청소년 임산부를 위한 모성역할지지 중재의 효과: 모유수유, 산후우울증 및 양육 환경에 대한 체계적인 검토

Effects of maternal role support intervention for adolescent mothers: A systematic review on breastfeeding, postpartum depression, and parenting environment

Article information

J Korean Acad Soc Nurs Educ. 2025;31(2):206-218

Publication date (electronic) : 2025 May 31

doi : https://doi.org/10.5977/jkasne.2025.31.2.206

Seungmi Park ¹⁾

, Eunju Kwak ²⁾^,

, Hana Kim ²⁾

, Hye Ok Park ³⁾

, Jung Eun Hong ⁴⁾

박승미¹⁾

, 곽은주²⁾^,

, 김하나²⁾

, 박혜옥³⁾

, 홍정은⁴⁾

¹⁾ Professor, College of Nursing Science · Research Institute of Nursing Science, Chungbuk National University

¹⁾ 충북대학교 간호대학 · 간호과학연구소, 교수

²⁾ Assistant Professor, Department of Nursing · Research Institute for Basic Sciences, College of Life & Health Science, Hoseo University

²⁾ 호서대학교 생명보건대학 기초과학연구소 · 간호학과, 조교수

³⁾ Associate Professor, Kumudini Nursing College, Bangladesh

³⁾ 방글라데시 꾸무디니 간호대학, 부교수

⁴⁾ PhD Candidate, College of Nursing Science · Research Institute of Nursing Science, Chungbuk National University

⁴⁾ 충북대학교 간호대학 · 간호과학연구소, 박사과정 수료

Address reprint requests to: Kwak, Eunju Department of Nursing · Research Institute for Basic Sciences, College of Life & Health Science, Hoseo University, 20, Hoseo-ro 79beon-gil, Baebang-eup, Asan-si, Chungcheongnam-do, 31499, Republic of Korea Tel: +82-41-540-9606, Fax: +82-41-540-9558, E-mail: kwak21@hoseo.edu

Received 2025 March 13; Revised 2025 March 31; Accepted 2025 April 10.

Abstract

Purpose:

This systematic review aimed to evaluate the effects of maternal role support interventions on pregnant adolescents, focusing on exclusive breastfeeding, postpartum depression, parenting environment, and child development. The study sought to inform the development of targeted support programs for adolescent mothers.

Methods:

Using PRISMA guidelines, we conducted a systematic review of randomized controlled trials published from January 2014 to July 2024 that were sourced from MEDLINE, CINAHL, Embase, RISS, and KISS. Twelve studies involving 4,991 adolescent participants were included. They measured outcomes such as exclusive breastfeeding, postpartum depression (EPDS scores), parenting environment quality (HOME-IT scores), and child development (BSID-III scores). The data were extracted independently and analyzed for pooled effects, with evidence certainty assessed via GRADE.

Results:

The review found that maternal role support interventions improved breastfeeding knowledge in adolescent mothers but did not significantly increase exclusive breastfeeding rates. Interventions involving family support and professional counseling effectively reduced postpartum depression with sustained effects. Positive changes were also observed in parenting environment factors such as home organization and learning materials. Minor improvements in children’s cognitive and language development were noted, though these were not statistically significant.

Conclusion:

Maternal role support interventions enhance breastfeeding knowledge, reduce postpartum depression, and improve certain aspects of the home environment for adolescent mothers. However, exclusive breastfeeding rates and child developmental gains require additional multifaceted support. Future interventions should incorporate comprehensive tailored approaches involving family and professional support to address the complex needs of adolescent mothers and their children.

Keywords: Pregnancy in adolescence; Maternal behavior; Breast feeding; Postpartum depression; Parent-child relations

Keywords: 청소년 임신; 모성행동; 모유수유; 산후우울증; 부모-자녀관계

Introduction

In modern society, the social perception of adolescents’ sexuality tends to be somewhat closed, while the sexual culture and sexual behavior of adolescents are changing rapidly [1]. According to the 2021 Youth Sexual Culture Survey and the survey results of Statistics Korea, 9.4% of adolescents have had sexual intercourse [1], and the average age of sexual intercourse was 14.1 years old [2]. In addition, 52.6% of adolescents’ first sexual intercourse with their partner occurred within a month of meeting [1]. These results suggest a high likelihood that this trend will ultimately contribute to adolescent pregnancy [3]. According to the World Health Organization, approximately 21 million adolescent girls aged 15~19 become pregnant each year in low- and middle-income countries, with around 12 million of them giving birth annually. Nearly half of these pregnancies are unintended [4,5].

