Fat-soluble vitamins during pregnancy are of vital importance for fetal growth and development. The present study aimed at exploring the association between vitamin A, E and D status during pregnancy and birth weight. A total of 19,640 women with singleton deliveries from a retrospective study were included. Data were collected by the hospital electronic information system. Maternal serum vitamin A, E and D concentrations were measured during pregnancy. Logistic regression was performed to estimate the association between the vitamins status and low birth weight (LBW) or macrosomia. Women with excessive vitamin E were more likely to have macrosomia (OR: 1.30, 95% CI: 1.07-1.59) compared with adequate concentration. When focusing on Z scores, there was a positive association between vitamin E and macrosomia in the 1st (OR: 1.07, 95% CI: 1.00-1.14), 2nd (OR: 1.27, 95% CI: 1.11-1.46) and 3rd (OR: 1.28, 95% CI: 1.06-1.54) trimesters; vitamin A was positively associated with LBW in the 1st (OR: 1.14, 95% CI: 1.01-1.29), 2nd (OR: 1.31, 95% CI: 1.05-1.63) and 3rd (OR: 2.00, 95% CI: 1.45-2.74) trimesters, and negatively associated with macrosomia in the 2nd (OR: 0.79, 95% CI: 0.70-0.89) and 3rd (OR: 0.77, 95% CI: 0.62-0.95) trimesters. The study identified that high concentrations of vitamin E are associated with macrosomia. Maintaining a moderate concentration of vitamin A during pregnancy might be beneficial to achieve optimal birth weight. Further studies to explore the mechanism of associations above are warranted.