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. 2025 Jan 20;5(1):100441. doi: 10.1016/j.xagr.2025.100441

Prevalence, determinants, and complications of adolescent pregnancy: an umbrella review of systematic reviews and meta-analyses

Biruk Beletew Abate 1,2,⁎, Ashenafi Kibret Sendekie 3,4, Addis Wondimagegn Alamaw 5, Kindie Mekuria Tegegne 5, Tegene Atamenta Kitaw 5, Molla Azmeraw Bizuayehu 5, Amare Kassaw 6, Gizachew Yilak 5, Alemu Birara Zemariam 5, Befkad Derese Tilahun 5
PMCID: PMC11915151  PMID: 40103846

Abstract

OBJECTIVE

This study aimed to assess the magnitude, determinants, and outcomes of adolescent pregnancy by combining data from previous systematic reviews and meta-analyses.

DATA SOURCES

Online databases.

STUDY ELIGIBILITY CRITERIA

Systematic Review and Meta-analysis.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar, which reported the magnitude, predictors, and/or outcomes of adolescent pregnancy, were searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse variance random-effects model was used to determine the pooled estimates. In addition, subgroup heterogeneity, publication bias, and sensitivity were assessed.

RESULTS

A total of 14 systematic reviews and meta-analyses involving 677,431 participants were included in the final analysis of this umbrella review. The pooled prevalence of adolescent pregnancy from global systematic reviews and meta-analyses was found to be 17.90 (95% confidence interval, 12.25–23.54). Level of education (adjusted odds ratio ranging from 1.40 to 9.07), socioeconomic status (lower: adjusted odds ratio ranging from 1.13 to 3.81), residency (rural: adjusted odds ratio ranging from 1.80 to 3.60), abuse (adjusted odds ratio ranging from 2.21 to 3.83), marital status (married: adjusted odds ratio ranging from 1.27 to 6.02), and contraceptive use (no: adjusted odds ratio ranging from 0.19 to 3.53) were identified as predictors of adolescent pregnancy. Anemia (adjusted odds ratio, 1.49; 95% confidence interval, 0.29–1.69; I2= 91.7%), stillbirth (adjusted odds ratio, 1.71; 95% confidence interval, 0.24–3.17; I2= 61.3%), preeclampsia/eclampsia, (adjusted odds ratio, 1.63; 95% confidence interval, 0.72–2.55), preterm birth (adjusted odds ratio, 1.90; 95% confidence interval, 1.36–2.40), and low birthweight (adjusted odds ratio, 1.46; 95% confidence interval, 1.25–1.66) were found to be significant complications of adolescent pregnancy in a global context.

CONCLUSION

The prevalence of adolescent pregnancy varied significantly across previous systematic reviews and meta-analyses. The key determinants identified included low socioeconomic status, rural residency, a history of abuse, early marriage, and no contraceptive use. The complications associated with adolescent pregnancy included anemia, stillbirth, preeclampsia/eclampsia, preterm birth, and low birthweight. To reduce the burden of adolescent pregnancy, collaborative efforts are required from global, regional, and local stakeholders, such as policymakers and reproductive health program planners, through health education and training that focus on the most vulnerable populations.

Key words: adolescent pregnancy, determinants, global, outcomes, prevalence, umbrella review

AJOG Global Reports at a Glance.

Why was this study conducted?

This study aims to understand better the global issue of adolescent pregnancy, which is especially prevalent in low-income countries, with nearly 15% of women under 18 giving birth between 2015 and 2020.

Key findings

The review identifies key factors contributing to adolescent pregnancies, such as early sexual activity, early marriage, illiteracy, and limited access to contraception. It also highlights complications like eclampsia, preterm births, and infections. By synthesizing data from 14 systematic reviews with over 677,000 participants, the study reveals a global prevalence of 17.90%. It identifies predictors like lower education, low socio-economic status, rural residency, abuse, early marriage, and lack of contraceptive use. The study found that complications such as anaemia, stillbirth, pre-eclampsia/eclampsia, preterm birth, and low birth weight are significant outcomes.

What does this add to what is known?

The study underscores the significant impact of adolescent pregnancy on health outcomes, with a focus on key contributing factors and complications. It emphasizes the need for collaborative efforts among stakeholders to reduce adolescent pregnancy, calling for health education and targeted interventions for vulnerable populations.

