title: The effectiveness of adolescent-specific prenatal interventions on improving attendance and reducing harm during and after birth: a systematic review.
abstract: BACKGROUND
  Adolescent pregnancy has been associated with poor pregnancy outcomes including pre-term birth (PTB), low birth weight (LBW) and perinatal death.
  
  
  OBJECTIVE
  To systematically review the effect of adolescent-specific interventions on reducing PTB, LBW, and perinatal death and increasing prenatal care attendance.
  
  
  METHODS
  Possible studies for inclusion were identified by a comprehensive search of OvidSP MEDLINE (limits: humans, 1990-present), EMBASE (limits: humans, 1990-2015), Popline and Global Health Database from the World Health Organisation (WHO) and PubMed International scientific databases, and references of identified articles were searched from 1990 to present.
  
  
  METHODS
  All types of controlled studies of prenatal interventions were exclusive to adolescents and at least one of the outcomes of interest.
  
  
  METHODS
  Investigators identified relevant studies and entered the data in a pro forma. Data were summarised as forest plots and narrative synthesis.
  
  
  RESULTS
  Twenty-two studies (three randomised controlled trials (RCTs), four prospective cohort studies, nine retrospective cohort studies, five case controls and one natural experiment) were included with all but one study being carried out in higher-income countries. Seven of the 16 studies reporting on PTB found a statistically significant reduction in PTB rates between adolescent-specific prenatal care (intervention) and non-age specific prenatal care odds ratio (OR) and 95% confidence intervals (CIs) ranged from OR: 0.15 (95% CI: 0.03-0.83) to OR: 0.59 (95% CI: 0.45-0.78). Nine of the 12 studies reported statistically significant higher mean prenatal attendance rates among the intervention group compared to controls (ranging from a mean number of visits of 14.3 vs. 10.7 p<0.001 to 10.8 vs. 7.6 visits p<0.001). The type and construct of the interventions, their implementation and local population differed sufficiently that a statistical synthesis was deemed inappropriate.
  
  
  CONCLUSIONS
  There is some evidence that adolescent-specific programs can increase prenatal attendance and reduce the risk of PTB and low birth rate but their effect on perinatal death is uncertain. There is a distinct lack of evidence of the effectiveness of these interventions for adolescents living in low-middle income countries, despite having the majority of adolescent pregnancies, and associated risk of harm. No high-quality intervention studies were identified. Robust, cluster-based RCTs are an urgent necessity to quantify the impact of these interventions and to identify factors contributing to their success.
authors.affiliation: The University of Manchester; Western University, 1151 Richmond St, London, Ontario N6A 3K7,Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Tibingana-Ahimbisibwe
authors.affiliation: Department of Anaesthesia, Makerere University, Kampala, Uganda.
authors.forename: Catherine
authors.initials: C
authors.lastname: Katabira
authors.affiliation: Life Link Hospital, Kampala, Uganda.
authors.forename: Lena
authors.initials: L
authors.lastname: Mpalampa
authors.affiliation: Centre for Epidemiology in the Institute for Population Health, The University of Manchester, Manchester, UK.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Harrison
keywords: adolescent pregnancy; interventions; prenatal