Background <p>Maternal smoking during pregnancy is associated with adverse outcomes, but its relationship with childhood seizures remains unclear. Previous studies have produced inconsistent findings regarding the link between maternal smoking during pregnancy and seizure risk in offspring. We aim to investigate the association between maternal smoking during pregnancy and seizures in offspring through systematic review and meta-analysis.</p> Methods <p>We conducted a search across multiple electronic databases such as PubMed, Embase, ScienceDirect, Scopus, and Web of Science. The search was performed on May 12, 2025. Papers reporting seizure frequency according to maternal smoking or odds ratios for seizure in offspring were selected. Dose-response analysis was performed based on restricted cubic spline analysis between the number of cigarettes per day and the effect estimate. The meta-analysis was performed using Review Manager version 5.4.1, and the dose-response analysis was conducted using STATA version 13 software.</p> Results <p>Among the 1,128 articles initially identified, 14 studies involving 12,887,398 subjects were included. Offspring exposed to maternal smoking during pregnancy exhibited an increased association with seizures (odds ratio 1.49, 95% confidence interval 1.21–1.84) compared to those whose mothers did not smoke during pregnancy. Subgroup analysis revealed a significantly heightened association in febrile convulsion, epilepsy, and neonatal seizure. Dose-response analysis shows a linear increase in childhood epilepsy with maternal smoking, where each additional daily cigarette raises the odds ratio by 1.7%.</p> Conclusions <p>Our study establishes a significant association between maternal smoking during pregnancy and seizures in offspring. These findings highlight the importance of public health efforts to reduce maternal smoking and highlight the potential impact on childhood health outcomes.</p> PROSPERO Registration number <p>CRD42023416464</p>