Ebola Virus Disease in Pregnancy: Maternal–Fetal Outcomes, Vertical Transmission, and Implications for Vaccination—A Narrative Review

Background/Objectives: Ebola virus disease (EVD) during pregnancy is associated with severe maternal illness and exceptionally poor fetal and neonatal outcomes. However, pregnancy-specific evidence remains limited by small cohorts, heterogeneous outbreak settings, and the historical exclusion of pregnant women from clinical research. This narrative review synthesizes evidence on maternal, fetal, and neonatal outcomes, placental involvement and vertical transmission, clinical management, and vaccination during pregnancy. Methods: PubMed, Scopus, and Google Scholar were searched from inception through May 2026 using predefined terms related to EVD, pregnancy, maternal and neonatal outcomes, placental infection, vertical transmission, and vaccination. WHO and CDC guidance documents and reference lists of relevant publications were also reviewed. Two reviewers independently screened records and assessed full texts. Data was extracted using a standardized template and independently verified by a second reviewer. A total of 55 publications met the inclusion criteria and were narratively synthesized. Results: Historical reports documented very high maternal mortality and pregnancy loss; however, more recent studies do not indicate that pregnancy independently increases maternal mortality among patients with EVD. A systematic review and meta-analysis estimated maternal mortality at 67.8% (95% CI 49.8–83.7), fetal loss at 76.9% (95% CI 45.0–98.3), and neonatal mortality at 98.5% (95% CI 84.9–100). Contemporary data from the 2018–2020 Democratic Republic of the Congo outbreak similarly found no increased maternal mortality associated with pregnancy, although fetal and perinatal outcomes remained poor. Evidence supports placental involvement in EVD, but placental viral RNA detection should be distinguished from confirmed fetal or neonatal infection. Pregnancy-specific vaccine evidence now includes a Phase 3 trial of Ad26.ZEBOV/MVA-BN-Filo in 2013 pregnant women, demonstrating favorable safety and immunogenicity profiles. Conclusions: EVD in pregnancy remains associated with substantial pregnancy loss and neonatal mortality despite improvements in maternal care. Important gaps persist regarding maternal–fetal transmission, long-term infant outcomes, and optimal management strategies, highlighting the need for further research.