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Pregnant adolescent women increasingly seek support during pregnancy and the puerperium through digital platforms instead of the traditional support system of family, friends, and the community. However, it is uncertain whether digital, web-based tools are reliable and effective in providing information to the user on a variety of topics such as fetal development, pregnancy outcomes, delivery, and breastfeeding to improve maternal and infant outcomes.
We aimed to identify web-based tools designed to promote knowledge, attitudes, and skills of pregnant adolescents or adolescent mothers and determine the efficacy of such web-based tools compared with conventional resources in promoting good pregnancy and infant outcomes.
A systematic search was conducted using Medline, Scopus, CINAHL, and PsycINFO for articles published from January 2004 to November 2020 to identify randomized trials and observational studies that evaluated digital, web-based platforms to deliver resources to pregnant adolescents. All articles written in the author’s languages were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. Risk of bias in each study was assessed using appropriate tools recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and the Joanna Briggs Institute. We adopted a qualitative synthesis and presented the results in a narrative format due to the heterogenous nature of the studies.
Seven articles met the inclusion criteria and were analyzed. The majority of the studies were graded to be of low to moderate risk for bias. The research methodologies represented were varied, ranging from randomized (n=1) and nonrandomized controlled trials (n=1) and prospective cohort studies (n=1) to mixed methods studies (n=1) and longitudinal surveys (n=3). Four studies included active web-based interventions, and 3 described exposure to web-based tools, including the use of social media and/or other internet content. Web-based tools positively influenced treatment-seeking intentions (intervention 17.1%, control 11.5%,
Despite almost universal web use, few studies have used this platform for health promotion and disease prevention. Social media interventions or web-based tools have the potential to positively influence both maternal and infant outcomes in adolescent pregnancy, but there is a need for more well-conducted studies to demonstrate the effectiveness of these support programs. The vastness of the information available on the web limits the ability of health care professionals to monitor or control sources of information sought by patients. Thus, it is important to create professionally curated platforms to prevent or limit exposure to potentially misleading or harmful information on the internet while imparting useful knowledge to the user.
PROSPERO International Prospective Register of Systematic Reviews CRD42020195854; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195854
Pregnant adolescents are an especially vulnerable population. Despite the significant decline of adolescent pregnancies in recent decades [
The transition from child-free adolescence to motherhood is daunting. Traditionally, those who are pregnant or postpartum turn to their family, friends, and partners for support [
With increasing access to technology, expectant mothers may seek pregnancy-related information or support from social media [
While the definition of social media is dynamic and constantly evolving [
The aims of this systematic review were to assess the impact of web-based tools used by pregnant adolescents or adolescent mothers on maternal and infant outcomes to compare these to conventional resources and critically appraise the evidence from relevant quantitative and qualitative studies. The research questions addressed were as follows:
What types of available web-based tools are designed to promote knowledge, attitudes, and skills of pregnant adolescents or adolescent mothers?
How effective are these web-based tools in promoting good pregnancy and infant outcomes compared with conventional resources?
The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42020195854]. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [
The study selection was conducted in two phases. During level 1 screening, two authors (JW, NA) independently screened all studies retrieved by electronic database searches based on key terms and resolved discrepancies by discussion with a third author until a list of studies for level 2 screening was agreed upon. During level 2 screening, the full texts of studies selected in level 1 were retrieved and independently reviewed by the same 2 authors to determine the eligibility of each study; discrepancies were again resolved by discussion with the third author until a final list of studies was agreed on. The reasons for exclusion were coded and recorded systematically.
