Background Shanxi Province in northern China has been identified as an area with the highest prevalence of neural tube defects in the world; however, the constituent and prevalence of adverse pregnancy outcomes (APOs) has changed in recent years. The aim of our study was to investigate the constituent and variation trend of the birth prevalence of APOs in rural northern China.Methods A population-based descriptive study was conducted. Data were derived from two birth surveillance systems that recorded all pregnancy outcomes from 2007 to 2012 in Pingding and Xiyang County in Shanxi Province, China.Results From 2007 to 2012, the birth prevalence of APOs in the two counties was 154.7 per 1,000 births. The birth prevalence of neonatal death, stillbirths, birth defects, premature birth, low birth weight (LBW), and macrosomia was 3.4 per 1,000 births, 12.3 per 1,000 births, 12.2 per 1,000 births, 21.9 per 1,000 births, 40.5 per 1,000 births, and 64.5 per 1,000 births, respectively. Birth prevalence of macrosomia increased from 59.6 per 1,000 births in 2007 to 74.4 per 1,000 births in 2012( {\chi }_{trend}^{2} =20.314,P < 0.001). Birth prevalence of LBW and premature birth declined, from 43.8 per 1,000 births and 19.1 per 1,000 births in 2007 to 30.1 per 1,000 births and 11.8 per 1,000 births in 2012 ( {\chi }_{trend}^{2}=21.748, P < 0.001; {\chi }_{trend}^{2} =14.342, P < 0.001). The birth prevalence of neonatal death, stillbirth and birth defects stayed at a relatively low level. The distribution of APOs birth prevalence took an obvious “U-shape” as maternal age rose from <20 year to over 40 year except for macrosomia.Conclusions More efforts should be made on finding causes and ways of interventions on APOs, especially prematurity, LBW and macrosomia which are currently under insufficient attention.