Introduction

Adolescent pregnancy is defined as the occurrence of pregnancy in girls between the ages of 10 and 19, in which most cases are unplanned pregnancies.1 Between 2015 and 2020, nearly 15% of women aged <18 years worldwide gave birth, with more than 90% of these births in developing countries, and globally, approximately 20% of adolescent girls have given birth, increasing to approximately 33% in low-income countries.1,2 Adolescent pregnancy rates are high in low- and middle-income countries, with 21 million girls aged 15 to 19 years becoming pregnant and 12 million girls giving birth each year, half of which are unplanned.3 Adolescent pregnancy is a problem not only for poor countries but also for developed countries. The World Health Organization (WHO) data reveals that approximately 21 million girls get pregnant yearly. Of these girls, 12.0 million give birth, and approximately 5.6 million end up with miscarriage, of which 3.9 million are reported as unsafe in the developing regions of the world, hence inclining the global burden more toward developing countries of the world. Adolescent pregnancy is influenced by early sexual activity, premature marriage, illiteracy, resource scarcity, violence, and poor family communication. In addition, it is linked to substance abuse, sexual violence, lack of contraceptives, family history, limited health services, low maternal education, socioeconomic status, parental support, religious beliefs, and social media.4,5

Adolescent pregnancy poses significant risks, including eclampsia, cephalopelvic disproportion, preterm premature rupture of membranes, sexually transmitted infections, and pregnancy-induced hypertension. These complications increase the risks for both the mother and baby, highlighting the need for specialized prenatal care and support to ensure better health outcomes for both.6, 7, 8 Poor outcomes of adolescent pregnancy can be reduced through sexual education, birth control knowledge, and restricting marriage before the age of 18 years. Despite several global meta-analyses, the results remain inconsistent, and this umbrella review aims to address these discrepancies by highlighting the significant variation in the magnitude, predictors, and outcomes of adolescent pregnancy.9, 10, 11, 12, 13, 14, 15, 16, 17 Few research studies have carefully analyzed and synthesized the available evidence, even though a growing body of work has examined the burden of adolescent pregnancy. Meta-analyses, systematic reviews, and primary research studies have examined the prevalence, risk factors, and complications of adolescent pregnancy from various national and local perspectives. However, inconsistent findings present challenges for healthcare programs and clinical decision-making. The mixed and inconsistent results from these reviews make it difficult to provide clear recommendations to reduce global adolescent pregnancy efforts. The burden, determinants, and complications of adolescent pregnancy have not yet been comprehensively reviewed. Therefore, an umbrella review is necessary to consolidate these dispersed findings into a unified summary of the determinants, magnitude, and complications of adolescent pregnancy worldwide.

Materials and methods

This umbrella review followed the established methodologies for reviewing existing systematic review and meta-analysis (SRM) studies.18 However, it was not registered at the International Prospective Register of Systematic Reviews. This review systematically synthesized eligible SRM reports on prevalence, determinants, and complications using clear inclusion criteria and appropriate data analysis techniques.

Study selection/eligibility criteria

The retrieved SRMs were imported into EndNote reference manager software (version 8; Clarivate, Philadelphia, PA) to remove duplicate studies. Of note, 2 investigators (B.B.A. and B.D.T.) independently screened the studies based on their titles and abstracts before retrieving the full-text articles. Full-text articles were further screened using the prespecified inclusion criteria. Eligible studies reported the prevalence and/or at least 1 associated factor or outcome of adolescent pregnancy and were published in English in a global context.

To be considered an SRM, the studies had to meet the following criteria: (1) a defined literature search strategy, (2) an appraisal of the included studies using a relevant tool, and (3) a standardized approach in pooling studies and providing summary estimates. Studies were excluded for the following reasons: (1) failure to report the measures of interest, (2) non-English language, or (3) narrative reviews, editorials, correspondence, abstracts, or methodological studies.

The screening and selection processes occurred in 2 stages: initial title and abstract screening followed by full-text review. Any disagreements were resolved through a consensus meeting with the other reviewers to ensure that final decisions were made collaboratively.

Searching strategy and information sources

We identified studies providing data on the prevalence, determinants, and outcomes of adolescent pregnancy by searching PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar, which reported the prevalence of adolescent pregnancy, determinants, and its outcomes in a global context using the patient/population, intervention, comparison and outcomes frameworks. The search included Medical Subject Headings (MeSH) terms and keywords, combinations, and snowball searches in the reference lists of articles found through the database search to retrieve additional articles. Of note, 2 reviewers independently performed the literature search. Any discrepancies were resolved through consensus. Articles with incomplete data were addressed by the corresponding authors. We used the search terms independently and/or in combination using “OR” or “AND” in the PubMed search engine: (prevalence OR incidence OR epidemiology OR magnitude) AND (adolescent pregnancy OR teen pregnancy OR teenage pregnancy OR young age pregnancy OR adolescent childbearing) AND (determinants OR associated factors OR risk factors OR cause OR predictors) AND (anemia OR maternal mortality OR maternal death OR pre-eclampsia OR preeclampsia OR eclampsia or preterm OR premature or prematurity OR low birthweight OR low birth weight OR Small for gestational age OR still birth OR stillbirth OR neonatal deaths OR perinatal deaths OR neonatal mortality) AND (Systematic Review OR Meta-analysis OR Meta-analysis). A sample of the literature search strategy, the PubMed search strategy, developed using a combination of MeSH terms and free texts is presented in Supplementary Table 1. In addition to the systematic database searching, article searching was performed using the reference list of the included studies and the “cited by” and “related articles” functions of PubMed.

