Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: A systematic review and meta-analysis

Paediatr Perinat Epidemiol. 2019 Jan;33(1):88-99. doi: 10.1111/ppe.12529. Epub 2018 Dec 5.


Background: Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers.

Methods: Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes. Study selection, risk of bias appraisal, and data extraction of study characteristics were independently performed by two reviewers. Pooled odds ratios (pOR) with 95% confidence intervals (95% CI) were calculated to assess the association between SDOH and adverse birth outcomes.

Results: Thirty-one studies met the inclusion criteria. The most frequently evaluated SDOH was race while the most commonly reported maternal and birth outcomes were caesarean section and preterm birth (PTB), respectively. The risk of bias of included studies was fair on the Newcastle-Ottawa Scale. Meta-analyses of retrospective cohort studies showed that, compared to White adolescent mothers, African American teens had increased odds of PTB (pOR 1.67; 95% CI 1.59, 1.75) and low birthweight (pOR 1.53; 95% CI 1.45, 1.62). Rural residence was consistently linked with PTB while low maternal socio-economic (SES) and illiteracy were found to increase the risk of adolescent maternal mortality and LBW infants.

Conclusion: Social determinants of health contribute to the risk of adverse pregnancy outcomes in adolescent mothers. African American race, rural residence, inadequate education, and low SES are markers for poor pregnancy outcomes in adolescent mothers. Further research needs to be done to understand the underlying causal pathways to inequalities in adolescent pregnancy outcomes.

Keywords: adolescent pregnancy; maternal and birth outcomes; social determinants of health.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adolescent
  • Cesarean Section / statistics & numerical data
  • Continental Population Groups / statistics & numerical data
  • Female
  • Humans
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy in Adolescence / statistics & numerical data*
  • Premature Birth / epidemiology
  • Premature Birth / etiology
  • Risk Factors
  • Social Determinants of Health / statistics & numerical data*
  • Socioeconomic Factors