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

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