Quality assessment

The methodological quality of all included reviews was assessed by 2 independent reviewers using the Assessment of Multiple Systematic Reviews 2 tool.19,20 This tool consists of 11 questions that measure the quality of the approaches used to pool the empirical studies included in the review and summarize their estimates. This tool has been validated and is frequently used to appraise the quality of SRMs. Quality scoring was performed out of 11, with scores of 8 to 11, 4 to 7, and <3 indicating high, medium, and low qualities, respectively. The decision as to whether to include a review can be made based on whether a predetermined proportion of all criteria or certain criteria are met. Decisions regarding the scoring system and any exclusion cutoffs were made in advance and agreed upon by all reviewers before the critical appraisal began. We assessed the quality of the studies included in each research synthesis in the umbrella review section.

Data extraction

Data from the included SRM studies were extracted using a standardized data abstraction form developed in an Excel spreadsheet. For each SRM study, the following data were extracted: (1) identification data (first author's last name and publication year), (2) prevalence of adolescent pregnancy (percentage), (3) risk factors of adolescent pregnancy (odds ratio [OR] or relative risk with 95% confidence interval [CI]), (4) number of primary studies included within each SRM study and their respective design type, (5) total number of sample size included, (6) publication bias assessment methods and scores, (7) quality assessment methods and scores, and (8) outcomes of adolescent pregnancy (Table 1).

Table 1.

Distribution of included SRMs on the prevalence, determinants, and outcomes of adolescent pregnancy

Serial no. Authors Year Country Study design Number of articles Sample size Prevalence of adolescent pregnancy
1 Kassa et al9 2018 Ethiopia SRM 10 36,052 23.59
2 Amjad et al14 2019 Africa SRM 52 254,350 19.00
3 Pradhan et al12 2015 Africa SRM 25 81,692 25.00
4 Garba et al25 2016 Africa SRM 23 43,758 30.00
5 Karaçam et al26 2021 Nepal SRM 14 4550 13.20
6 Maravilla et al11 2017 Ghana Meta-analysis 11 14,556 15.40
7 Grønvik et al63 2014 Global Meta-analysis 38 75,390 —
8 Noll et al16 2009 Global Meta-analysis 21 3956 —
9 Madigan et al15 2014 Global SRM 26 168,796 —
10 Mohammed17 2023 Africa SRM 18 29,869 —
11 Yah et al64 2020 Turkey SRM 38 20,768 —
12 Eyeberu et al13 2022 Nigeria Systematic review 3 540 5.80
13 Shrestha et al65 2015 LMIC Systematic review 12 3650 —
14 Mamo et al10 2021 HIC SRM 10 35,752 23.59
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HIC, high-income country; LMIC, low- and middle-income country; SRM, systematic review and meta-analysis.

Abate. Prevalence, determinants, and complications of adolescent pregnancy. Am J Obstet Gynecol Glob Rep 2025.

Statistical analysis

After the data were extracted using Microsoft Excel, we imported the data to Stata (version 17.0; StataCorp, College Station, TX) for further analysis. Narrative and qualitative approaches were used to summarize the estimates of the included reviews. When ≥2 estimates were provided on the same topic, we presented the range of the estimates and calculated a summary (pooled). Using the binomial distribution formula, the standard error was calculated for each study. We pooled the overall magnitude estimates of adolescent pregnancy by a random-effects meta-analysis.21 The pooled prevalence of adolescent pregnancy with 95% CI was presented using forest plots, and the OR with 95% CI in the forest plots showed the associated factors and outcomes of adolescent pregnancy. We examined the heterogeneity between the studies using the Cochrane Q statistics (chi-square), inverse variance (I2), and P values.22 Here, the I2 statistic value of zero indicated true homogeneity, whereas the values 25%, 50%, and 75% indicated low, moderate, and high heterogeneity, respectively.20,23 For the data identified as heterogeneous, we performed our analysis using the DerSimonian-Laird random-effects model analysis. The subgroup analysis was performed using the article's year of publication. A sensitivity analysis was employed to determine the effect of a single study on the overall estimation. Publication bias was checked using a funnel plot and was checked more objectively using the Egger regression test.24

In this umbrella review, overlapping studies and chronologies were carefully managed to ensure valid results. To handle overlapping studies, identify and account for repeated research across the included systematic reviews, and perform sensitivity analyses to assess any effect on the overall findings. Regarding chronology, studies were stratified by publication date to examine trends over time, such as whether recent research provided different conclusions or better methodologies. A subgroup analysis based on publication period can help assess changes in findings over time, providing a context for the evolution of evidence.

Results

A total of 3394 reviews were identified, of which 3380 were sourced from various databases and 14 from other sources. After removing 1963 duplicates, 1431 articles remained. Ultimately, 206 studies were selected for full-text review, and 14 SRMs with 677,431 participants were included in the final analysis (Supplementary Figure 1 and Table 1).

