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Background Maternal exposures to environmental hazards during pregnancy are key determinants of birth outcomes that affect health, cognitive and economic status later in life. In Ethiopia, various epidemiological evidences have suggested associations between environmental exposures such as household air pollution, cigarette smoking, and pesticide exposure and pregnancy outcomes such as low birth weight, preterm birth, and birth defects. Objective This review aimed at generating summarized evidence on the association between maternal exposure to environmental factors (household air pollution, cigarette smoking, and pesticide) and pregnancy outcomes (birth weight, preterm birth, and birth defects) in Ethiopia. Method A systematic literature search was performed using PubMed, Google Scholar, and the Cochrane Library databases. All observational study designs were eligible for inclusion in the review. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) quality assessment tools adopted for case-control and cross-sectional studies. The random-effects model was applied in computing the pooled estimates and their corresponding 95% confidence interval (CI). Funnel and Doi plots were used for detecting the potential publication bias. All statistical analyses were performed using comprehensive meta-analysis (CMA 2.0) and MetaXL version 5.3 software. Result The pooled estimates revealed that prenatal biomass fuel use increased the risk of giving a low birth weight baby by twofold (OR = 2.10, 95% CI: 1.33–3.31), and has no separate kitchen increases the risk of having low birth weight baby nearly by two and half times (OR = 2.48, 95% CI: 1.25–4.92). Overall, using biomass fuel as the main energy source for cooking and /or having no separate kitchen from the main house is 2.37 times more likely to give low birth weight babies (OR = 2.37, 95% CI: 1.58–3.53). Active cigarette smoker women were 4 times (OR = 4.11, 95% CI: 2.82–5.89) more prone to have low birth weight babies than nonsmokers; and passive smoker women were 2.6 times (OR = 2.63, 95% CI: 1.09–6.35) more risked to give low birth weight babies. It was also estimated that active cigarette smoker women were nearly 4 times (OR = 3.90, 95% CI: 2.36–6.45) more likely to give preterm birth babies. Pesticide exposure during pregnancy also increases the risk of the birth defect 4 times (OR = 4.44, 95% CI: 2.61–7.57) compared with non-exposed pregnant women. Conclusion Household air pollution from biomass fuel use, active and passive cigarette smoking, and pesticide exposures are significantly associated environmental risk factors for low birth weight, preterm birth, and birth defects in Ethiopia. Therefore, Pregnant and lactating women should be aware of these environmental hazards during pregnancy. Promoting clean energy and improved and efficient stoves at the household level will help to reduce household air pollution-related adverse health effects. Trial registration PROSPERO 2022: CRD42022337140.背景 妊娠期孕妇暴露于环境有害因素，是影响子代出生结局，并进而影响其日后健康、认知与经济状况的关键决定因素。在埃塞俄比亚，多项流行病学证据表明，家庭空气污染、吸烟、农药暴露等环境暴露与低出生体重、早产、出生缺陷等妊娠结局存在关联。 目的 本综述旨在总结埃塞俄比亚境内孕妇暴露于环境因素（家庭空气污染、吸烟、农药）与妊娠结局（出生体重、早产、出生缺陷）之间关联的相关证据。 方法 本研究通过PubMed、Google Scholar及Cochrane Library数据库开展系统性文献检索。本综述纳入所有观察性研究设计的文献。采用针对病例对照研究与横断面研究优化的纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale, NOS）进行质量评价。采用随机效应模型计算合并效应量及其95%置信区间（confidence interval, CI）。使用漏斗图与Doi图检测潜在的发表偏倚。所有统计学分析均采用综合meta分析（CMA 2.0）与MetaXL 5.3版本软件完成。 结果 合并效应量分析结果显示，产前使用生物质燃料可使低出生体重儿的分娩风险升高至两倍（比值比[Odds Ratio, OR]=2.10，95%置信区间[CI]:1.33–3.31）；未设置独立厨房可使低出生体重儿的分娩风险升高近2.5倍（OR=2.48，95%CI:1.25–4.92）。综合来看，以生物质燃料作为主要烹饪能源，以及/或厨房未与主住宅分离的情况下，分娩低出生体重儿的风险为对照组的2.37倍（OR=2.37，95%CI:1.58–3.53）。与非吸烟孕妇相比，主动吸烟孕妇分娩低出生体重儿的风险升高至4倍（OR=4.11，95%CI:2.82–5.89）；被动吸烟孕妇分娩低出生体重儿的风险升高至2.6倍（OR=2.63，95%CI:1.09–6.35）。此外，主动吸烟孕妇分娩早产儿时的风险升高近4倍（OR=3.90，95%CI:2.36–6.45）。与未暴露孕妇相比，妊娠期农药暴露可使出生缺陷的发生风险升高至4倍（OR=4.44，95%CI:2.61–7.57）。 结论 在埃塞俄比亚，生物质燃料使用产生的家庭空气污染、主动与被动吸烟以及农药暴露，均为与低出生体重、早产及出生缺陷显著相关的环境危险因素。因此，妊娠期及哺乳期女性应警惕此类环境有害因素。在家庭层面推广清洁能源与改良高效炉灶，有助于降低家庭空气污染相关的不良健康影响。 试验注册 PROSPERO 2022: CRD42022337140.