All inclusion and exclusion criteria were defined a priori. We included both quantitative and qualitative studies that explored the association between the use of web-based tools by pregnant adolescents or adolescent mothers and maternal and neonatal outcomes. Studies that defined their population as adolescents or studied women aged 21 years and younger were included. Social media was defined as online platforms providing avenues to exchange content with other users (eg, Facebook, Instagram, Twitter, blogs, vlogs, forums, chatrooms) while internet content was defined as online platforms that did not provide direct opportunities to interact with other users (eg, websites, online reading materials, internet programs). Conventional tools developed to support adolescent mothers such as brochures, school-based counseling, community-based counseling, and group and personal counseling were the comparison of interest. Maternal outcomes measured were physical (nutrition, physical activity, breastfeeding practices, birth complications, and risky behaviors such as smoking and alcohol consumption) and psychosocial (mental health, depression, anxiety, loneliness and stress, self-esteem, birth preparedness, and parenting outcomes) factors. Infant or child outcomes included preterm birth, low birth weight, sudden infant death syndrome, and obesity. All outcomes collected met the inclusion criteria. We included studies with or without a comparison group that were relevant to answering our research questions and excluded reviews, abstracts, conference proceedings, letters, editorials, comments, opinions, and book chapters. We excluded studies that were not in English, Chinese, Malay, or French, the languages of the authors. Studies that only examined the use of social media or internet content with no quantitative or qualitative outcomes were also excluded.
We extracted relevant evidence using a standard proforma including study design, settings, observational period, sample size, participant characteristics, description of intervention and comparison tools, maternal outcomes, infant or child outcomes, adjusted factors, findings, and limitations.
We conducted a mixed methods systematic review to assess the relevant studies using various critical appraisal tools that are validated and widely used. Qualitative studies [
We categorized included studies into 2 groups to answer our research questions. To explore the variety and effectiveness of web-based tools in promoting knowledge, we analyzed and compared all 7 studies [
The search in the various medical databases (Medline [using PubMed platform], Scopus, CINAHL [using EbscoHost platform], and PsycINFO) for articles published from January 2008 to November 2020 yielded a total of 6157 records. After removing the duplicates, 4722 records were eligible for further screening. After 2 reviewers screened all titles and abstracts, 135 records met the inclusion criteria and were eligible for further full-text screening. Following the full text review, we excluded 128 articles based on the predefined exclusion criteria, and 7 articles were finally included in the systematic review for analysis (
PRISMA flow diagram.
Characteristics of the 7 studies are summarized in
Descriptive characteristics.
Author, country | Study design | Participants | Intervention/exposure | Control group (if any) | Outcomes evaluated | Key findings |
Hudson et al [ |
Quantitative; RCTa | Adolescents: 16-21 years (mean 18.3 [SD 1.7] years); 1-week postpartum; single, low-income, African Americans | n=15; NMNb website: internet-based education resource, discussion forum, direct email contact with nurses (6 months) | n=19; usual care: hospital parenting instructions, parent’s own resources | Maternal: Mental health Parenting outcomes Birth complications Health care use Breastfeeding |
The NMN website is well poised for nursing-driven social support intervention. The social support component was identified as a key strength with positive qualitative comments. |
Logsdon et al [ |
Quantitative; matched prospective cohort study | Adolescents: 13-21 years; up to 1-year postpartum; living in urban, suburban and rural counties, mixture of White (8.6%), Black (88.0%) and others (3.4%) | n=154 (mean 17.9 [SD 2.1] years); internet intervention website: internet-based education resources (2 weeks) | n=138 (mean 18.2 [SD 1.9] years); home visitation program | Maternal: Mental health |
