To systematically review published case reports and series of Guillain–Barré syndrome (GBS) with onset during pregnancy, focusing on maternal disease course, obstetric management, and neonatal outcomes.

Guillain–Barré syndrome is a rare but clinically significant complication in pregnancy, associated with high maternal and perinatal risks. Diagnosis may be delayed because early neurological symptoms overlap with common pregnancy-related complaints. Although case reports describe variable maternal severity and neonatal outcomes, evidence is fragmented, and no prior systematic review has synthesized these data.

A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251127698). PubMed, Embase, and Scopus were searched to August 2025 for case reports and series of pregnancy-onset GBS. Eligible studies required a confirmed diagnosis and at least one maternal, obstetric, or neonatal outcome.

A total of 90 studies comprising 101 cases were included. Mean maternal age was 27.3 years, with symptom onset most frequent in the third trimester (52.5%). Preceding infection was reported in nearly half. Limb weakness (98%) and areflexia (87.6%) were predominant, and acute inflammatory demyelinating polyneuropathy accounted for 70% of subtypes. ICU admission occurred in 64% and mechanical ventilation in 45%. Bulbar weakness (OR 5.29, p=0.001) and autonomic dysfunction (OR 7.17, p<0.001) were strongly predictive of ICU requirement. Neurological recovery was complete in 35%, partial in 59.4%, with maternal mortality of 5.2%. Obstetric outcomes showed cesarean delivery in 54.8% and preterm birth in 36%. One-third of neonates were low birthweight, though overall survival was 85.6%. Third-trimester onset correlated with higher risks of preterm delivery and maternal respiratory compromise, underscoring the vulnerability of late gestation.

GBS in pregnancy predisposes to substantial maternal morbidity and obstetric risk. Early recognition and multidisciplinary care are crucial. Despite high neonatal survival, risks of preterm birth and maternal ventilation remain significant.