Background: The enduring conflict in Somalia has precipitated significant humanitarian crises, including severely weakened health systems and poor health indicators. The situation has led to almost two million Somalis living abroad, often as refugees or asylum seekers in more high-resource settings in the Global North. To understand outcomes of care of pregnant women and their babies in host countries, this systematic review and meta-analysis aims to synthesise existing evidence on adverse maternal and perinatal outcomes among Somali migrant women compared to host populations. Methods: We conducted a comprehensive search across multiple electronic databases, including PubMed, Scopus, CINAHL Plus, and the Directory of Open Access Journals, using tailored keyword combinations. No language or date restrictions were applied, and the search concluded on June 30, 2024. Following data extraction and quality assurance using the STROBE Checklist, we conducted a meta-analysis for outcomes with sufficient data, using a random-effects model to account for heterogeneity across populations. Subgroup analyses were conducted by host country, with heterogeneity assessed using I2 and τ2 statistics. Potential publication bias was evaluated through Egger’s test and funnel plots. The results provide pooled estimates of maternal and perinatal outcomes. Results: Across all databases, 116 articles were retrieved, with 17 meeting the eligibility criteria. From these articles, pregnancy-related data from 1978 to 2018 on 55,119 Somali migrant women and 5,190,459 women from the host population was extracted. Somali migrant women, compared to host populations, had significantly increased odds of emergency caesarean section (CS) (pooled OR 2.54, 95%CI: 2.22–2.86), non-progressing/induced labour (pooled OR 1.25, 95%CI: 1.19–1.31). Their babies had higher odds of small for gestational age (SGA) (pooled OR 2.03, 95%CI: 1.89–2.17), neonatal morbidity (pooled OR 1.51, 95%CI: 1.40–1.61), and neonatal mortality (pooled OR 1.39, 95%CI: 1.25–1.54). Conversely, Somali migrant women had lower odds of assisted instrumental delivery (OR 0.72, 95%CI: 0.66–0.78), post-partum depression (OR 0.27, 95% CI: 0.12–0.63), preterm birth (OR 0.92, 95%CI: 0.88–0.96), and low birth weight (OR 0.87, 95% CI: 0.80–0.94) compared to host populations. Conclusion: Significant disparities in maternal and perinatal outcomes between Somali migrant women and host populations exist. Though more research is needed, available evidence points to the need for more culturally aware obstetric services that address the specific needs of Somali migrant women.