Adolescent pregnancy and adverse maternal and perinatal outcomes: a systematic review and meta-analysis

Abstract

Adolescent pregnancy remains a major global public health concern, yet evidence on its association with a broad range of maternal and perinatal outcomes remains fragmented. We conducted a systematic review and meta-analysis of observational studies comparing adolescents (13–19 years) with adult comparison groups defined differently across studies. MEDLINE, Embase, Emcare, and MIDIRS were searched from inception to 23 February 2026. Pooled unadjusted risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects models based on crude event counts extracted from cohort studies, while eligible cross-sectional studies were synthesized narratively. Subgroup analyses by country income level and adult comparator age group, and meta-regression, were performed to explore heterogeneity. The certainty of evidence for selected outcomes was assessed using GRADE. Twenty-six studies comprising approximately 3.6 million pregnancies were included. Adolescent pregnancy was associated with a heterogeneous pattern of maternal outcomes, including increased risks of anemia (RR 1.29, 95% CI 1.07–1.56; I²=92%), preeclampsia/eclampsia (RR 1.33, 95% CI 1.15–1.54; I²=76%), preterm prelabor rupture of membranes (RR 1.53, 95% CI 1.05–2.23; I²=66%), and intensive care unit admission (1.66, 95% CI 1.31–2.11; I²=0%), alongside a lower pooled risk of gestational diabetes (RR 0.52, 95% CI 0.37–0.73; I²=92%). Perinatal outcomes also showed an overall pattern of increased risk, with higher risks of neonatal death (RR 1.71, 95% CI 1.21–2.40; I²=92%), birth asphyxia (RR 2.22, 95% CI 1.08–4.57; I²=85%), preterm birth (RR 1.33, 95% CI 1.21–1.46; I²=96%), low birth weight (RR 1.47, 95% CI 1.25–1.74; I²=98%), and small for gestational age (RR 1.36, 95% CI 1.26–1.47; I²=73%). Heterogeneity was substantial across several outcomes and was not fully explained by subgroup analyses or meta-regression. The certainty of evidence was very low for selected outcomes assessed using GRADE. Adolescent pregnancy was associated with a higher pooled risk of several adverse perinatal outcomes and a more heterogeneous pattern of maternal outcomes. Given the very low certainty of evidence for the selected outcomes and the limitations of the underlying observational evidence, the findings should be interpreted cautiously. Findings of this review highlight the importance of integrated strategies to prevent adolescent pregnancy and improve care for pregnant adolescents. Pregnancy during the teenage years is a major health concern worldwide, especially in low- and middle-income countries, yet we do not have a clear overall picture of how it affects the health of mothers and babies. We reviewed 26 studies from around the world involving approximately 3.6 million pregnancies, comparing health outcomes between teenage mothers (aged 13–19 years) and adult comparison groups, which varied across studies but generally included women aged 20–35 years. We found that teenage mothers had higher risks of certain complications during pregnancy, including anemia, preeclampsia/eclampsia, early rupture of the membranes, and needing intensive care, while some other maternal outcomes showed different or no clear associations. Babies born to teenage mothers had higher risks of several adverse health outcomes than those born to adult mothers, although the strength of these associations varied across outcomes. Babies were more likely to be born too early, have a low birth weight, be small for their gestational age, or die in the newborn period. It is important to note that these findings are based on observational studies and show associations between teenage pregnancy and health outcomes, but do not prove that teenage pregnancy directly causes these outcomes. The observed differences may also reflect social, economic, and healthcare factors in addition to maternal age. The findings highlight the importance of supporting the health of teenage mothers and their babies during pregnancy and childbirth. Preventing teenage pregnancy through better education and access to reproductive health services remains important. At the same time, when a teenage pregnancy occurs, ensuring high-quality and accessible antenatal and maternity care, especially in low- and middle-income countries, is important to protect both mother and baby.

The authors' abstract, as published at the source. Reproductive Health, 2026 · DOI ↗