The internet intervention was successful in changing attitudes, perceived control, intention to seek treatment, and actually seeking treatment. The intervention effect was equal in adolescents regardless of where they lived, but the impact on changing attitudes may be dose dependent. |
Fleming et al [ |
Qualitative | First-time mothers; mean 18-21 [SD 19.5] years); 6-8 weeks postpartum; single (85.7%), low-income | n=7; personal electronic media use: websites, internet blogs, internet chat rooms, online shows (duration not specified) | —c | Maternal: Birth preparedness Mental health |
This study demonstrated adolescents’ desire and need for clear, accurate, and easily accessible information about birthing. Providing credible electronic sources will educate the mothers and increase their confidence and birthing preparedness levels. |
Vander Wyst et al [ |
Mixed methods; non-RCT | Adolescents: 14-18 years; 12-28 weeks pregnant; low-income, mixture of Black (70%), Hispanic White (20%), and non-Hispanic White (10%) | n=10 (median 17.0 [IQRd 16.4, 17.7] years); |
n=12 (median 29.2 [IQR 23.7, 33.8] years); adult participantse | Maternal Physical anthropometric data Nutrition knowledge Nutrition behavior Physical activity Attitudes and beliefs on prenatal health Social support Birth weight Gestational age Breastfeeding |
Poor diet quality persists among both adolescent and adult low-income pregnant women. Although social media-based education was well received by the participants, this did not result in significant changes in dietary intake and knowledge. |
Nolan et al [ |
Qualitative | Adolescents; 16-19 years; 3-17 months postpartum; single, living with parents (71.4%), extended relatives (14.3%), or partner/friend (14.3%) | n=7; personal social network site use: website that enables users to create public profiles and form relationships with other users (duration not specified) | — | Maternal: Social support Mental health Parenting outcomes |
The use of social network sites affords adolescent mothers access to tangible, informational, and emotional support. There is a potential role for midwives to use such platforms to provide additional social support. |
Rueda et al [ |
Qualitative | Adolescents; 14-22 years; currently pregnant or mothers; single, living in residential foster care home, mixture of ethnic minorities: Hispanic (43.5%), Black (30.4%), Mixed race (10.9%) | n=13; personal electronic media use: social media websites, phone apps that facilitate communication between individuals (duration not specified) | — | Maternal: Relationship with intimate partners Mental health Child protection |
The use of technology among adolescent mothers living in foster homes is associated with multiple social issues. Technology should be included in various models of care to increase understanding between professionals and adolescents. |
Logsdon et al [ |
Quantitative; non-RCT | Adolescents; mean 16.8 years; mothers; single, students of a public school–based program for adolescent parents; mixture of African American (48.6%), White (34.1%), and others (17.3%) | n=138; internet intervention website: internet-based education resources (single class period) | — | Maternal Mental health |
The testing of a prototype website for adolescent mothers with postpartum depression showed promising results. Attitudes related to depression and seeking treatment improved after viewing the website. |
aRCT: randomized controlled trial.
bNMN: New Mothers Network.
cNot applicable.
dIQR: interquartile range.
eControl group (adult participants) is not relevant to answering the research question.
fWA: Western Australia.
Overview of the studies’ risk of bias.
Author | Study design | Quality assessment instrument | Rating |
Hudson et al [ |
Quantitative; RCTa | Cochrane Risk of Bias 2 | Include; risk of bias: low |
Logsdon et al [ |
Quantitative; matched prospective cohort study | Newcastle-Ottawa Quality Assessment Scale (Cohort studies) | Include; selection: ***; comparability: **; outcome: **; risk of bias: low |
Vander Wyst et al [ |
Mixed methods; non-RCT | MMATb | Include; risk of bias: low |
Logsdon et al [ |
Quantitative; non-RCT | JBIc (quasi-experimental studies) | Include; risk of bias: moderate-high |
Fleming et al [ |
Qualitative | JBI (qualitative research) | Include; risk of bias: low |
Nolan et al [ |
Qualitative | JBI (qualitative research) | Include; risk of bias: low |
Rueda et al [ |
Qualitative | JBI (qualitative research) | Include; risk of bias: low |
aRCT: randomized controlled trial.
bMMAT: Mixed Methods Appraisal Tool.
cJBI: Joanna Briggs Institute.
The study results are summarized in
Synthesis of quantitative results.
