By Ahizechukwu C. Eke, MD, PhD, MPH
Synopsis: Adolescent pregnancy is shaped by socioeconomic disadvantage, rural residence, early marriage, history of abuse, and limited contraceptive access. These factors increase the risk for anemia, stillbirth, preeclampsia, preterm birth, and low birthweight in adolescent mothers. Meaningful reduction requires coordinated, multisectoral action, with targeted educational and reproductive health interventions focused on adolescents.
Source: Abate BB, Sendekie AK, Alamaw AW, et al. Prevalence, determinants, and complications of adolescent pregnancy: An umbrella review of systematic reviews and meta-analyses. AJOG Glob Rep. 2025;5(1):100441.
Adolescent pregnancy, defined as pregnancy occurring in females aged 10 to 19 years, represents a significant public health concern because of its profound biological, social, and economic implications.1,2 In the United States, the Centers for Disease Control and Prevention (CDC) reports that approximately 146,973 births occurred among females aged 15-19 years in 2022, corresponding to a birth rate of 13.6 per 1,000 females — a historic low, yet still disproportionately higher compared to other developed nations.3
Despite recent declines attributed to improved access to contraception and comprehensive sexual education, teenage pregnancy rates remain elevated among marginalized populations, particularly among Black, Hispanic, and Native American communities.3 Several troubling dynamics threaten to reverse these gains, including reduced access to reproductive healthcare, persistent socioeconomic inequalities, rising rates of school dropout, and systemic deficiencies in sexual health education, particularly in rural and underserved areas.4,5 Furthermore, the increasing influence of social media and digital platforms has paradoxically heightened sexual risk behaviors among adolescents, contributing to early sexual debut and inconsistent contraceptive use, factors that fuel the complexity of tackling adolescent pregnancy trends.6,7
The etiology of adolescent pregnancy is multifactorial, stemming from an intricate interplay between individual, familial, societal, and structural determinants.8 Psychosocial vulnerabilities — including adverse childhood experiences, exposure to intimate partner violence, unstable family dynamics, poverty, and low educational attainment — substantially elevate the risk, while inadequate access to contraception and reproductive counseling exacerbates susceptibility.9,10
From a pathophysiological standpoint, adolescents face unique biological risks during pregnancy; incomplete physical maturation, including immature uterine and cervical anatomy, predisposes to obstetric complications such as preterm birth, hypertensive disorders of pregnancy (e.g., preeclampsia), low birth weight infants, and higher cesarean delivery rates.1,2 Furthermore, the metabolic demands of pregnancy may exceed the adolescent’s still-developing endocrine and musculoskeletal systems, leading to greater nutritional deficiencies (such as iron and folate depletion) that predispose to anemia, which adversely affects both maternal and fetal outcomes.11
Socially, teenage pregnancy perpetuates cycles of educational disruption, social stigma, and diminished economic potential, while economically, it imposes billions of dollars in healthcare, social services, and lost productivity annually on public systems.4
Given that adolescent pregnancy is a manifestation of several factors, including individual, familial, societal, and structural determinants, Abate and colleagues conducted this meta-synthesis of published systematic reviews and meta-analyses on adolescent pregnancy and outcomes.12
This was an umbrella systematic review and meta-analysis of all existing systematic reviews and meta-analyses that reported the prevalence, determinants, and outcomes of adolescent pregnancies.12 Studies were eligible for inclusion if they employed a clearly defined literature search strategy, conducted a quality appraisal of included studies using a validated tool, and used a standardized methodology for pooling data and generating summary estimates. Studies were excluded if they failed to report the measures of interest, were published in a language other than English, or were narrative reviews, editorials, correspondence, abstracts, or methodological papers.12
The authors employed narrative and qualitative approaches to synthesize estimates from the included reviews. When two or more estimates addressed the same outcome, the authors reported the observed range and calculated a pooled summary estimate. Standard errors for individual studies were derived using the binomial distribution formula. To estimate the overall magnitude of adolescent pregnancy, the authors conducted a random-effects meta-analysis using the DerSimonian-Laird method.12 Pooled prevalence rates with corresponding 95% confidence intervals (CIs) were displayed in forest plots; similarly, adjusted odds ratios (aORs) and 95% CIs were presented to summarize associated factors and outcomes.
