<p>Coastal wetlands are among the most productive ecosystems, rich in scientific, historical, cultural, and recreational values. They provide numerous ecosystem services, such as filtration, habitat protection, and carbon sequestration. However, the water quality of these ecosystems has recently been threatened due to both climatic and anthropogenic stressors. This systematic review examines water quality dynamics of coastal wetlands by analyzing studies published from 2015 to 2025 using Scopus databases. Anthropogenic stressors, mainly land use and land cover changes, including agricultural runoff, urbanization, industrial activities, shipping and port activities, overfishing and destructive fishing practices, along with tourism and recreational activities, adversely impact the water quality of coastal wetlands, altering their physical, chemical, and biological characteristics. Further, the climatic stressors such as rising temperatures and rising sea levels, altered precipitation regimes, frequent extreme weather events, and other climatic stressors such as El Niño compound the water quality issues. These stressors can be additive or non-additive and may act synergistically, leading to increased frequency and intensity of eutrophication, algal blooms, hypoxia, and shifts in ecosystem composition. The impacts of individual climatic/anthropogenic stressors are well presented in the existing literature; however, substantial gaps lie in understanding the impacts of multiple stressor interactions (additive or non-additive) within the ecosystem. Remote sensing and hydrological modeling contribute significantly to the comprehension of these dynamics; nevertheless, considerable deficiencies exist in interdisciplinary strategies aimed at mitigation and management. The review underscores the need for adaptive, ecosystem-based management that integrates nature-based solutions, policy reforms, and community engagement to foster coastal wetlands’ resilience and ecological integrity amid rapid global change.</p>