Author, country | Statistically significant outcomes with intervention ( |
Non–statistically significant trends following intervention |
Hudson et al [ |
Assuming α=.10, Intervention group had lower self-esteem than control group at 6 months; scale: RSEa Intervention group had higher levels of perceived competence after 6 months; scale: PPSb Intervention group had higher parenting satisfaction levels after 6 months; scale: WPBL-Rc ERd use reduced >50% in intervention group compared to control group (35.7% vs 70.6%); data collection: questionnaire Intervention group was less likely to exclusively breastfeed compared to control group; data collection: questionnaire |
Increasing: Social support Depression symptoms Loneliness Perceived stress Birth complications |
Logsdon et al [ |
Intervention group had more positive attitudes toward seeking psychological help than the control group after 2 weeks; scale: ATSPHe Intervention group had more positive perceived behavior control than the control group after 2 weeks; scale: HSDIf Intervention group had greater intention to seek treatment for depression than the control group after 2 weeks; scale: MHIg Intervention group had higher treatment seeking behavior for depression than the control group after 2 weeks; data collection: questionnaire |
No differences in: Depression symptoms Stigma for receiving psychological help |
Vander Wyst et al [ |
There was higher sugar intake in both groups after 18 weeks compared to baseline; data collection: 24-hour diet recall calculated via FPPh There was a lower likelihood of adolescents cooking at home at baseline compared to adults; data collection: questionnaire There was a lower likelihood of adolescents buying their own groceries at baseline and after 18 weeks compared to adults; data collection: questionnaire Adolescents were less knowledgeable in nutrition (eg, identifying fiber rich food, recommended whole grain consumption, fruit, vegetable and fat intake) compared to adults at baseline and/or after 18 weeks; data collection method: questionnaire |
No differences in: Participant anthropometric data Mean caloric consumption Macronutrient distribution of food Infant birth weight Infant gestational age |
Logsdon et al [ |
Adolescents had more positive attitudes toward seeking psychological help postintervention compared to baseline; scale: ATSPH |
No differences in: Mental health acceptability Stigma for receiving psychological help |
aRSE: Rosenberg Self-Esteem.
bPPS: How I Deal With Problems Regarding Care of My Baby.
cWPBL-R: What Being the Parent of a Baby is Like–Revised.
dER: emergency room.
eATSPH: Attitude Toward Seeking Psychological Help.
fHSDI: Health Self Determination Index.
gMHI: Mental Health Intention.
hFPP: Food Processor Program.
Synthesis of qualitative results.
Study, country | Outcomes |
Fleming et al [ |
Increased anxiety due to graphic media, birthing process, potential complications, and neonatal care Birth preparedness: suboptimal birth preparedness due to fragmented, inconsistent, weakly linked, and poorly referenced information although a small subset of women developed improved or enhanced understanding Social support: platform allowed connection with others and peer support |
Vander Wyst et al [ |
Nutrition behavior: adolescents had improved attitudes toward nutrition with dietary changes (eg, limiting high fat fast food, increasing vegetable and fruit intake), motivated by time, convenience, and food preferences Physical activity: adolescents had an increased tendency to exercise during pregnancy as they believed it to help with labor Breastfeeding: adolescents tended to be less likely to breastfeed compared to adults Social support: both adolescents and adults had both good and poor sources of social support |
Nolan et al [ |
Increased social support and connectedness: participants had unlimited access to relationships, minimizing feelings of exclusion, and social isolation. They could maintain both old and new friendships. Social network sites provide valuable tangible, emotional, and informational support for adolescent mothers, contributing to mothers’ social capital Parental stress and anxiety: social network sites served as a medium for problem sharing and helped to reduce parental stress and anxiety. Drawbacks were the absence of adequate privacy controls and negative comments that could potentially threaten emotional well-being Increased parenting confidence: peer support and positive affirmations significantly increased adolescents’ confidence levels |
Rueda et al [ |
Social media tools provided positive experiences in: Interacting with a potentially intimate partner Maintaining contact and fostering feelings of closeness with their child’s father Social media tools provided negative experiences in: Unwanted sexual solicitations Child protection, as meetings with strangers in offline spaces place both the adolescent and their children at risk Cyber abuse (eg, cyber bullying, stalking) of which adolescents were both victims and perpetuators Adverse emotional side effects fueled by jealousy and mistrust |
aWA: Western Australia.
Maternal mental well-being was explored in 5 studies [
Only one study by Vander Wyst et al [
Parenting outcomes were explored in 3 studies [
Infant outcomes were studied less. None of the studies investigated putative associations between the use of web-based tools and premature birth, low birth weight, infant obesity, or sudden infant death syndrome. Hudson et al [
Based on current available literature, there is much that needs to be explored concerning the potential benefits and harms of social media for pregnant and postnatal adolescents. This is despite most adolescent participants having grown up in the presence of advanced technology and with extensive social media use. We have systematically studied the impact of web-based tools used by adolescents on various maternal and infant outcomes to address our research questions. We found that available web-based tools include professionally curated programs (via websites or social media), readily available information on the internet, and personal use of various social media platforms.
