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SARS-CoV-2 has infected millions of pregnant people worldwide, raising concerns about neurodevelopmental sequelae. This systematic review examined the effects of prenatal SARS-CoV-2 exposure on neurodevelopmental and neuroimaging outcomes in children.We systematically searched for articles in published any language before 12th November 2024, using terms related to SARS-CoV-2, pregnancy, and neurodevelopment. Only original research was included. We performed meta-analyses on outcomes reported in ≥3 studies. Study quality was assessed using the Newcastle-Ottawa Scale.We identified 68 studies reporting on neurodevelopmental disorders (n=2), motor development (n=3), and neuroimaging (n=11), as well as neurological (n=7), audiological (n=29) and neurodevelopmental assessments (n=36) with follow-up periods up to 36 months. Overall, results were mixed with some studies reporting significant associations between prenatal SARS-CoV-2 exposure and social, communication, motor, auditory and neuroimaging outcomes, and others finding no associations. Study quality was generally low to moderate with small sample sizes, inappropriate control groups, and unmeasured confounding (e.g., parental mental health, lifestyle factors). Meta-analyses of neonatal auditory (n=9) and Ages and Stages Questionnaire (ASQ) (n=9) data suggested higher risks of hearing issues and fine motor and problem-solving delays in children prenatally exposed to SARS-CoV-2 compared to unexposed children.This systematic review revealed statistically significant associations between prenatal SARS-CoV-2 exposure and a wide range of adverse neurodevelopmental outcomes. However, given the low quality of evidence and unmeasured confounding, these associations are unlikely to reflect causal relationships. High-quality, longer-term research is needed to elucidate the neurodevelopmental sequelae of SARS-CoV-2 infection during pregnancy.