As of 2019, in low- and middle-income countries, approximately 21 million pregnancies occurred annually among adolescents aged 15~19, with 55.0% being unplanned, resulting in approximately 12 million births [4]. In Korea, according to the 2020 Statistics Korea results, the total number of newborns in Korea was 272,337, of which 918 were newborns born to female adolescents aged 19 or younger, and 10,530 were infants born to female adolescents aged 20~24 or younger [6].

It is known that adolescent pregnancy is classified as a high-risk pregnancy, and complications of adolescent pregnancy and childbirth are a significant cause of death in female adolescents [5]. Adolescent pregnant women are at higher risk of postpartum endometritis, preeclampsia, and systemic infections, and their babies are at higher risk of low birth weight, premature birth, and severe neonatal diseases [7]. In addition, adolescent pregnancy can reduce the range of social career options for female adolescents due to interruption of educational opportunities [5].

In this way, the process of giving birth and raising children brings about various difficulties for adolescent pregnant women. In addition to physical and mental burdens, they are accompanied by economic pressure and can experience social isolation [8]. Pregnant adolescents cannot often adjust to the imbalance between parenting expectations and parenting stress and thus feel a significant burden of parenting stress [9], as well as low interaction skills with infants and toddlers and parenting efficacy [8]. Therefore, a review of maternal programs that can support and mediate pregnant adolescents is required. Existing maternal programs in Korea are limited to maternal roles or maternal role adaptation for first-time mothers [10], married immigrant women [11], and postpartum mothers [12], and systematic comparative analysis of maternal intervention methods and effectiveness evaluations that take into account the transition process and exceptional circumstances experienced by pregnant adolescents is insufficient. Therefore, this study attempted to systematically examine the effects of domestic and international experimental intervention studies on the actual effects of maternal programs on pregnant adolescents. In addition, based on this, it aims to provide essential data for developing maternal programs that can effectively promote parenting support and maternal role enhancement for pregnant adolescents, considering the domestic situation.

This study aims to analyze the effectiveness of maternal role support interventions for adolescent pregnant women through a systematic literature review and to provide essential data for developing effective motherhood-related programs. The specific objectives are to identify the general characteristics of maternal role support intervention studies for adolescent pregnant women; to conduct a methodological quality assessment of maternal role support intervention studies for adolescent pregnant women; to analyze the effects of maternal role support interventions for adolescent pregnant women on breastfeeding, postpartum depression and parenting environment; to provide grounds for developing effective maternal role support intervention programs for domestic adolescent pregnant women.

Methods

Research design

This study is a systematic literature review of randomized controlled trials (RCTs) that evaluated the intervention effects of maternal role support programs implemented for adolescent pregnant women.

Literature search and selection criteria and exclusion criteria

The literature analysis process of this study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis), and the systematic literature review manual of the Korea Institute for Health and Social Affairs [13,14], and the search protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42023469004). Data were collected using three databases: MEDLINE, CINAHL, and Embase. For domestic data, two databases, the RISS and the KISS, were used to search for papers published over the past 10 years, from January 2014 to July 2024. Each database selected domestic and international data that is widely used by health care and nursing researchers to secure the expertise of the data. When searching foreign databases, search terms were included in both controlled and natural words of each data, and searched for adolescent pregnancy, adolescent mothers, teenager pregnancy, maternal behavior, parenting, and child care. Document type was limited to articles, and language was limited to English. Domestic literature was searched for “teen pregnancy” and “parenting” and was limited to registered sites. For the literature search, five researchers created a combination formula for each search term, and four researchers independently searched through search engines and then checked whether the retrieved literature matched. The research subjects (P) of this study were teenage pregnant women, and the specific conditions were women who became pregnant during their teenage years (before the age of 20). The intervention (I) was set as a maternal role support program for teenage pregnant women, and the intervention comparison (C) was set as a general postpartum program. Results (O) are results collected by tools that have direct or indirect relevance to the results of maternal role support programs, for example, studies that reported at least one outcome among breastfeeding, postpartum depression, re-pregnancy, home environment, child sensitivity, and maternal sensitivity as the mean, standard deviation, and number of subjects. The study design was limited to RCT.

