A Systematic Review and Meta-Analysis of Maternal Dengue Infection and Adverse Pregnancy Outcomes

Dengue virus (DENV) infection is endemic in many regions with high fertility rates and poses a significant public health concern during pregnancy. This systematic review and meta-analysis aimed to evaluate the association between maternal dengue infection and adverse pregnancy outcomes. A comprehensive search of PubMed, Embase, and Web of Science was conducted up to July 11, 2025. Eligible studies were comparative observational in design, with laboratory-confirmed dengue infection in pregnant women and at least one fetal or neonatal outcome reported. Outcomes of interest included stillbirth rate (SBR), miscarriage rate (MBR), preterm birth rate (PBR), low birth weight (LBW), small for gestational age (SGA), neonatal death (ND), and postpartum hemorrhage (PPH). Random-effects models were employed to calculate pooled odds ratios (OR), and the risk of bias was assessed using the Newcastle-Ottawa Scale. A total of 35 studies encompassing approximately 65,000 pregnancies from 14 countries were included. Dengue infection during pregnancy was significantly associated with increased odds of stillbirth (OR 2.70; 95% CI: 1.44-5.10), miscarriage (OR 3.51; 95% CI: 1.15-10.77), and ND (OR 3.03; 95% CI: 1.17-7.83). Associations with preterm birth, LBW, and SGA were inconsistent but appeared stronger in cases of severe or first-trimester infections. These findings underscore the need for targeted clinical and public health interventions in dengue-endemic regions to mitigate maternal and perinatal risks. This review is registered with PROSPERO (CRD420251102253).