Background <p>Second-generation mothers (SGMs), born in European countries to foreign-born parents, represent a growing population. While disparities in maternal and neonatal health outcomes among first-generation migrants and natives are well documented, less is known about these outcomes among SGMs. This systematic review and meta-analysis aimed to synthesize evidence on maternal and neonatal health outcomes among SGMs, comparing them to both native-born women and first-generation migrants.</p> Methods <p>We searched MEDLINE, Embase, and Scopus databases up to December 2024, for studies reporting on maternal and/or neonatal outcomes in SGMs in Europe. Eligible studies were critically appraised, and random-effects meta-analyses were conducted where possible to obtain pooled, unadjusted odds ratios.</p> Results <p>A total of 19 studies were included, mostly conducted in Germany and Nordic countries. SGMs had a lower risk of C-section compared to natives (pooled OR = 0.68, 95% CI: 0.60–0.78). They also seemed to have a higher risk of late access to antenatal care (ANC) and of gestational diabetes, although not significant for the latter. For other outcomes, such as near-miss, low birth weight and preterm birth, included studies reported conflicting results or the pooled estimates were not significant. The generalizability of findings is strongly affected by the limited number of studies, data heterogeneity and underrepresentation of key migrant groups and countries.</p> Conclusions <p>Structural factors, acculturation, and persistent inequalities may shape health trajectories across generations. Late access to ANC highlights that SGMs still face barriers in accessing care, despite being born and educated in host countries. Improved data collection, disaggregation by parental background, and attention to social determinants are essential to better understand and address the needs of this growing population.</p>