6 weeks postpartum. Main outcome measures included health-related functioning, physical symptoms, anxiety and depression.Results Among the 624 participants, health-related functioning scores were significantly higher during late pregnancy than at 6 weeks postpartum (16.33±4.78 vs 14.40±3.65, p<0.001), reflected by a marked reduction in the prevalence of severe functional impairment (from 20.5% to 11.2%). Multivariate analyses revealed that antenatal impairment was significantly associated with moderately high physical symptoms (aOR=3.618, 95% CI 1.061 to 12.354, p<0.05), mild to moderate anxiety (mild: aOR=2.986, 95% CI 1.318 to 6.767, p<0.01; moderate: aOR=7.250, 95% CI 1.076 to 48.813, p<0.05) and mild depression (aOR=3.808, 95% CI 1.652 to 8.776, p<0.01). Postnatal impairment was linked to forceps delivery (aOR=1.874, 95% CI 1.007 to 3.483, p<0.05), moderately high to high physical symptoms (moderately high: aOR=4.591, 95% CI 1.960 to 10.751, p<0.01; high: aOR=13.277, 95% CI 5.501 to 32.073, p<0.01), moderate anxiety (aOR=3.059, 95% CI 1.015 to 9.217, p<0.05) and moderate to moderately severe depression (moderate: aOR=10.538, 95% CI 3.327 to 33.415, p<0.01; moderately severe: aOR=23.453, 95% CI 1.383 to 398.218, p<0.05). A dose-response relationship was observed between the severity of antenatal impairment and postpartum morbidities (all p<0.001 for moderate and severe impairment).Conclusion Functional impairment is prevalent perinatally and associated interactively with maternal morbidities. Assessment of health-related functioning and the provision of targeted interventions are recommended to improve maternal health outcomes in the perinatal period and beyond.