Inclusion criteria were: (1) participants were adolescent mothers (<20 years); (2) studies used RCT design; (3) intervention involved maternal role support; and (4) outcomes reported included breastfeeding, postpartum depression, or parenting environment. Exclusion criteria included studies with adult mothers, non-interventional designs, or lacking standardized outcome measurements.

Analysis literature selection process

Five researchers independently reviewed the retrieved papers. After searching domestic and international databases, duplicates were excluded, and the titles and abstracts of the papers were reviewed to assess the selection criteria. Finally, the full texts of the papers were reviewed to select the literature. The retrieved papers were organized using Endnote and Excel, online bibliographic management programs. A total of 7,832 papers were retrieved through the initial search, 6,166 duplicate papers were excluded, the titles and abstracts were confirmed, and the full texts were reviewed. After reviewing and discussing the results independently performed by five researchers, 12 papers were finally selected (Figure 1). Of the 1,666 full-text articles assessed for eligibility, studies were excluded for reasons including: non-RCT design (n=742), participants not adolescents (n=401), intervention not focused on maternal role support (n=293), and insufficient outcome reporting (n=202). The list of the 12 studies included in the final analysis is provided in Appendix 1.

Figure 1

PRISMA flow diagram summarizing the studies identified during the literature search process

Literature quality assessment

The literature quality assessment used the risk of bias tool. After five researchers evaluated each study, disagreements were resolved through discussion and consensus, and no studies were excluded.

Data analysis

The characteristics of the included literature (first author, year, number of participants, duration [weeks], time [prenatal/postpartum], location, provider, intervention program, results, and quality assessment) were extracted using the data collection form.

In order to confirm the effect of maternal role support intervention for adolescent pregnant women and to present quantitative effect estimates for each study, Cohen’s d values were presented for the results indicating direct and indirect relationships with the results of maternal role support programs, and relative risk (RR) values were calculated. An integrated effect estimate was calculated for the results of the identical studies. In addition, the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology [15].

Results

General characteristics of literature

The characteristics of the studies included in this review are shown in Table 1. The total number of subjects in the included studies was 4,991, and the average intervention period was 13 weeks. The timing of the intervention was antenatal in 2 cases (16.7%) [16,17], postnatal in 5 cases (41.7%) [18-22], and both antenatal and postnatal in 5 cases (41.7%) [23-27]. The intervention was conducted in hospitals and other institutions in 5 cases (41.7%) [16,17,19,21,23], at home in 4 cases (33.3%) [18,20,26,27], and in both home and institutions in 3 cases (25.0%) [22,24,25]. The quality assessment results of all included studies assessed the risk of bias to be low.

Table 1

Descriptive Summary of the Included Studies (K=4,991, N=12)

Among the 12 included studies, 7 were conducted in low- or middle-income countries (e.g., Nigeria, Colombia, Thailand), while 5 were from high-income countries (e.g., Germany, UK, USA). This diversity in economic settings is important for interpreting the generalizability of the intervention outcomes.

Characteristics of maternal role support interventions

The interventions in the studies included in the systematic literature review showed various characteristics (Table 1). In 7 cases (58.3%), the providers were medical professionals such as doctors or nurses [19,20,22-24,26,27], and in others, trained home visitors [18], psychotherapists, or clinical social workers [20] provided the interventions. In the study by Gureje et al. [25], older women in the neighborhood with experience in childbirth and childrearing were included as interventionists to provide social support and complementary parenting skills training, and in the other two studies, the intervention providers were described as researchers [17] or interventionists [21] and their qualification criteria were not provided. In addition, two studies (16.7%) [22,24] included mothers or family members of pregnant adolescents in the interventions, although they were not intervention providers. The study by Sangsawang et al. [24] aimed to provide interventions to prevent postpartum depression, including the families of adolescent pregnant women, and to raise awareness of the importance of providing social support to the families and their ability to provide support. The study by Giugliani et al. [22] evaluated whether including mothers of adolescent pregnant women in breastfeeding education and counseling would reduce pacifier use.

For instance, in the study by Sangsawang et al. [24], the intervention included biweekly home visits by midwives, structured counseling sessions, and telephone-based follow-ups involving family members. In contrast, Gureje et al. [25] employed community-based peer mentoring supported by health workers once a month.

