The objectives of this study were to determine the effect of calving body condition score (BCS) on cow health during the transition period in a pasture-based dairying system. Feed inputs were managed during the second half of the previous lactation so that BCS differed at drying off (BCS 5.0, 4.0, and 3.0 for high, medium, and low treatments, respectively: a 10-point scale); feed allowance was managed after cows were dried off, such that the BCS differences established during lactation remained at the subsequent calving (BCS 5.5, 4.5, and 3.5; n=20, 18, and 19, for high, medium, and low treatments, respectively). After calving, cows were allocated pasture and pasture silage to ensure grazing residuals >1,600 kg of DM/ha. Milk production was measured weekly; blood was sampled regularly pre- and postpartum to measure indicators of health, and udder and uterine health were evaluated during the 6 wk after calving. Milk weight, fat, protein, and lactose yields, and fat content increased with calving BCS during the first 6 wk of lactation. The effect of calving BCS on the metabolic profile was nonlinear. Before calving, cows in the low group had lower mean plasma β-hydroxybutyrate and serum Mg concentrations and greater mean serum urea than cows in the medium and high BCS groups, which did not differ from each other. During the 6 wk after calving, cows in the low group had lower serum albumin and fructosamine concentrations than cows in the other 2 treatment groups, whereas cows in the low- and medium-BCS groups had proportionately more polymorphonucleated cells in their uterine secretions at 3 and 5 wk postpartum than high-BCS cows. In comparison, plasma β-hydroxybutyrate and nonesterified fatty acid concentrations increased linearly in early lactation with calving BCS, consistent with a greater negative energy balance in these cows. Many of the parameters measured did not vary with BCS. The results highlight that calving BCS and, therefore, BCS through early lactation are not effective indicators of functional welfare, with the analyses presented indicating that both low and high BCS at calving will increase the risk of disease: cows in the low group were more prone to reproductive compromise and fatter cows had an increased risk of metabolic diseases. These results are important in defining the welfare consequences of cow BCS.