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Background: Foreign citizenship and low socioeconomic status are key determinants of health inequalities and may influence maternal and neonatal outcomes. This study aimed to assess maternal health during pregnancy and the main adverse maternal and neonatal outcomes related to labour and childbirth among women living in Trentino (Northern Italy), comparing women with Italian and foreign citizenship. Methods: A retrospective epidemiological study was conducted using data from the Birth Assistance Certificate (CedAP) database of the Autonomous Province of Trento. This study included all women who gave birth in Trentino between 2012 and 2016. Associations between citizenship and adverse outcomes were assessed using multivariable logistic regression models adjusted for potential confounders. Results: The analysis included 23,165 women, of whom 25.9% had foreign citizenship. Women with foreign citizenship showed a significantly higher risk of gestational diabetes mellitus compared with Italian women and an increased risk of extremely preterm birth (<28 weeks of gestation), particularly among women from Central and South America, Asia and Eastern Europe. Regarding labour and mode of delivery, women with foreign citizenship had a higher risk of caesarean section, especially among women from Central and South America and Africa. In terms of neonatal outcomes, infants born to women with foreign citizenship showed a higher likelihood of requiring phototherapy and admission to the neonatal intensive care unit. Conclusions: Significant differences were observed between immigrant and Italian women in both social determinants and maternal and neonatal perinatal outcomes. Identifying factors associated with adverse outcomes during pregnancy may help improve targeted maternal care and reduce health inequalities for both mothers and newborns.