All studies included in the review implemented education as an intervention method, and nine studies (75.0%) provided counseling [16,18-20,22-25,27]. In addition, three studies (25.0%) provided emotional support [18,19,24], and other intervention methods included problem-solving therapy [25], video feedback [20], and conversation and feedback [21].

Among the maternal role support interventions, 9 (75.0%) [16,18,19,21-25,27] focused on the maternal role, and 3 (25.0%) [17,20,26] focused on maternal attachment. Among the interventions focusing on the maternal role, 2 (16.7%) [21,24] were interventions to prevent postpartum depression in pregnant adolescents without a diagnosis of mental illness, and 1 (8.3%) [25] was a study that provided behavioral activation and problem-solving therapy and parenting skills training to pregnant adolescents with postpartum depression. In addition, 2 (16.7%) [22,23] focused on breastfeeding, and both studies provided education and counseling on breastfeeding. In addition, considering the characteristics of adolescent pregnant women, two studies (16.7%) included interventions on re-pregnancy prevention, contraception, education, and career planning [18,19].

Effect of maternal role support intervention

Table 2 shows the main results of the maternal role support intervention. Due to differences in outcome measurement variables between studies, the combined effect size was calculated for only four outcome variables and their subdomains reported in five studies [20,23-26]. The GRADE certainty of the outcome variables for the maternal role support intervention was confirmed as high.

Table 2

Effectiveness Results of Maternal Role Support Interventions

● Exclusive breastfeeding

Two studies [23,25] reported evaluating subjects who performed exclusive breastfeeding. The evaluation was determined by the number of subjects performing exclusive breastfeeding at the time of evaluation and the number of subjects who stopped. Accordingly, the number of subjects who performed exclusive breastfeeding was standardized. A meta-analysis was performed on two studies, and the results showed that the effect of maternal role support intervention on exclusive breastfeeding was not statistically significant (RR, 0.88; 95% confidence interval [CI], 0.40~1.92).

In an intervention study on exclusive breastfeeding, Ulloa Sabogal et al. [23] focused on breastfeeding counseling nursing intervention aimed at improving breastfeeding knowledge and maintaining exclusive breastfeeding in adolescent mothers in Colombia. Although the intervention significantly increased the mothers’ knowledge of breastfeeding, the rate of exclusive breastfeeding abandonment did not significantly decrease. The reasons for abandoning exclusive breastfeeding included external pressure, such as insufficient milk production, the perception that the child was hungry, and the influence of the family. Gureje et al. [25] used an intervention that integrated psychological support with breastfeeding education for exclusive breastfeeding, and the results showed that the level of breastfeeding knowledge increased. However, it was limited in maintaining exclusive breastfeeding.

Both studies showed that educational interventions increased adolescent mothers’ knowledge of breastfeeding but did not maintain exclusive breastfeeding.

● Edinburgh Postnatal Depression Scale

The Edinburgh Postnatal Depression Scale (EPDS) is a tool used to measure postpartum depression symptoms in women after giving birth. The cutoff point for depressive symptoms is 13 points or higher, and a higher score indicates more severe depressive symptoms [28]. Two studies [24,25] reported that evaluated depression in adolescent pregnant women using the EPDS, and the results of a meta-analysis showed that the combined effect size of maternal role support interventions on postpartum depression was -1.37 (95% CI: -3.24, 0.50), which was not significant. In the study by Sangsawang et al. [24], a Midwife-Family Provided Social Support (MFPSS) intervention was implemented for adolescent pregnant women. The intervention was mainly carried out immediately at hospitals and homes, and regular follow-up measures were conducted through telephone calls and home visits to monitor progress and encourage them. As a result, the EPDS score of the intervention group significantly decreased compared to the control group after childbirth, 6 weeks postpartum, and 3 months postpartum. In particular, the intervention group showed a significant decrease from the EPDS baseline of 7.1 to 3.65 at 3 months postpartum, indicating the sustainability of the intervention effect.

In the study by Gureje et al. [25], adolescent mothers with postpartum depression were educated on parenting skills at a local primary medical institution before birth. Afterward, neighboring mothers recruited from the community provided postpartum support, and combined psychosocial intervention via telephone from a medical institution was implemented. As a result, 55.7% of the intervention group showed an EPDS score of less than 6 points after 6 months, down from the EPDS baseline score of 14.2 points.