Characteristics of included studies

Most included reviews (9 of 14) were both systematic reviews and meta-analyses, whereas the remaining studies consisted of 2 systematic reviews and 3 meta-analyses. The number of studies included ranged from 3 to 52, whereas the sample sizes in these SRMs varied from 540 to 254,350 participants (Table 1).

Prevalence of adolescent pregnancy

Most included studies (n=8)9, 10, 11, 12, 13, 14,25,26 reported the prevalence of adolescent pregnancy. The magnitude of the prevalence of adolescent pregnancy ranged from 5.80% in Eyeberu et al's13 study to 23.59% in Kassa et al's9 study. The random-effects model analysis from those studies revealed that the pooled prevalence of adolescent pregnancy globally is found to be 17.90 (95% CI, 12.25–23.54; I2=95%; P<.001) (Figure 1).

Figure 1.

Figure 1

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PRISMA flow diagram showing the results of the search

Abate. Prevalence, determinants, and complications of adolescent pregnancy. Am J Obstet Gynecol Glob Rep 2025.

Subgroup analysis

Subgroup analysis was performed based on the year of article publication. Based on this, the prevalence of adolescent pregnancy was found to be 20.42 (95% CI, 14.5–26.35) in studies conducted in 2020 and after, whereas the magnitude of adolescent pregnancy was found to be 12.40 (95% CI, −0.54 to 25.34) in studies conducted before 2020 (Supplementary Figure 2).

Publication bias

A funnel plot showed a symmetrical distribution. The Egger regression test value was 0.422, indicating the absence of publication bias (Supplementary Figure 3). Because of the absence of publication bias, we did not use a trim-and-fill analysis.

Sensitivity analysis

A leave-one-out sensitivity analysis was used to identify the effect of the individual study on the pooled prevalence of adolescent pregnancy. Sensitivity analysis revealed that the pooled finding was not dependent on a single study (Supplementary Figure 4).

Determinants of adolescent pregnancy

Of the total included SRMs, 9 revealed the determinants of adolescent pregnancy.9, 10, 11, 12, 13, 14, 15, 16, 17 Level of education (adjusted OR [AOR] ranging from 1.40 to 9.07), socioeconomic status (lower; AOR ranging from 1.13 to 3.81), residency (rural; AOR ranging from 1.80 to 3.60), abuse (AOR ranging from 2.21 to 3.83), marital status (married; AOR ranging from 1.27 to 6.02), and contraceptive use (no; AOR ranging from 0.19 to 3.53) were identified as predictors of adolescent pregnancy (Table 2).

Table 2.

Determinants and outcomes of adolescent pregnancy

Variable OR (95% CI) Year Pooled AOR (95% CI) I2 (P value)
Determinants of adolescent pregnancy
Level of education (lower) 1.84 (1.22–3.76) Mamo et al10 2021 2.32 (1.24–3.39) 78.8 (.001)
2.49 (1.58–3.92) Kassa et al9 2018
3.60 (2.70–4.80) Mohammed17 2023
1.40 (1.10–1.70) Maravilla et al11 2017
9.07 (2.58–3.07) Pradhan et al12 2015
Socioeconomic status (lower) 1.13 (0.75–1.51) Mamo et al10 2021 1.51 (1.19–1.82) 36.2 (.180)
1.84 (1.38–2.43) Eyeberu et al13 2022
1.70 (1.06–2.80) Mohammed17 2023
3.81 (1.35–11.61) Pradhan et al12 2015
1.55 (1.25–1.93) Amjad et al14 2019
Residency (rural) 1.45 (1.08–1.82) Mamo et al10 2021 1.74 (1.39–2.09) 23.9 (.262)
2.04 (1.30–3.18) Kassa et al9 2018
1.80 (1.35–2.30) Mohammed17 2023
3.60 (1.90–6.90) Pradhan et al12 2015
2.12 (1.33–3.40) Amjad et al14 2019
Abuse 3.83 (2.96–4.97) Madigan et al15 2014 2.95 (1.36–4.52) 89.2 (.002)
2.21 (1.94–2.51) Noll et al16 2009
Marital status (married) 2.35 (1.36–3.34) Mamo et al10 2021 1.84 (0.71–2.97) 67.9 (.044)
1.27 (1.14–1.67) Kassa et al9 2018
6.02 (2.35–15.43) Eyeberu et al13 2022
Contraceptive use (no) 3.53 (1.94–5.12) Mamo et al10 2021 1.81 (−0.25 to 3.81) 91.7 (<.001)
2.04 (3.70–1.10) Mohammed17 2022
0.19 (0.08–0.45) Maravilla et al11 2017
Complications of adolescent pregnancy
Anemia 1.34 (0.73–2.43) Karaçam et al26 2021 1.49 (1.29–1.69) 0.0 (.720)
1.50 (1.32–1.73) Garba et al25 2016
Stillbirth 0.87 (0.49–1.54) Grønvik et al63 2018 1.71 (0.24–3.17) 61.3 (.108)
2.71 (0.20–37.39) Karaçam et al26 2021
Preeclampsia/eclampsia 3.52 (2.26–5.48) Grønvik et al63 2018 1.63 (0.72–2.55) 75.4 (.017)
1.24 (0.68–2.26) Karaçam et al26 2021
1.14 (1.06–1.63) Garba et al25 2016
Preterm birth 1.75 (1.18–2.61) Grønvik et al63 2018 1.90 (1.36–2.44) 59.2 (.086)
2.91 (2.01–4.21) Karaçam et al26 2021
1.13 (1.02–1.35) Garba et al25 2016
1.67 (1.59–1.75) Amjad et al14 2019
Low birthweight 1.61 (1.24–2.09) Grønvik et al63 2016 1.46 (1.25–1.66) 48.1 (.123)
2.21 (0.94–5.21) Karaçam et al26 2021
1.22 (1.40–1.73) Garba et al25 2016
1.53 (1.45–1.62) Amjad et al14 2019
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AOR, adjusted odds ratio; CI, confidence interval; OR, odds ratio.

