This review aimed to compare data regarding the effectiveness and safety of azithromycin with alternative regimens in the treatment of pregnant women with Chlamydia trachomatis infection. PubMed and Scopus databases were searched to identify relevant randomised controlled trials (RCTs). The main analysis focused on comparison of azithromycin with erythromycin. In a secondary analysis, azithromycin was compared with erythromycin or amoxicillin. Eight RCTs studying 587 pregnant women with microbiologically documented C. trachomatis infection were included in the meta-analysis. Overall, there was no difference between azithromycin and erythromycin regarding treatment success in intention-to-treat patients (pooled odds ratio (OR)=2.66, 95% confidence interval (CI) 0.69-10.29) or in clinically evaluated patients (OR=1.46, 95% CI 0.56-3.78). Furthermore, azithromycin was associated with fewer gastrointestinal adverse events (OR=0.11, 95% CI 0.07-0.18), fewer total adverse events (OR=0.11, 95% CI 0.07-0.18), a smaller proportion of patients who withdrew from the study (OR=0.12, 95% CI 0.04-0.37) and better compliance (OR=23.7, 95% CI 9.34-60.14) than erythromycin. The results of the secondary analysis comparing azithromycin with erythromycin or amoxicillin were similar to those of the main analysis. In conclusion, azithromycin was associated with similar effectiveness but less adverse events compared with erythromycin or amoxicillin in the treatment of pregnant women with C. trachomatis infection.