● Home Inventory for the Environment–Infant/Toddler

Home Inventory for the Environment-Infant/Toddler (HOME-IT) evaluates the quality of stimulation and support provided in the environment where children are raised, and a higher score indicates a better parenting environment. Two studies [25,26] reported HOME-IT due to maternal role support intervention. A meta-analysis was performed on the measurement values of six sub-areas. Significant results were confirmed in the organization of the home environment (0.69; 95% CI, 0.40~0.98) and the provision of appropriate play materials (0.49; 95% CI, 0.24~0.75). Therefore, it can be judged that the degree of organization of the home environment and provision of appropriate play materials increased after the maternal role support intervention. In addition, no statistically significant results were confirmed in the remaining sub-areas of HOME-IT, such as emotional and verbal responsiveness, avoidance of restrictions and punishment, participation of children and parents, and diversity of daily stimuli.

● Bayley Scales of Infant Development 3rd Edition

Bayley Scales of Infant Development 3rd Edition (BSID-III) is a tool to evaluate children’s motor, language, and cognitive development, and a higher score indicates better development. Two studies [20,26] reported BSID-III as a result of maternal role support intervention, and no area among the five subareas showed statistically significant results from the meta-analysis.

Firk et al. [20] implemented a home visiting program that focused on improving the home environment and improving care and provided educational support to parents. The study’s results showed that the cognitive score of the intervention group was 10.04±2.1, while that of the control group was 9.66±2.0. The intervention group scored slightly higher in cognitive tasks, but the difference was insignificant. In addition, the intervention group showed slightly better performance than the control group in expressive language development and fine motor skills, but the difference was insignificant. Fatori et al. [26] implemented a nurse-led home visiting program. The study showed a statistically significant positive effect with a p-value of .014 at the 95% CI. There was no significant difference in cognitive development between the intervention and control groups.

Discussion

This study showed that maternal role support intervention for adolescent pregnant women effectively increased the subjects’ understanding of breastfeeding knowledge but did not affect exclusive breastfeeding [23,25]. Skouteris et al. [29] stated that increasing breastfeeding knowledge through education increases the possibility of increasing the exclusive breastfeeding rate. However, since exclusive breastfeeding is influenced by various factors such as family influence and insufficient breast milk production in addition to breastfeeding knowledge [23,25], it is thought that fragmentary breastfeeding knowledge education alone is not practical. Despite improved breastfeeding knowledge, exclusive breastfeeding rates did not significantly increase. This gap may stem from cultural beliefs, pressure from family members favoring formula feeding, and limited peer or professional support, especially in low-resource settings. Therefore, in order to increase exclusive breastfeeding in adolescent pregnant women, it is necessary to develop customized individual interventions for adolescent pregnant women that include breastfeeding knowledge, breastfeeding methods, appropriate posture and techniques, and problem-solving methods during breastfeeding, as in the study of Fahim et al. [30]. Postpartum depression has a significant impact on the mental health of pregnant women. The risk is even higher for adolescent pregnant women [31]. In the study by Sangsawang et al. [24], postpartum depression in the intervention group was significantly reduced through the MFPSS program provided by midwives and families. This was likely because the midwives and families provided continuous education, monitoring, and active follow-up measures for problem-solving.

The effectiveness of the MFPSS program was attributed to its multifaceted approach, combining emotional support, family involvement, and follow-up monitoring, which are known to enhance emotional resilience and reduce depressive symptoms.