Abate. Prevalence, determinants, and complications of adolescent pregnancy. Am J Obstet Gynecol Glob Rep 2025.

Level of education

Of included studies, 5 SRM reported a significant association between level of education (low) and adolescent pregnancy. Of these studies, the highest risk factor was among respondents with lower educational levels (AOR, 9.07; 95% CI, 2.58–3 3.07), and the lowest risk factor was among those with higher educational level (AOR, 1.40; 95% CI, 1.10–1.70) (Table 2). The pooled estimate of the AOR of lower level of education was 2.32 (95% CI, 1.24–3.39; I2= 78.8%; P=.001) (Supplementary Figure 5).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .155, indicating the absence of publication bias (Supplementary Figure 6). Therefore, trim-and-fill analysis was not needed to identify the effect of an individual study on the pooled estimate of level of education as a determining factor of adolescent pregnancy. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 7).

Low socioeconomic status

Of note, 5 SRM studies reported a significant association between low socioeconomic status and adolescent pregnancy. Of these studies, the highest risk factor was among respondents with low socioeconomic status (AOR, 3.81; 95% CI, 1.35–11.61), and the lowest risk factor was among those with higher socioeconomic status (AOR, 1.13; 95% CI, 0.75–1.51) (Table 2). The pooled estimate of the AOR of low socioeconomic status was 1.51 (95% CI, 1.19–1.82; I2=36.2%; P=.180) (Supplementary Figure 8).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .155, indicating the absence of publication bias (Supplementary Figure 9). Therefore, trim-and-fill analysis was not needed to identify the effect of an individual study on the pooled estimate of socioeconomic status as a determining factor of adolescent pregnancy. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 10).

Rural residence

Of note, 5 SRM studies reported a significant association between rural residence and adolescent pregnancy. Of these studies, the highest risk factor was among respondents with rural residence (AOR, 3.60; 95% CI, 1.90–6.90), and the lowest risk factor was among those with urban residence (AOR, 1.45; 95% CI, 1.08–1.82) (Table 2). The pooled estimate of the AOR of rural residence was 1.74 (95% CI, 1.39–2.09; I2=23.9%; P=.262) (Supplementary Figure 11).

Publication bias

A funnel plot showed an asymmetrical distribution. During the Egger regression test, the P value was .021, indicating the presence of publication bias (Supplementary Figure 12). Therefore, trim-and-fill analysis was performed, 2 studies were added, and the total number of studies became 7. The pooled estimate of the AOR of rural residence was 1.67 (95% CI, 1.29–2.40) (Supplementary Figure 13). Trim-and-fill analysis was performed to identify the effect of an individual study on the pooled estimate of rural residence as a determining factor of adolescent pregnancy. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 14).

Abuse

Of note, 2 SRM studies reported a significant association between history of sexual abuse and adolescent pregnancy. Of these studies, the highest risk factor was among respondents with a history of abuse (AOR,  3.83; 95% CI, 2.83–4.83), and the lowest risk factor was among those with no history of sexual abuse (AOR, 2.21; 95% CI, 1.93–2.49) (Table 2). The pooled estimate of the AOR of abuse was 2.95 (95% CI, 1.36–4.35; I2=89.2%; P=.002) (Supplementary Figure 15).

Sensitivity analysis

Sensitivity analysis was performed to identify the effect of the individual study on the pooled estimate of abuse as a determining factor of adolescent pregnancy. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 16).

Marital status

Of note, 3 SRM studies reported a significant association between marital status and adolescent pregnancy. Of these studies, the highest risk factor was among respondents with a history of abuse (AOR, 6.02; 95% CI, 2.35–15.43), and the lowest risk factor was among those with no history of abuse (AOR, 1.27; 95% CI, 1.14–1.67) (Table 2). The pooled estimate of the AOR of being married was 1.84 (95% CI, 0.71–2.97; I2=67.9%; P=.044) (Supplementary Figure 17).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .214, indicating the absence of publication bias (Supplementary Figure 18). Therefore, trim-and-fill analysis was not needed to identify the effect of the individual study on the pooled estimate of marriage as a determining factor of adolescent pregnancy. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 19).

