Impact of Maternal Malaria on Fetal Development and Pregnancy Outcomes: A Systematic Review and Meta-Analysis-Ready Evidence Synthesis

Abstract

Background: Maternal malaria remains an important contributor to preventable maternal, fetal, and neonatal morbidity in malaria-endemic and mobile populations. The evidence base is heterogeneous, with variations in malaria species, timing of infection, diagnostic methods, comparator definitions, and outcome ascertainment. Objectives: To synthesise primary quantitative evidence on associations between maternal malaria during pregnancy and fetal development or pregnancy outcomes, and to prepare a RevMan-ready evidence dataset. Methods: A PRISMA 2020-aligned systematic review was conducted using a PECO framework. Searches were conducted in PubMed and Europe PMC, with supplementary count/access documentation for Crossref, Google Scholar, WHO Global Index Medicus, AJOL, Semantic Scholar, OpenAlex, BASE, and CENTRAL. Eligible studies were English-language primary human studies published from 2016 to 2026 that evaluated maternal malaria during pregnancy against a malaria-free comparator and reported extractable quantitative outcome data. Generic inverse-variance random-effects analyses were derived from the locked extraction dataset. Results: PubMed and Europe PMC yielded 1,834 exported records. After 204 duplicates were removed, 1,630 records were screened; 36 candidate reports were assessed for strict PECO and RevMan-ready data, and 19 studies were included. Included studies represented Africa, Asia, Latin America, and the Thailand–Myanmar border. Systematic review and meta-analysis outcomes included low birth weight, preterm birth, maternal anaemia, congenital malaria, stillbirth, neonatal death, fetal growth, birth weight, head circumference, pre-eclampsia, and perinatal mortality. Random-effects generic inverse-variance synthesis supported increased risks of maternal anaemia, low birth weight, and preterm birth, although heterogeneity was substantial for several outcomes. Conclusion: The extracted evidence supports associations between maternal malaria and adverse fetal development and pregnancy outcomes, particularly maternal anaemia, low birth weight, preterm birth, congenital malaria, stillbirth, and neonatal mortality. Causal interpretation should remain cautious because most evidence was observational, diagnostically heterogeneous, and vulnerable to residual confounding.