ObjectiveTo systematically review the relationship between maternal alcoholic consumption during pregnancy and the occurrence of childhood cancer in offspring. MethodsPubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, VIP, and CBM databases were electronically searched to obtain related case-control and cohort studies from inception to December 2024. Two reviewers independently screened articles, extracted data and assessed the risk of bias of the included articles. Meta-analysis was performed by using the RevMan 5.4 software. ResultsA total of 18 articles involving 9 childhood tumors' outcome were included. The results of meta-analysis showed that compared with women who never drink alcohol during pregnancy, alcoholic consumption during pregnancy increased the incidence risk of childhood cancer by 13% (OR=1.13, 95%CI 1.01 to 1.26, P=0.040). Subgroup analysis showed that alcoholic consumption during pregnancy significantly increased the incidence risk of acute leukemia (OR=1.17, 95%CI 1.06 to 1.30, P=0.002) and acute lymphocytic leukemia (OR=1.23, 95%CI 1.02 to 1.48, P=0.030). We conducted further meta-analysis involving articles with better control of confounding factors, and found that alcoholic consumption during pregnancy increased the risk of childhood acute myeloid leukaemia (OR=1.38, 95%CI 1.00 to 1.90, P=0.050). ConclusionThe current evidence suggests that alcoholic consumption during pregnancy significantly increases the incidence risk of childhood cancer in offspring, particularly acute leukemia and acute lymphocytic leukemia. As for childhood cancer prevention, it is of great practical significance to formulate and implement the publicity and education program for pregnant women to abstain from alcohol. Due to the limited quantity and quality of the included articles, more high-quality birth cohort studies are needed to verify the above conclusion.