Contraceptive

Of note, 3 SRM studies reported a significant association between marital status and adolescent pregnancy. Of these studies, the highest risk factor was among respondents with no history of contraceptive use (AOR,  3.53; 95% CI, 1.94–5.12), and the lowest risk factor was among those with history of contraceptive use (AOR, 2.01; 95% CI, 0.74–3.34) (Table 2). The pooled estimate of the AOR of being married was 1.81 (95% CI, −0.25 to 3.87; I2=91.7%; P≤.001) (Supplementary Figure 20).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .113, indicating the absence of publication bias (Supplementary Figure 21). Therefore, trim-and-fill analysis was not needed to identify the effect of the individual study on the pooled estimate of having no history of contraceptive use as a determining factor for adolescent pregnancy. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 22).

Complications of adolescent pregnancy

Anemia

Of note, 2 SRM studies reported a significant association between adolescent pregnancy and anemia. Of these studies, the highest risk factor was among respondents with adolescent pregnancy (AOR, 1.50; 95% CI, 1.30–5.70), and the lowest risk factor was among those without adolescent pregnancy (AOR, 1.34; 95% CI, 0.49–1.70) (Table 2). The pooled estimate of the AOR of anemia was 1.49 (95% CI, 0.29–1.69; I2=91.7%; P≤.001) (Supplementary Figure 23).

Sensitivity analysis

Sensitivity analysis was performed to identify the effect of the individual study on the pooled estimate of adolescent pregnancy as a determining factor for anemia. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 24).

Stillbirth

Of note, 2 SRM studies reported a significant association between adolescent pregnancy and stillbirth. Of these studies, the highest risk factor was among respondents with adolescent pregnancy (AOR, 2.71; 95% CI, 0.94–2.71), and the lowest risk factor was among those without adolescent pregnancy (AOR, 1.15; 95% CI, 0.46–1.84) (Table 2). The pooled estimate of the AOR of stillbirth was 1.71 (95% CI, 0.24–3.17; I2=61.3%; P=.108) (Supplementary Figure 25).

Sensitivity analysis

Sensitivity analysis was performed to identify the effect of the individual study on the pooled estimate of adolescent pregnancy as a determining factor of stillbirth. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 26).

Preeclampsia/eclampsia

Of note, 3 SRM studies reported a significant association between adolescent pregnancy and preeclampsia/eclampsia. Of these studies, the highest risk factor was among respondents with adolescent pregnancy (AOR, 3.52; 95% CI, 1.91–5.13), and the lowest risk factor was among those without adolescent pregnancy (AOR, 1.14; 95% CI, 0.86–1.42) (Table 2). The pooled estimate of the AOR of preeclampsia/eclampsia was 1.63 (95% CI, 0.72–2.55; I2=75.4%; P=.017) (Supplementary Figure 27).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .408, indicating the absence of publication bias (Supplementary Figure 28). Therefore, trim-and-fill analysis was not needed to identify the effect of the individual study on the pooled estimate of adolescent pregnancy as a determining factor of preeclampsia/eclampsia. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 29).

Preterm birth

Of note, 3 SRM studies reported a significant association between adolescent pregnancy and preterm birth. Of these studies, the highest risk factor was among respondents with adolescent pregnancy (AOR,  2.91; 95% CI, 1.81–4.01), and the lowest risk factor was among those without adolescent pregnancy (AOR, 1.67; 95% CI, 1.59–1.75) (Table 2). The pooled estimate of the AOR of preterm birth was 1.90 (95% CI, 1.36–2.4; I2=59.2%; P=.086) (Supplementary Figure 30).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .425, indicating the absence of publication bias (Supplementary Figure 31). Therefore, trim-and-fill analysis was not needed to identify the effect of the individual study on the pooled estimate of adolescent pregnancy as a determining factor of preterm birth. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 32).

Low birthweight

Of note, 4 SRM studies reported a significant association between adolescent pregnancy and low birthweight (LBW). Of these studies, the highest risk factor was among respondents with adolescent pregnancy (AOR,  2.21; 95% CI, 1.19–2.03), and the lowest risk factor was among those without adolescent pregnancy (AOR, 1.22; 95% CI, 0.01–4.34) (Table 2). The pooled estimate of the AOR of LBW was 1.46 (95% CI, 1.25–1.66; I2=48.1%; P=.123) (Supplementary Figure 33).

Publication bias

A funnel plot showed a symmetrical distribution. During the Egger regression test, the P value was .866, indicating the absence of publication bias (Supplementary Figure 34). Therefore, a trim-and-fill analysis was not needed to identify the effect of the individual study on the pooled estimate of adolescent pregnancy as a determining factor of LBW. The results of the sensitivity analysis showed that our findings were not dependent on a single study (Supplementary Figure 35).