Heterogeneity was assessed by the authors using Cochrane’s Q statistic (chi-square test), inverse variance (I2), and P-values, with I2 values of 0%, 25%, 50%, and 75% reflecting no, low, moderate, and high heterogeneity, respectively. Where significant heterogeneity was identified, the authors applied a random-effects model to account for between-study variation. Subgroup analyses were stratified by the year of publication, and sensitivity analyses were undertaken to evaluate the influence of individual studies on the pooled estimates. Publication bias was assessed both visually, using funnel plots, and quantitatively, using Egger’s regression test.12
Findings from 14 systematic reviews and meta-analyses, collectively encompassing 677,431 participants, were included. The pooled prevalence of adolescent pregnancy was estimated at 17.9% (95% CI, 12.25 to 23.54).
Several predictors were consistently associated with adolescent pregnancy, including rural residence (aOR, 1.80, 3.60), lack of contraceptive use (aOR, 1.19, 3.53), low socioeconomic status (aOR, 1.13, 3.81), lower levels of education (aOR, 1.40, 9.07), history of abuse (aOR, 2.21, 3.83), and early marriage (aOR, 1.27, 6.02). In addition to these risk factors, adolescent pregnancy was significantly associated with multiple adverse outcomes, including low birthweight (aOR, 1.46; 95% CI, 1.25, 1.66) and preterm birth (aOR, 1.90; 95% CI, 1.36, 2.40). The rates of preeclampsia/eclampsia (aOR, 1.63; 95% CI, 0.72, 2.55), anemia (aOR, 1.49; 95% CI, 0.29, 1.69; I2 = 91.7%), and stillbirth (aOR, 1.71; 95% CI, 0.24, 3.17; I2 = 61.3%) were not statistically significant.
Commentary
These findings highlight the substantial burden of adolescent pregnancy worldwide. Key predictors include living in rural areas, limited or absent use of contraceptives, lower socioeconomic status, reduced educational attainment, a history of abuse, and early marriage. In addition to these risk factors, adolescent pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, including low birthweight and preterm birth. These findings underscore the complex interplay between social vulnerability, inadequate access to reproductive health services, and biological immaturity in shaping the risks associated with adolescent pregnancy, and they reinforce the urgent need for comprehensive, context-specific prevention and intervention strategies.
Effective strategies to reduce adolescent pregnancy require a multi-tiered approach that simultaneously addresses biological, behavioral, and structural determinants of risk.13 At the clinical level, confidential, adolescent-centered reproductive healthcare — including early and repeated discussions of sexual health, provision of long-acting reversible contraception (LARC) methods, and culturally sensitive counseling — has been shown to markedly decrease unintended pregnancies among adolescents.14 School- and community-based comprehensive sexual education programs that emphasize both abstinence and contraceptive literacy are critical, particularly when they incorporate discussions of healthy relationships, consent, and empowerment.15,16 Policy interventions that increase access to healthcare through programs such as Title X Family Planning Services and Medicaid expansion have demonstrated efficacy in mitigating disparities by ensuring adolescents receive timely preventive care irrespective of socioeconomic status.17,18
Beyond medical interventions, broader societal efforts — such as poverty alleviation, parental engagement initiatives, mentorship programs, and the promotion of female educational attainment — are essential to alter the upstream social determinants fueling teenage pregnancy.5,13 Emerging models, including digital health interventions and mobile-based contraceptive delivery systems, also offer promising avenues for reaching high-risk youth.19 A coordinated, cross-sectoral response that integrates clinical medicine, education, public health, and social policy is necessary to sustain the downward trend in adolescent pregnancies and improve the lifelong health and socioeconomic trajectories of affected individuals.
In summary, adolescent pregnancy remains a significant global public health concern, with a pooled prevalence of approximately 17.9% and persistent disparities among marginalized populations. Key contributors include rural residence, limited contraceptive access, poverty, lower educational attainment, early marriage, and a history of abuse. Adolescent pregnancy is associated with serious maternal and neonatal complications, including low birthweight and preterm birth. Effective prevention requires confidential, adolescent-centered reproductive care, expanded access to LARC, and comprehensive sexual education programs that address both abstinence and contraceptive literacy.
Broader strategies to address poverty, support educational attainment, and empower young women are critical to breaking intergenerational cycles of disadvantage. Consistent with recommendations from the American College of Obstetricians and Gynecologists, interventions must prioritize confidential, culturally sensitive reproductive healthcare and policies that ensure adolescents’ unfettered access to comprehensive reproductive services.20,21
Ahizechukwu C. Eke, MD, PhD, MPH, is Associate Professor in Maternal Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore.
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