Abstract: OBJECTIVE Tenofovir disoproxil fumarate (TDF), as a first-line antiviral drug recommended by guidelines, is commonly used to block mother-to-child transmission of hepatitis B virus (HBV) or human immunodeficiency virus (HIV) viruses. However, there are some discrepancies regarding its long-term impact on the growth and development of infants and young children. This study aims to objectively evaluate the impact of TDF exposure during pregnancy or lactation on the growth and development of infants and young children through a meta-analysis. METHODS Six databases, namely CNKI, Wanfang, PubMed, Web of Science, Embase and Cochrane, were searched up to Feb. 2025. Data on growth and development from randomized controlled trials (RCTs) and cohort studies were included for meta-analysis. RESULTSA total of 46 studies (n=13 079) were included. The results showed that the birth weight in the TDF group was slightly lower than that in the control group (RCTs: mean difference (MD)=-41.611 g, 95%CI: -81.178 to -2.044, P=0.039. Cohort studies: MD=-31.716 g, 95%CI: -61.230 to -2.202, P=0.035). Cohort data indicated that the weight at 52 weeks (MD=-48.285 g, 95%CI: -88.470 to -8.099, P=0.019) and height at 52 weeks (MD=-0.464 cm, 95% CI: -0.735 to -0.192, P<0.001) were also slightly lower in the TDF exposure group. There were no statistically significant differences in most other outcomes. Subgroup analysis suggested that the negative associations observed in the overall analysis were primarily driven by the HIV-infected group. CONCLUSIONTDF exposure is slightly negatively associated with height and weight at birth and weight at 52 weeks, but causality could not be determined.