Zinc and manganese are essential nutrients for fetal growth and development. Since deficiency of maternal nutrition may lead to preventable adverse pregnancy outcomes, we aimed to examine the association of maternal dietary zinc and manganese levels with low birth weight (LBW). A nested case-control study was conducted in 605 cases and 7497 controls in Lanzhou, China. Eligible participants reported on their diet and characteristics during pregnancy. The relationship between dietary zinc and manganese intake and the risk of LBW was analyzed by unconditioned logistic regression and multivariate adjusted restricted cubic spline (RCS) model. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of zinc and manganese. The dietary intake below the cut-off value was defined as the low level group, and greater than or equal to the cut-off value was defined as the high level group. Low dietary zinc (< 5.05 mg/d before pregnancy and < 7.36 mg/d during pregnancy) and manganese (< 2.66 mg/d before pregnancy and < 3.41 mg/d during pregnancy) intake was associated with increased risk of LBW and some subtypes. Both zinc and manganese have a nonlinear relationship with the risk of LBW (P<0.001). In addition, there was a synergistic effect of low zinc and low manganese intake on LBW risk. There were separate and interaction effects of zinc and manganese on the occurrence of LBW. Appropriate range of zinc and manganese intake may be beneficial to reduce the risk of LBW.