Background Pregnancy in women with sickle-cell disease (SCD) is associated with increased adverse outcomes. Findings on the association between SCD and adverse pregnancy outcomes are conflicting, and the results do not address whether these associations are similar in both low-and high-income countries.Objectives We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with SCD.Search strategy The MEDLINE database was searched using medical subject headings (MeSH) and keywords for articles on pregnancy outcomes in women with SCD.Selection criteria We used full research articles published in English that compared women with SCD with women who did not have SCD, as controls.Data collection and analysis Data were abstracted and analysed using comprehensive Meta-analysis 2.2. The primary outcomes were intrauterine growth restriction and perinatal mortality. Secondary outcomes were rates of caesarean sections, preeclampsia, eclampsia, postpartum haemorrhage, maternal mortality, prematurity, and low birthweight. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs).Main results Sixteen studies met all of the selection criteria and were included in the analysis. SCD was associated with intrauterine growth restriction (pooled OR 2.79, 95% CI 1.85-4.21), perinatal mortality (pooled OR 3.76, 95% CI 2.34-6.06), and low birthweight (pooled OR 2.00, 95% CI 1.42-2.83). SCD was also associated with an increased risk of pre-eclampsia (pooled OR 2.05, 95% CI 1.47-2.85), maternal mortality (pooled OR 10.91, 95% CI 1.83-65.11, P = 0.009), and eclampsia (pooled OR 3.02, 95% CI 1.20-7.58).Conclusion Pregnancy in women with SCD is associated with increased risks of adverse perinatal and maternal outcomes in both low-and high-income countries.Keywords Maternal and perinatal outcome, pregnancy, sickle-cell disease.Tweetable abstract This meta-analysis showed worse pregnancy outcomes in women with sickle-cell disease compared with controls.Please cite this paper as: Boafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, Kassim AA, Aliyu MH, Galadanci H, Tuuli MG, Rodeghier M, DeBaun M, Oppong SA. Pregnancy outcomes in women with sickle-cell disease: a systematic review and meta-analysis. BJOG 2016;123:691-698.