While the limited evidence shows mixed and conflicting findings, we observe that web-based tools may be useful in improving mental health outcomes, positively influencing treatment-seeking intentions, and actual treatment-seeking behavior for depression among postpartum adolescents [
Aside from mental health outcomes, there may be other benefits for adolescent mothers, including fewer emergency room visits (with increased knowledge and confidence in postpartum care) [
Preexisting social media platforms and internet-based tools play an integral role in an adolescent’s life and are associated with positive and negative outcomes, particularly with maintaining beneficial friendships and fostering precarious and potentially dangerous relationships, respectively [
Only 2 studies compared the efficacy of web-based tools and conventional methods in influencing maternal and neonatal outcomes in the adolescent population [
A Singaporean study described increased risks of perinatal complications like anemia and preterm births and reduced likelihood of regular clinic attendance and sexually transmitted infection screening in a group of younger, vulnerable, predominantly Malay parturients with poorer access to prenatal care [
Overall, our findings demonstrate a paucity of studies in this important aspect of managing adolescent pregnancies and highlight the effectiveness of web-based tools to reach pregnant and postpartum adolescents who may be more comfortable seeking help on online platforms. These tools allow health care professionals and policy makers to spread valuable pregnancy-related information to this vulnerable population in an age and peer acceptable way. Local or regional governments can potentially harness internet platforms and social media to drive public health policies. It may prove to be a more efficient allocation of resources, improving compliance to prenatal follow-ups and reducing pregnancy-related complications. Aside from antenatal care, governments can broaden their focus and cover topics pertaining to general women’s health and, importantly, contraception use.
Our systematic review is timely as advanced technology and social media use are pervasive in modern societies, particularly among youth. Including both quantitative and qualitative studies in the review allowed for a broader interpretation of both statistical outcomes and adolescents’ qualitative feedback.
Key limitations of this systematic review are the weaknesses inherent in the included studies and the lack of research in this important area, particularly in Asian societies, despite being the most connected globally. Notwithstanding the extensive internet and social media use among adolescents, few studies have been conducted to directly establish the relationship between technology use in pregnant adolescents or adolescent mothers and pregnancy outcomes. Across the 7 studies there was great variability in measurement scales and reported outcomes, contributing to the heterogeneity of our results, and making it challenging to draw well-grounded conclusions. For this reason, we were not able to conduct a meta-analysis and were only able to provide a descriptive narrative of the studies. These studies were based in the United States and Western Australia, and findings may not be directly applicable to more ethnically diverse populations given the cultural differences in family traditions, community infrastructure, and child-raising practices [
The vastness of the information available on the web limits the ability of health care professionals to monitor or control sources of information sought by patients. It is important to create professionally curated platforms that patients can be directed to in order to prevent or limit exposure to potentially misleading or inaccurate information. Although our study is limited by the scope of the included studies, it is evident that web-based tools have the potential to improve outcomes in adolescent pregnancies. This review highlights the potential for web-based tools to target this vulnerable population, which is usually excluded from public health policies. The data presented can be highly informative to local health care policy makers. Overall, community-specific research is urgently needed to explore the potential of social media to guide novel interventions for this important vulnerable group.
Search strategy.
Risk of bias.
Preferred Reporting Items for Systematic Reviews and Meta-analyses
International Prospective Register of Systematic Reviews
randomized controlled trial
We would like to thank the medical librarians Ms Wong Suei Nee and Ms Wong Huey Lih Winnifred from the National University of Singapore for their valuable feedback in the search strategy.
JJYW conceptualized the research, conducted the database search, screened records, performed data extraction, critically appraised studies, analyzed the data, wrote the first draft of the paper, and reviewed the paper. NA conceptualized the research, screened articles, critically appraised studies, analyzed the data, and wrote and reviewed the paper. MS wrote and reviewed the paper. SL and CNZM conceptualized the research, critically appraised studies, and wrote and reviewed the paper.
None declared.