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Despite significant biomedical advances in the prevention of mother-to-child transmission (MTCT) of HIV, residual transmission and suboptimal maternal outcomes persist across Europe. The challenge is no longer primarily virological but structural: aggregated ART coverage indicators mask important discontinuities across the perinatal care pathway. This scoping review maps evidence on clinical and psychosocial dimensions of the perinatal HIV pathway among adult women living with HIV (WLHIV) in Europe, and identifies key gaps in their integration across the continuum of care. Following PRISMA-ScR guidelines, five databases were searched for studies published between 2010 and 2026. Of 1881 records identified, 109 met inclusion criteria. Findings were synthesized thematically using an inductively developed framework spanning preconception through long-term postpartum outcomes. MTCT rates declined from approximately 1-1.2% in the mid-2000s to below 0.5% in recent data, and vaginal delivery rates increased markedly with sustained viral suppression. However, persistent inequalities remain among younger women, migrants, and those with histories of injecting drug use. Stigma, migration-related vulnerability, mental health difficulties, constrained disclosure, and socioeconomic insecurity shape engagement with care, influencing treatment continuity, retention, and virological outcomes, particularly during the postpartum period. Equitable perinatal HIV outcomes require integrated care models that combine clinical HIV and obstetric services with mental health support, social needs screening, and migration-sensitive services to address the structural conditions shaping care trajectories. A substantial proportion of WLHIV in Europe originate from high-prevalence regions, making perinatal HIV in this context a direct interface between global infectious disease burden and migration health. Addressing care in European settings therefore contributes to broader global health equity goals in HIV elimination. The protocol was pre-registered on Open Science Framework with registration number: 10.17605/OSF.IO/9BZGY.