Maternal and fetal outcomes in pregnant women with burn injuries: a systematic review and Meta-analysis

Abstract Burn injuries during pregnancy are associated with significant maternal and fetal morbidity and mortality; however, available evidence is fragmented and largely based on small observational studies. To estimate pooled maternal and fetal mortality among pregnant women with burn injuries and explore the impact of burn severity. A systematic review and meta-analysis of proportions was conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and LILACS were searched from inception to March 2026. Observational studies and case series reporting maternal and/or fetal outcomes were included. Risk of bias was assessed using NOS and JBI tools, and certainty of evidence using GRADE. Random-effects models with Freeman–Tukey double arcsine transformation were applied. Results: Twenty-two studies including 1,162 pregnant women were analyzed. Most studies were case series (n=15), followed by cohort studies (n=5) one cross-sectional study, and one case report. Maternal mortality ranged from 0% to 70%. The pooled maternal mortality proportion was 0.43 (95% CI: 0.36.0.50), with substantial heterogeneity (I2=72.9%). Fetal mortality ranged from 31.3% to 90.5%, with a pooled estimate of 0.57 (95% CI: 0.49.0.65; I2=78.6%). Burn severity, particularly TBSA burned .50%, was consistently associated with worse outcomes. Funnel plots suggested possible publication bias. The overall certainty of evidence was low. Burn injuries during pregnancy are associated with high maternal and fetal mortality, strongly influenced by burn severity. Despite consistent findings, the low certainty of evidence highlights the need for high-quality prospective studies.