Objective: To analyze the impact of different degrees of meconium-stained amniotic fluid on neonatal outcomes, so as to provide guidance for clinical diagnosis and treatment. Methods: Clinical data of 482 parturients with meconium-stained amniotic fluid who delivered in the Third Hospital of Baogang Group from January 2023 to January 2024 were collected. They were divided into degree Ⅰ (n=292), degree Ⅱ (n=132) and degree Ⅲ (n=58) groups according to the degree of contamination. Clinical data of parturients and neonates were collected; neonates were divided into the good outcome group (n=429) and the adverse outcome group (n=53) according to their outcomes, and the characteristics of the two groups were compared. The neonates with adverse outcomes were divided into mild and severe pollution subgroups, and the risk factors of adverse outcomes were analyzed by Logistic regression. Results: There were statistically significant differences in maternal age, gestational age, AFI and umbilical artery blood flow parameters among the three groups (all P＜0.05). The incidences of gestational hypertension increased with the severity of contamination, and the degree Ⅲ group had the highest vaginal delivery rate. No neonatal death occurred in the three groups, and the incidence of adverse neonatal outcomes increased with the severity of contamination (P＜0.001). The degree Ⅲ group had lower Apgar scores and higher inflammatory markers. The adverse outcome group had higher rates of advanced maternal age, gestational hypertension and vaginal delivery, as well as more obvious abnormalities in maternal age, amniotic fluid and umbilical artery blood flow-related indicators. The mother-infant related abnormal indicators were more prominent in the severe contamination subgroup. Logistic regression showed that maternal age, degree of amniotic fluid contamination, AFI and AFV were independent risk factors for adverse neonatal outcomes (all P＜0.001). Conclusion: The severity of meconium-stained amniotic fluid is closely related to multiple maternal and neonatal indicators. Severe contamination, advanced maternal age and abnormal amniotic fluid are independent risk factors for adverse neonatal outcomes. Clinical attention should be paid to evaluation and individualized management should be implemented.