Congenital malaria is a public health concern globally. This report reviews publications on congenital malaria in the last two decades (1990-2010) with the view to establishing the current global epidemiological trends and the public health implications. A Medline Entrez-PubMed search was performed and published studies on congenital malaria in the last two decades (1990–2010) were identified. A combination of key words “congenital malaria” were used for the search which yielded 180 publications as of December 2010. Of the 180 publications, 93 were within the period 1990 to 2010. Bibliographies of all publications selected were checked for additional relevant references and were obtained and included in the review. The critical issues identified and discussed include the (i) current global trends of congenital malaria; (ii) controversies associated with the frequency of occurrence of congenital malaria; (iii) mechanism and clinical features; (iv) role of maternal HIV infection (v) effects of congenital malaria on infants; (vi) diagnostic challenges; and (vii) treatment considerations. Operational research into various aspects of congenital malaria is essentially lacking as many unresolved issues requiring urgent scientific investigation abound. Public health policy on malaria control should integrate guidelines on congenital malaria management and control.