On the other hand, in the study by Gureje et al. [25], there was no significant difference in EPDS scores between the intervention and control groups. This may be because subjects with moderate postpartum depression were connected to community neighbors rather than medical professionals, and there was a lack of continuous medical intervention after one-time education. These results are consistent with the study by O’Connor et al. [32], which stated that professional counseling and continuous support are important for the management of postpartum depression. Therefore, continuous intervention by professionals and active participation of families is necessary to prevent and manage postpartum depression in adolescent pregnant women, and this will contribute to the promotion of mental health in adolescent pregnant women. The results of this study show that maternal role support intervention positively improves the ability of pregnant adolescents to organize their home environment and provide learning materials for their children among the subdomains of HOME-IT [25,26]. Systematic home visiting programs for infants and toddlers effectively improved the home environment of pregnant adolescents, but they had limitations in fostering continuous emotional and social stimulation. A systematic literature review by Flaherty and Sadler [9] emphasized the importance of a comprehensive family support system in addressing this gap. Family support improves the ability of pregnant adolescents to have meaningful emotional and social interactions with their children by reducing stress levels. Therefore, it is important to integrate comprehensive family support into maternal role support interventions to enhance emotional aspects as well as improve the physical environment for pregnant adolescents and their children. Finally, in maternal role support interventions, the results of studies by Firk et al. [20] and Fatori et al. [26] showed that the home visiting program had some effects on cognitive and language development in terms of child development of pregnant adolescents, but the results were not statistically significant. To overcome these limitations, holistic support is needed to promote environmental and socio-emotional factors important for infant development by integrating the family support system, as suggested by Flaherty and Sadler [9].

This study has several limitations: the heterogeneity of interventions and settings limits comparability; most studies focused on short-term outcomes; and cultural variability was not controlled. Future research should explore which components (e.g., frequency of counseling, type of family involvement) are most effective for subgroups such as primiparous vs. multiparous adolescent mothers.

In this way, maternal role support interventions for adolescent pregnant women can positively affect maternal role performance, alleviate postpartum depression, and improve the childrearing environment. For integrated and customized interventions through family and expert intervention to be continuously implemented in the future, the development of specific intervention methods and various institutional support is necessary, and it is expected that this will contribute to promoting the health of adolescent pregnant women and children.

Conclusion

This study confirmed that maternal role support intervention targeting adolescent pregnant women was effective in improving breastfeeding knowledge, alleviating postpartum depression, and improving the home environment. Since there are limitations in increasing exclusive breastfeeding and supporting child development, continuous support from families and experts is necessary, and comprehensive and systematic support is needed to promote the health of adolescent pregnant women and their children. Based on these results, customized interventions, including breastfeeding methods and problem-solving, are needed, and continuous intervention by families and experts is required to alleviate postpartum depression and promote the emotional development of infants. In addition, strengthening institutional support is essential to promote the health of adolescent pregnant women and their children.

Notes

Author contributions

S Park: Funding acquisition, Conceptualization, Methology, Data curation, Project administration, Supervision, Resources, Software, Writing - original draft, Writing - review & editing. E Kwak: Conceptualization, Methology, Data curation, Formal analysis, Project administration, Supervision, Resources, Software, Writing - original draft, Writing - review & editing. H Kim: Conceptualization, Methology, Data curation, Formal analysis, Resources, Software, Writing - original draft, Writing - review & editing. HO Park: Conceptualization, Methology, Resources, Writing - original draft. JE Hong: Conceptualization, Methology, Resources, Writing - original draft.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (RS-2023-00250613).