Discussion

This umbrella review aimed to provide a holistic view of adolescent pregnancy based on its determinants, magnitude, and complications in a global context. Accordingly, in this umbrella review, the overall pooled global prevalence of adolescent pregnancy was 17.90% (95% CI, 12.25–23.54). The major factors identified for adolescent pregnancy included unmet contraceptive needs, unprotected sex,27 social resistance to contraceptive use,28 childhood sexual abuse or violence,15,16,29 and limited involvement of teenage girls in decision-making.30

Regarding the determinants of adolescent pregnancy, adolescent girls with low educational attainment were more susceptible to pregnancy than those with higher educational attainment. These findings align with those of previous studies.9,31, 32, 33, 34, 35 Education empowers women to increase their autonomy and decision-making regarding sexual and reproductive rights. It contributes to economic independence, reducing early marriage and fertility rates. In contrast to previous findings, other studies have reported conflicting results, suggesting that adolescents in higher grade levels, particularly those in the 11th and 12th grades, are more likely to experience pregnancy than their peers in the 9th and 10th grades. These studies highlight a potential shift in the patterns of adolescent pregnancy, indicating that older adolescents may face greater risks, possibly because of factors, such as increased autonomy, social pressures, or exposure to riskier behaviors.36 This indicates that educational status has a great effect on preventing adolescent pregnancy.

The current study revealed that married or cohabiting adolescent mothers exhibited a higher incidence of repeat adolescent pregnancies than those who had never been in a union. Various studies have provided support for the notion that married adolescent girls face increased odds of becoming pregnant compared with unmarried girls in similar circumstances.33,34,36, 37, 38, 39, 40, 41 This could be attributed to the fact that married adolescent girls are more likely to be exposed to regular and unprotected sexual activity, which often results in early and high-risk pregnancies. Furthermore, their husbands’ influence on them to not use contraception may be a factor.31,34 Societal expectations for young married or cohabiting adolescents increase the risk of pregnancy, emphasizing the need for advocacy to change the legal age of marriage and empower young women.

Individuals who did not use contraceptives had a higher likelihood of adolescent pregnancy than those who had previous experience with contraceptive use. These findings are consistent with those of previous studies.9,32, 33, 34, 35,42,43 Contraceptive services can delay the first pregnancy. However, 1 study found a higher likelihood of adolescent pregnancy in adolescent girls using contraceptives. This could be due to insufficient counseling, awareness, and skills in contraceptive use, leading to unplanned and unwanted pregnancies in developing countries.40

Adolescents residing in rural areas were found to have a higher likelihood of experiencing pregnancy than their urban counterparts. This finding aligns with the results of previous studies.34,37,38,40,44, 45, 46 Rural teenagers are more likely to become pregnant because of their lower education, early marriage, and limited contraceptive access. However, 1 study found no significant association between place of residence and adolescent pregnancy or motherhood. However, it is worth noting that other studies have reported conflicting findings regarding the relationship between residence.39 This review calls for the development of health services specifically tailored to rural adolescents to reduce adolescent pregnancy in rural areas.

The results of this umbrella review support the conclusion that sexual abuse increases the risk of pregnancy in adolescents. Adolescents with a history of sexual abuse were more likely to experience pregnancy during adolescence than those without such a history. These findings are consistent with those of previous studies.15,16,32,47 Adolescents who experience sexual abuse often feel helpless and are unable to stop unwanted advances because of their limited interpersonal skills or confidence. This can lead to forceful sexual activity, multiple partners, and an increased risk of early adolescent pregnancy.15,48 Adolescents who have experienced severe sexual abuse may resort to alcohol or drugs as a coping mechanism, leading to transactional, increased, and unprotected sex, which potentially contributes to adolescent pregnancy.49,50

Adolescent girls from low-income households displayed a greater likelihood of experiencing pregnancy than their wealthier counterparts. Consistent with the literature,37,40,50, 51, 52, 53 poverty has long been recognized as a significant contributing factor to health and social challenges. In the context of adolescent pregnancy, poverty plays a dual role, acting as both a determinant and consequence. As a determinant, poverty can contribute to early marriage and early sexual initiation. Consequently, young girls from impoverished households often lack the financial resources to access reproductive health services and contraceptives. Another reason for this relationship may be that teenage girls with higher incomes may continue their education and pursue higher career goals, whereas teenage girls from low-income families may settle for early marriage. Adolescent pregnancy poses significant risks to both the mother and child, affecting health, education, and development. Young adolescents, whose bodies may not be physically ready, are particularly vulnerable to complications, such as anemia, stillbirth, preeclampsia, preterm birth, and LBW. In addition, lower prenatal care attendance among adolescent mothers increases the risk of complications.54

