Informing the Development of Tailored Antenatal Care Services for Pregnant Adolescents: A Systematic Review and...

Background: Pregnant adolescents are at higher risk of adverse birth outcomes. Tailoring antenatal care (ANC) to adolescents' unique needs may be a way to reduce adverse maternal and child outcomes within this population. This systematic review aimed to evaluate ANC services for pregnant adolescents and their impact on maternal and infant outcomes. Methods: Two reviewers independently searched five electronic databases (September 2024) to evaluate existing ANC services that are tailored to adolescents and the impact they have on maternal and infant outcomes. Studies were assessed for quality using the NICE quality appraisal tool and a narrative synthesis was carried out to present the findings. In addition, a survey was disseminated through the Global Adolescent Nutrition Network (GANN) to gain further insights into stakeholder views and experiences of tailored ANC for adolescents. Results: 11,236 articles were reviewed, with 14 studies included for analysis. Interventions as part of ANC for pregnant adolescents included micronutrient supplementation, supplementary feeding, community-based delivery, group-delivery, tailored nutrition education, and additional support and counselling. Outcomes such as birthweight, preterm birth, and gestational age were reported, with most studies (11/14) demonstrating positive effects. Of 103 survey responses, 100% agreed that ANC for pregnant adolescents need to be delivered in a youth-friendly manner, and 57% indicated that providing both youth-friendly delivery and additional support are crucial. Inclusive and supportive care, tailored educational support, tailored nutrition care, and mental health support were most commonly mentioned as key components for tailored ANC. Conclusions: The systematic review and survey data concur in identifying key elements of adolescent-tailored ANC. Some of these have already been shown to be effective; however, due to the high heterogeneity of the study designs, a stronger evidence-base is needed. Specific elements of future ANC packages for pregnant adolescents might include group ANC delivery, community-based services, increased confidentiality measures, mental health support and counselling, health education, and nutrition care tailored to adolescents' physiological and emotional needs.