MATERNAL AND FETAL OUTCOMES OF ABDOMINAL WALL AND GROIN HERNIAS IN PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Importance: Pregnancy imposes predictable biomechanical and hormonal changes that both favor hernia formation and complicate the choice and timing of the repair. Objective: To compare maternal and fetal outcomes following expectant management, elective repair, and emergency repair of abdominal wall and groin hernias during pregnancy. Data Sources and Study Selection: MEDLINE, Embase, Scopus, and the Cochrane Library were searched from inception through September 30, 2025. We included observational studies with at least five pregnancies that reported maternal or fetal outcomes. Data Extraction and Synthesis: Two independent reviewers extracted data and assessed bias using ROBINS-I. We pooled outcomes with random-effects meta-analysis and applied the Hartung-Knapp adjustment. Heterogeneity was reported with I 2 , τ 2 , and 95% prediction intervals. Certainty was judged with GRADE. E-values were computed to gauge susceptibility to unmeasured confounding. Main Outcomes and Measures: Primary outcomes were severe maternal complications, preterm birth, and fetal loss. Results: Nine studies provided data on a total of 21,013 pregnancies. Emergency repair compared with elective repair was associated with a higher risk of severe maternal complications, RR 1.79 (95% CI 1.25 to 2.56), absolute risk difference 11.7% (95% CI 5.8% to 17.6%), number needed to harm 9, I 2 38%, prediction interval 1.10 to 2.91 and E-value 2.9. Surgery versus expectant management was associated with increased risk of preterm birth, RR 1.71 (95% CI 1.08 to 2.73), absolute risk difference 7.3% (95% CI 1.2% to 15.6%), I 2 46%, prediction interval 0.83 to 3.49 and E-value 2.8. There was no clear effect on fetal loss, RR 1.12 (95% CI 0.64 to 1.97). Among 18,942 pregnancies managed expectantly, incarceration occurred in 57 cases, pooled incidence 0.3% (95% CI 0.1% to 0.6%). No maternal deaths or bowel necrosis were reported in that group. Conclusions and Relevance: Emergency hernia repair nearly doubles the risk of severe maternal complications without reducing fetal loss. Expectant management is safe for largely asymptomatic hernias. Elective repair in the second trimester is reasonable for symptomatic patients who do not respond to conservative measures, and ultrasound confirmation can reduce unnecessary operations for groin masses.