Background Pregnancy toxemia is a common metabolic disease of periparturient small ruminants. Information on its effects on metabolism and perinatal adaptation of newborn lambs and kids is lacking. Objectives Evaluate differences in morbidity, mortality, and common biochemical and hematologic variables between pregnancy toxemia kids (PT) and control kids (CON). Animals Sixteen kids born to does being treated at the hospital for pregnancy toxemia (blood beta‐hydroxybutyrate concentration BHB > 1.2 mmol/L) and 12 kids from healthy dams (dam BHB < 1.2 mmol/L) that kidded at the hospital. Methods In this cohort study, serial measurements of blood L‐lactate, glucose, and BHB concentrations, arterial blood gases, hematocrit, total protein concentrations, nonesterified fatty acids (NEFAs) concentrations, and body weight were compared between groups over the first 72 hours of life. Long‐term follow‐up was performed after 3 months. Results Pregnancy toxemia kids were more likely to require tube feeding at 0 and 12 hours (relative risk 7.7 1.13, 52.45 and 2.8 1.39, 5.65). Pregnancy toxemia kids were more acidemic (7.26 ± 0.069 vs 7.34 ± 0.079, P = .003) and hyperlactatemic (8.17 ± 2.57 vs 5.48 ± 2.71, P = .003) at birth than CON kids. Control kids were 1.1 1.01, 1.77 times more likely to survive to discharge and 2.2 1.15, 4.20 times more likely to survive to 3 months than PT kids. Conclusions and Clinical Importance Pregnancy toxemia kids had higher short‐ and long‐term mortality and were more likely to require perinatal intervention. Weight loss in the first few days could be a useful predictor of nonsurvival.