Health Counseling for Self-Care in Adolescent and Young Women During Pregnancy and Motherhood: A Systematic Review and Meta-Analysis

Abstract

This study aimed to evaluate the effectiveness of counseling and educational interventions delivered during pregnancy and early motherhood in promoting maternal health knowledge, self-care behaviors, and related health outcomes among adolescent and young women. A systematic review of randomized controlled trials and quasi-experimental studies published in English or Spanish was conducted using Medline, Web of Science, Scopus, Cinahl, and the Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and risk of bias was evaluated using the Risk-of-Bias 2 and ROBINS-I tools. Data were synthesized narratively and in tables. When comparable outcomes were reported, preliminary meta-analyses were performed using standardized mean differences with random-effects models. The certainty of evidence was assessed using the GRADE approach. Seven studies (n = 7) involving 776 participants were included. Interventions consisted of counseling or educational programs delivered through face-to-face sessions, group activities, or digital resources. Overall, the interventions were associated with improvements in pregnancy-related knowledge, self-care behaviors, psychological outcomes, and maternal health practices and attitudes; however, the certainty of evidence was low to very low and a high risk of bias was identified across studies. Meta-analysis suggested a possible beneficial effect favoring the intervention for pregnancy-related health knowledge (SMD = 1.90; 95% CI: −0.02 to 3.83) and self-care behaviors (SMD = 2.39; 95% CI: 0.29 to 4.49), although substantial heterogeneity was observed. Counseling and educational interventions during pregnancy may contribute to improvements in pregnancy-related health knowledge and self-care among pregnant adolescents and young women; however, the current evidence is limited and of low certainty. Further well-designed studies conducted in diverse settings are needed to confirm these findings and strengthen the evidence base.

1. Introduction

Pregnancy is a complex and multidimensional process that involves physical, psychological, and social changes [1], and it requires maturity to assume new responsibilities associated with the maternal role, while not being exempt from complications [2]. Therefore, specialized professional prenatal care is essential to prevent and manage such complications [2].

According to the World Health Organization (WHO), adolescence is the developmental period following childhood and preceding adulthood, ranging from 10 to 19 years of age [3]. It is a transitional stage with physical and psychological changes in which young women face new challenges and vulnerabilities related to risk behaviors, including pregnancy. Thus, adolescent pregnancy refers to women who become mothers before the age of 19 at the time of delivery [2]. It is a global phenomenon that may be associated with health, social, and economic challenges for both the mother and the newborn, including difficulties related to educational continuity, emotional well-being, health literacy, access to healthcare resources, and social support, which may influence adolescents’ adaptation to the responsibilities associated with motherhood [1,4].

Adolescents and young women may experience important educational, psychosocial, and healthcare support needs during pregnancy and early motherhood, particularly in many low- and middle-income countries where adolescent pregnancy rates remain high [3]. According to the WHO, approximately 21 million girls aged 15 to 19 years become pregnant each year, and around 12 million give birth [3]. These estimates underscore the global magnitude of adolescent pregnancy and the persistent inequalities affecting maternal health across different regions. Despite a global decline in adolescent birth rates in recent years, particularly in developed countries, substantial regional disparities persist. According to the Spanish National Institute of Statistics, in 2021 there were 7202 births among mothers under 20 years of age, representing a 50% decrease since 2008 [5]. However, in regions such as sub-Saharan Africa and Central Asia, trends vary considerably between countries, with some settings experiencing slower declines or even increases in adolescent birth rates, reflecting differences in access to education, reproductive health services, and broader social determinants of health [3,6]. Nevertheless, the present review does not aim to frame pregnancy among all adolescents and young women as inherently problematic or pathological, but rather to explore the potential role of counseling and educational interventions in supporting maternal health knowledge, self-care, and psychosocial adaptation during pregnancy and early motherhood.

These differences may be due to the lack of promotion of comprehensive sexual education, lack of family support, and insufficient health system services [6,7]. In addition, adolescents’ access to contraceptive education is influenced by health professionals’ attitudes, including limited training, personal beliefs, and cultural biases that may restrict open discussions about sexual and reproductive health [8,9]. In this regard, health literacy is fundamental for adequate prenatal care for both the mother and the newborn [10]. According to the 2011 European project, improving this literacy requires enhancing communication between professionals and adolescents, with the aim of fostering self-care and empowerment in the context of maternity [11].

According to WHO, self-care is the ability of individuals, families, and communities to promote their own health, prevent disease, maintain health, and cope with illness and disability, with or without professional support [12]. In the context of pregnant women, promoting self-care can help maintain their health and well-being. Although pregnancy is not itself a health problem, adequate monitoring is necessary to prevent complications [13]. In this sense, adopting healthy practices includes recommendations on maintaining a balanced diet, engaging in physical activity, taking nutritional supplements, and avoiding the consumption and abuse of toxic substances [14].