Acknowledgements

None

Supplementary materials

Appendix 1

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Appendix

Appendix 1

본 연구에서 사용된 분석논문의 목록

1. Rezaie R, Mohammad-Alizadeh-Charandabi S, Nemati F, Mirghafourvand M. The effect of self-care counseling on health practices of adolescent pregnant women: A randomized controlled trial. BMC Pregnancy and Childbirth. 2021;21:726. https://doi.org/10.1186/s12884-021-04203-8
2. Jahdi F, Kaheh A, Haghani H. Effect of attachment behaviors training on maternal competence attainment in nulliparous adolescent women. Journal of Babol University of Medical Sciences. 2019;21:78-84. https://doi.org/10.22088/jbums.21.1.78
3. Rotz D, Shiferaw M, Wood RG. The impact of a home visiting program enhanced to address repeat adolescent pregnancy—A randomized controlled trial of steps to success. Maternal and Child Health Journal. 2022;26:1453-1463. https://doi.org/10.1007/s10995-022-03413-6
4. Talungchit P, Kwadkweang S, Limsiri P. Mother-role development program and postpartum health-service utilization by adolescent mothers: A randomized, controlled trial. The Journal of Obstetrics and Gynaecology Research. 2021;47(2):653-660. https://doi.org/10.1111/jog.14576
5. Firk C, Dahmen B, Dempfle A, Niessen A, Baumann C, Schwarte R, et al. A mother–child intervention program for adolescent mothers: Results from a randomized controlled trial (the TeeMo study). Development and Psychopathology. 2021;33(3):992-1005. https://doi.org/10.1017/s0954579420000280
6. Phipps MG, Ware CF, Stout RL, Raker CA, Zlotnick C. Reducing the risk for postpartum depression in adolescent mothers: A randomized controlled trial. Obstetrics & Gynecology. 2020;136(3):613-621. https://doi.org/10.1097/aog.0000000000004003
7. Giugliani ERJ, Nunes LM, Issler RMS, Santo LCDE, Oliveira LD. Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: A randomized clinical trial. Jornal de Pediatria. 2019;95(2):166-172. https://doi.org/10.1016/j.jped.2017.12.011
8. Ulloa Sabogal IM, Domínguez Nariño CC, Díaz LJR. Educational intervention for the maintenance of exclusive breastfeeding in adolescent mothers: A feasibility study. International Journal of Nursing Knowledge. 2023;34(4): 297-306. https://doi.org/10.1111/2047-3095.12404
9. Sangsawang B, Deoisres W, Hengudomsub P, Sangsawang N. Effectiveness of psychosocial support provided by midwives and family on preventing postpartum depression among first-time adolescent mothers at 3-month follow-up: A randomised controlled trial. Journal of Clinical Nursing. 2022;31(5-6):689-702. https://doi.org/10.1111/jocn.15928
10. Gureje O, Oladeji BD, Kola L, Bello T, Ayinde O, Faregh N, et al. Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): A cluster randomized controlled trial. Journal of Affective Disorders. 2022;312:169-176. https://doi.org/10.1016/j.jad.2022.06.032
11. Fatori D, Fonseca Zuccolo P, Shephard E, Brentani H, Matijasevich A, Archanjo Ferraro A, et al. A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents. Scientific Reports. 2021;11(1):14432. https://doi.org/10.1038/s41598-021-93938-7
12. Robling M, Bekkers MJ, Bell K, Butler CC, Cannings-John R, Channon S, et al. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): A pragmatic randomised controlled trial. The Lancet. 2016;387(10014):146-155. https://doi.org/10.1016/s0140-6736(15)00392-x

Article information Continued

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No	References	n	Intervention						QA

			Duration (weeks)	Time (prenatal/ postpartum)	Location	Provider	Program	Result
1	Ulloa Sabogal et al., 2023 [23]	100	4	+/+	Institution	Nurse	Education and counseling -Breast feeding	Increase breastfeeding knowledge No effect abandonment of breastfeeding	Low risk
2	Sangsawang et al., 2022 [24]	42	4	+/+	Institution Home	Nurse (midwife)	Education, counseling and emotional support -Preventing postpartum depression -Provide interventions that include main	Preventing postpartum depression and the preventive effect is sustained for up to 3-month postpartum family member	Low risk
3	Rotz, et al., 2022 [18]	483	104	-/+	Home	Trained home visitors -Decrease in the rate of repeat pregnancies	Education, counseling and emotional support among adolescent mothers -Consists of contraception, education, employment and career training, and relationships	Increased use of long-acting reversible contraceptives and reduced unprotected sex No effect on reducing repeat pregnancies	Low risk
4	Gureje et al., 2022[25]	242	6	+/+	Institution Home	Community health workers or community health extension workers Neighborhood mother	Education, counseling and problem solving treatment -Psychosocial intervention for perinatal depression designed for adolescents -Provided to adolescents with perinatal depression -Neighborhood mother participates in program	Remission of depression and improved parenting skills	Low risk
5	Talungchit et al., 2021 [19]	37	96	-/+	Institution	Doctor (pediatrician)	Education, counseling and emotional support -Offering the same program (mother-role development program) to both groups -Reminder calls prior to appointment were implemented only in the experimental group	Higher MHS utilization by the experimental group Increase in the use of long-acting reversible contraception and breastfeeding rate	Low risk
6	Rezaie et al., 2021[16]	54	6	+/-	Institution	Researcher	Education and counseling -Health practices and their effects	Improving health practices, attitude towards motherhood	Low risk
7	Firk et al., 2021	56	36	-/+	Home	Doctor	Education and video feedback (psychiatrists) Psychotherapists	No significant effect confirmed -Promote secure parent-child attachment by using video feedback Clinical social workers	Low risk
8	Fatori et al., 2021 [26]	80	96	+/+	Home	Nurse	Education -Helping mothers prioritize their child and be sensitive to their behaviors and emotions	Positive effects on child expressive language development, maternal emotional/verbal responsibility, and opportunities for variety in daily stimulation	Low risk
9	Phipps et al., 2020 [21]	250	48	-/+	Institution	Interventionist	Education, Interactive activities and feedback -Interpersonal therapy-based intervention on reducing the risk of postpartum depression	No significant effect confirmed	Low risk
10	Jahdi et al., 2019 [17]	73	4	+/-	Institution	Researcher	Education -Three sessions of group education related to fetal attachment behavior	Maternal competence was significantly higher in the experimental group	Low risk
11	Giugliani et al., 2019 [22]	323	16	-/+	Institution Home	Doctor (pediatrician) Nurse	Education and counseling -Breast feeding counseling sessions, including the recommendation to avoid Nutritionist	Reducing pacifier use only in the group in which grandmothers were involved the use of a pacifier -Intervention with teenagers and their mothers	Low risk
12	Robling et al., 2016[27]	3,251	136	+/+	Home	Nurse	Education and counseling -Educating risks and protective factors within prenatal health-related behaviors, sensitive and competent caregiving, and early parental life-course	No significant effect confirmed	Low risk

