Ebola virus disease and maternal–neonatal health: direct and indirect impacts and health system preparedness gaps

Background Ebola virus disease (EVD) is a severe viral infection that can substantially affect maternal and neonatal health through both direct disease and disruption of essential health services. Pregnant women and neonates may experience serious adverse outcomes during outbreaks, yet pregnancy-specific evidence remains limited and maternal–neonatal health has historically received insufficient attention in Ebola preparedness and research. Methods This narrative review synthesized evidence on Ebola virus disease and maternal–neonatal health from peer-reviewed literature, international guidance, and outbreak reports. Relevant literature was identified through targeted searches of PubMed, Scopus, and Google Scholar and through reference-list screening of key publications. Findings were synthesized narratively, with attention to study design, methodological limitations, and differences across outbreak settings. Findings Available evidence indicates that EVD during pregnancy is associated with severe maternal complications and poor fetal and neonatal outcomes, although risk estimates remain uncertain because of small and heterogeneous studies. Placental infection and mother-to-child transmission have been documented. Ebola outbreaks also disrupt antenatal, delivery, immunization, and emergency obstetric services, contributing to additional maternal and neonatal morbidity and mortality. Key preparedness gaps include limited maternity-specific IPC, inadequate pregnancy-disaggregated surveillance, and insufficient evidence on vaccines and therapeutics in pregnancy. Conclusion EVD poses serious but context-dependent risks to maternal and neonatal health through direct disease and disruption of essential healthcare services. Preparedness should prioritize continuity of essential maternity and newborn care, maternity-specific IPC, pregnancy-disaggregated surveillance, and the responsible inclusion of pregnant and breastfeeding women in vaccine and therapeutic research and access.