ABSTRACT Objectives This study estimated the progress in elimination mother-to-child transmission of syphilis (EMTCT) in Zhejiang province. Design Retrospective study Setting Eastern China Population or Sample Pregnant women with syphilis who gave birth at 28 gestational weeks or more during 2015-2019 were recruited. Methods Data were obtained from the Zhejiang provincial EMTCT network. We calculated the changes in coverage of maternal syphilis screening, treatment, incidence and associated adverse pregnancy outcomes (APOs). Main Outcome Measures The incidences of APOs; Crude odds ratio presented together with 95% confidence intervals (OR and 95% CI) for the risk of APOs. Results During 2015-2019, 11,713 out of 3,184,022 pregnant women were identified with syphilis infection. Generally, the coverage of syphilis screening in pregnant women increased (χ2trend= 1704.663, P<0.001), reaching 99.99% in 2019. The incidence of maternal syphilis was high in all years, with an incidence of 0.37% in 2019 (χ2trend = 0.344, P=0.557). The overall incidence of APOs dropped from 20.17% to 11.76% (χ2trend= 92.528, P<0.001).Based on rough estimation, treatment (OR=0.361, 95% CI 0.306–0.426), particularly full treatment (OR=0.307, 95% CI 0.259–0.363), successfully reduced the risk of APOs compared to those untreated. Conclusions A universal screening and treatment contributed to the decline of overall APOs. Keywords Elimination of mother-to-child transmission (EMTCT); Adverse pregnancy outcomes (APOs); Screening; Treatment; Pregnant women