Outcome and outcome domain		References	Effect estimate (Cohen’s d/RR*)	95% CI		GRADE certainty
Outcome and outcome domain		References	Lower limit	Upper limit
EBF		Ulloa Sabogal et al., 2023 [23]	1.25*	0.36	4.34	High
		Gureje et al., 2022 [25]	0.70*	0.25	1.90	High
		Total	0.88*	0.40	1.92
EPDS		Sangsawang et al., 2022 [24]	-2.36	-3.17	-1.55	High
		Gureje et al., 2022 [25]	-0.45	-0.74	-0.16	High
		Total	-1.37	-3.24	0.50
HOME-IT	Emotional/verbal responsibility	Fatori et al., 2021 [26]	3.33	2.49	4.17	High
		Gureje et al., 2022 [25]	0.51	0.22	0.80	High
		Total	1.89	-0.87	4.66
	Avoidance of restriction and punishment	Fatori et al., 2021 [26]	0.92	0.35	1.49	High
		Gureje et al., 2022 [25]	0.08	-0.20	0.37	High
		Total	0.46	-0.35	1.28
	Organization	Fatori et al., 2021 [26]	0.96	0.38	1.53	High
		Gureje et al., 2022 [25]	0.61	0.31	0.90	High
		Total	0.69	0.40	0.98
	Learning materials	Fatori et al., 2021 [26]	0.42	-0.13	0.97	High
		Gureje et al., 2022 [25]	0.52	0.23	0.81	High
		Total	0.49	0.24	0.75
	Parental involvement	Fatori et al., 2021 [26]	1.64	1.01	2.27	High
		Gureje et al., 2022 [25]	0.32	0.03	0.61	High
		Total	0.95	-0.34	2.25
	Variety	Fatori et al., 2021 [26]	2.76	2.01	3.53	High
		Gureje et al., 2022 [25]	0.37	0.08	0.66	High
		Total	1.54	-0.81	3.89
BSID-III	Cognition	Firk et al., 2021 [20]	-0.31	-0.89	0.27	High
		Fatori et al., 2021 [26]	0.49	-0.09	1.06	High
		Total	0.09	-0.69	0.87
	Language receptive	Firk et al., 2021 [20]	0.00	-1.45	1.45	High
		Fatori et al., 2021 [26]	1.03	0.43	1.64	High
		Total	0.74	-0.18	1.65
	Language expressive	Firk et al., 2021 [20]	-0.00	-0.58	0.57	High
		Fatori et al., 2021 [26]	2.25	1.52	2.97	High
		Total	1.11	-1.10	3.32
	Motor fine	Firk et al., 2021 [20]	-0.28	-0.86	0.30	High
		Fatori et al., 2021 [26]	0.33	-0.24	0.90	High
		Total	0.03	-0.57	0.63
	Motor gross	Firk et al., 2021 [20]	0.09	-0.49	0.66	High
		Fatori et al., 2021 [26]	1.27	0.65	1.89	High
		Total	0.67	-0.49	1.83