Paternal lead exposure has emerged as a potential contributor to adverse pregnancy outcomes, yet its impact remains underexplored compared to maternal exposure. This systematic review and meta-analysis synthesize evidence on the association between paternal lead exposure and pregnancy outcomes to inform public health interventions and future research. To evaluate the association between paternal lead exposure and adverse pregnancy outcomes, including spontaneous abortion, low birth weight, preterm birth, small-for-gestational-age, and congenital anomalies. A systematic search of PubMed, Scopus, and Google Scholar was conducted up to August 2024. Observational studies examining paternal lead exposure (⩾15 µg/dL) and its effects on pregnancy outcomes were included. Data synthesis adhered to PRISMA 2020 guidelines, and study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model to compute pooled odds ratios (ORs) with 95% confidence intervals (CIs). Eleven studies were included in the systematic review, with 7 contributing to the meta-analysis. The pooled OR for congenital anomalies associated with paternal lead exposure was statistically significant (OR = 2.09, 95% CI: 2.09-3.35; P < .01), indicating a strong association. However, no significant associations were observed for other outcomes: spontaneous abortion (OR = 1.11, 95% CI: 0.75-1.64), low birth weight (OR = 0.98, 95% CI: 0.68-1.39), preterm birth (OR = 1.57, 95% CI: 0.61-4.05), and small-for-gestational-age infants (OR = 0.92, 95% CI: 0.78-1.09). Heterogeneity was low for most outcomes, except for spontaneous abortion (  = 39%) and preterm birth (  = 52%). This study highlights a significant association between paternal lead exposure and congenital anomalies, emphasizing the need for occupational and environmental regulations targeting lead exposure among men of reproductive age.