Background <p>Placental malaria (PM) is among the leading public health problems associated with adverse outcomes for the mother, the foetus, and the newborn, particularly in sub-Saharan Africa (SSA). Although there are many studies published on PM in SSA, comprehensive evidence for targeted interventions is limited. Thus, this study aimed to synthesize evidence on the prevalence, predictors, and adverse perinatal outcomes of PM in SSA.</p> Methods <p>Pertinent studies online searching, selection, data extraction, and quality assessment were conducted. Data were extracted using Microsoft Excel and analyzed by STATA Version 17.0. Pooled estimates were determined by random-effect meta-analyses. Sub-group analysis was conducted to account for sources of heterogeneity.</p> Results <p>Overall, 178 observational studies published from 2000 to 2024 involving 93,809 parturient women from 23 countries were included. The overall pooled prevalence of PM in SSA was 25.1% (95% CI: 22.0–28.3), which was 16.9% (95% CI: 12.3–21.6), 19.1% (95% CI: 17.4–20.9), 24.8% (95% CI: 20.9–28.8), and 34.8% (95% CI: 29.3–40.2) by RDT, microscopy, PCR, and histopathology, respectively. Predictors of PM were: younger age (OR = 2.50 95% CI: 1.89–3.12), primigravidae (OR = 2.65 95% CI: 2.12–3.18), primiparae (OR = 1.62 95% CI: 1.23–2.01), not using insecticide-treated nets (OR = 2.11 95% CI: 1.34–2.89), not using ANC (OR = 7.43 95% CI: 2.47–12.40), not using intermittent preventive treatment during pregnancy (OR = 1.98 95% CI: 1.42–2.54), MiP history (OR = 3.05 95% CI: 1.85–4.25), HIV infection (OR = 2.67 95% CI: 1.22–4.62), and delivering during rainy season (OR = 2.24 95% CI: 1.05–4.07). The pooled prevalence of gestational malaria and congenital malaria was 22.1% (95% CI: 19.8–24.5) and 7.6% (95% CI: 6.5–8.8), respectively. The pooled prevalence of LBW, maternal anaemia, preterm delivery, small-for-gestational age, stillbirth and neonatal malaria was 12.7% (95% CI: 11.1–14.3), 39.0% (95% CI: 34.1–44.0), 11.2% (95% CI: 9.0–13.4), 17.9% (95% CI: 13.7–22.1), 3.4% (95% CI: 2.0–5.1), and 6.9% (95% CI: 3.9–9.8), respectively. PM increased the odds of maternal anaemia (OR = 2.18 95% CI: 1.73–2.63) and LBW (OR = 1.71 95% CI: 1.26–2.16).</p> Conclusion <p>Placental malaria was a multifactorial and multifaceted significant health problem with many adverse perinatal outcomes in SSA. Concerted efforts targeting the identified predictors through multidimensional approaches are needed.</p> <p>The protocol of this systematic review and meta-analysis was registered on PROSPERO with the code number: CRD42024528199.</p>