Maternal death, anemia, and preeclampsia/eclampsia were the major adverse outcomes that could affect the mother. Maternal anemia is one of the main negative outcomes of adolescent pregnancy.55 It shows that adolescent pregnancy is 1.49 times higher in adolescent women than nonadolescent women. Anemia can lead to iron deficiency, resulting in physical and cognitive damage to both adolescents and fetuses. Thus, it can worsen the burden of complications. As per the WHO's attention on maternal and child health, prophylactic supplementation of elemental iron is advised from the beginning of pregnancy to 3 months after delivery to all pregnant women.56 However, these age groups were lower attendees of the antenatal carefollow-up.54 For this reason, they missed iron supplementation. In addition, this overview suggests that preeclampsia/eclampsia is a common adverse outcome in pregnant adolescent girls. Consistently, the WHO affirms that this complication is one of the most common attention problems and that they are working on a solution.57 In addition, the previous review showed that 67 preeclampsia/eclampsia cases per 1000 adolescent pregnant girls were found.58 There was no clear cause identified. However, the suggested factors may include poorly developed uterine placental spiral arterioles (which decrease uteroplacental blood flow during late pregnancy), a genetic abnormality, immunologic abnormalities, and placental ischemia or infarction.59 Although the cause is not clear, this hypertensive disorder frequently leads to serious maternal and perinatal complications.

Adverse outcomes in neonates include preterm birth, stillbirth, and LBW, all of which increase mortality among children. Previous reviews found that these factors were the main determinants of the child's health and resulted in an increased risk of death.60 In addition, this review found that stillbirth was another major outcome. The risk of stillbirth showed a significant difference in adolescent pregnant women, which is consistent with previous single and review studies.61 The risk of LBW among adolescent girls was also higher than that among nonadolescent women. This can be explained, in part, by biological factors, such as the immaturity of the female reproductive system and inadequate prenatal weight gain, and, in part, by sociocultural and lifestyle factors, such as race and poverty. This finding is consistent with those of previous studies.61,62 In addition, LBW is a main contributor to childhood morbidity and mortality. Preterm birth is a common adverse outcome among women in these age groups. The relationship between preterm birth and adolescent pregnancy is mainly explained in the studies by DeMarco et al61 and Ghose and John.62

Conclusions and recommendations

This umbrella review revealed significant variations in the prevalence of adolescent pregnancy across previous SRMs. The key determinants identified were low socioeconomic status, rural residency, history of abuse, early marriage, and lack of contraceptive use. Adverse outcomes associated with adolescent pregnancy included anemia, stillbirth, preeclampsia/eclampsia, preterm birth, and LBW. Based on the findings of this umbrella review, interventions should target high-risk groups, such as adolescents with lower educational levels, lower socioeconomic status, rural residency, history of abuse, early marriage, and lack of contraceptive use, to reduce adolescent pregnancy rates. Healthcare systems must prioritize providing specialized prenatal care to adolescent mothers to address complications, such as anemia, stillbirth, preeclampsia, preterm birth, and LBW. Expanding community-based programs in rural areas, improving access to contraception, and advocating policies that address the root causes of adolescent pregnancy, including poverty and early marriage, are crucial. Further research is needed to evaluate the effectiveness of these interventions and explore the long-term effect of adolescent pregnancy.

CRediT authorship contribution statement

Biruk Beletew Abate: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Ashenafi Kibret Sendekie: . Addis Wondimagegn Alamaw: Writing – review & editing, Writing – original draft, Visualization, Software, Project administration, Investigation, Formal analysis, Conceptualization. Kindie Mekuria Tegegne: Writing – review & editing, Writing – original draft, Validation, Supervision, Methodology, Formal analysis, Data curation. Tegene Atamenta Kitaw: Writing – review & editing, Writing – original draft, Visualization, Formal analysis, Data curation. Molla Azmeraw Bizuayehu: Writing – review & editing, Writing – original draft, Software, Investigation, Formal analysis, Data curation, Conceptualization. Amare Kassaw: Writing – review & editing, Writing – original draft, Visualization, Supervision, Software, Methodology, Formal analysis, Conceptualization. Gizachew Yilak: Writing – review & editing, Writing – original draft, Visualization, Methodology, Formal analysis, Data curation, Conceptualization. Alemu Birara Zemariam: Writing – review & editing, Writing – original draft, Visualization, Investigation, Formal analysis, Data curation, Conceptualization. Befkad Derese Tilahun: Writing – review & editing, Writing – original draft, Visualization, Validation, Resources, Data curation, Conceptualization.

Footnotes

The authors report no conflict of interest.

There was no funding source for this study.

The datasets used and/or analyzed in the current study are fully available in the manuscript and supplemental files.

Supplementary material associated with this article can be found in the online version at doi:10.1016/j.xagr.2025.100441.

Appendix. Supplementary materials

mmc1.docx (15KB, docx)
mmc2.docx (10.4MB, docx)

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mmc2.docx (10.4MB, docx)

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