For adolescent mothers, the transition to motherhood often occurs within broader processes of social and developmental transition, which may vary across contexts and can present additional challenges. Their ability to adapt depends on the amount of information, attitudes, and behaviors acquired. However, some adolescents may experience limitations in health-related knowledge, access to information, or psychosocial support, making it important to implement comprehensive programs that include health education strategies tailored to the needs of this population sector [15,16]. Although adolescence is commonly defined as the period between 10 and 19 years of age, young women aged 20 to 25 years were also considered in this review because this group may still experience important educational, psychosocial, and healthcare support needs during the transition to motherhood, particularly in vulnerable social or healthcare contexts.

Recent evidence has highlighted the importance of health counseling and educational interventions in promoting self-care, improving health literacy, and enhancing psychological well-being among pregnant women, including adolescents. However, the available evidence remains limited and heterogeneous, particularly in low- and middle-income countries, where adolescent pregnancy is most prevalent. A recent systematic review has emphasized significant gaps in the evidence regarding effective interventions targeting pregnant adolescents and their newborns, particularly in relation to behavioral outcomes, mental health, and access to care [17]. Similarly, other reviews have reported that, although psychosocial interventions may improve positive mental health outcomes, there is still limited evidence regarding their effectiveness in preventing mental health disorders and other risk behaviors among pregnant and parenting adolescents, highlighting an important gap in current knowledge [18].

Additionally, motherhood in young women aged 20 to 25 years may present different contextual characteristics compared to adolescents. While both groups may experience vulnerabilities, young women may experience different social, educational, and healthcare context compared with adolescents, which could influence their experience of the transition to motherhood. However, these differences are not uniform and may vary depending on individual and contextual factors. Importantly, the current evidence does not allow for definitive conclusions regarding the extent to which these factors translate into differences in maternal or neonatal outcomes [8,19]. It is essential that health interventions, such as professional counseling, address the specific needs of this age group to promote self-care, mental health, and empowerment in the context of motherhood [8].

While these developmental and social differences are relevant to understanding the context of pregnancy in these populations, the present review does not aim to directly compare outcomes between adolescents and young adult women. Instead, it focuses on evaluating the overall effectiveness of counseling and educational interventions across both groups. Therefore, the findings should be interpreted considering the heterogeneity of developmental stages, social contexts, and healthcare settings represented in the included studies.

In this context, the following research question was posed: What is the effectiveness of counseling and educational interventions in promoting self-care, knowledge, attitudes toward the transition to motherhood, and healthy practices among pregnant and parenting adolescent and young women? Accordingly, the aim was to evaluate the effectiveness of counseling and educational interventions delivered during pregnancy and early motherhood in promoting maternal health knowledge, self-care behaviors, and related health outcomes among adolescent and young women.

2. Materials and Methods

2.1. Design

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [20], the checklist of which can be found in the Supplementary Materials. The research question was formulated using the PICO framework: Population (P): pregnant and parenting adolescent and young women; Intervention (I): counseling and educational interventions aimed at promoting self-care and improving maternal health knowledge, attitudes toward motherhood, and healthy practices; Comparison (C): routine care or standard prenatal/postpartum care; and Outcomes (O): self-care behaviors, maternal health knowledge, attitudes toward motherhood, healthy practices, and related psychosocial outcomes. The review protocol was prospectively registered in PROSPERO (CRD420251132537). Generative artificial intelligence (GenAI) was not used in the conception, preparation, or writing of this paper.

2.2. Information Sources and Search Strategy

The first step involved identifying relevant publications on the topic through preliminary searches in Google Scholar^® and PROSPERO to refine research question. Subsequently, comprehensive searches were conducted in the databases Medline (PubMed), Web of Science (WOS), Scopus, Cinahl, and Cochrane Library in February 2026. The search strategy employed Medical Subject Headings (MeSH) terms: “Pregnancy”, “Pregnant People”, “Adolescent Mothers”, “Health Knowledge, Attitudes, Practice”, “Self Care”, and “Counseling”, combined using the Boolean operators AND and OR. All searches were conducted by one researchers (CRS) and independently verified by a second reviewer (CARS) in accordance with the PRISMA-S guidance [21]. Detailed search strategies are presented in Table 1.

Table 1. Search strategy in each of the databases.

Database Search Date	Search Strategy
Medline (Pubmed) 23 February 2026	(“Pregnant People” [MeSH Terms] OR “Pregnancy” [MeSH Terms] OR “pregnant women” [Title/Abstract] OR “pregnan*” [Title/Abstract] OR “adolescent mother*” [Title/Abstract]) AND (“health knowledge, attitudes, practice” [MeSH Terms] OR “knowledge” [Title/Abstract] OR “attitude*” [Title/Abstract] OR “awareness” [Title/Abstract] OR “perception*” [Title/Abstract] OR “belief*” [Title/Abstract]) AND (“self care” [MeSH Terms] OR “self care” [Title/Abstract] OR “self care” [Title/Abstract] OR “self management” [Title/Abstract]) AND (“Counseling” [MeSH Terms] OR “Health Education” [MeSH Terms] OR “counsel*” [Title/Abstract] OR “educat*” [Title/Abstract])
Scopus 23 February 2026	TITLE-ABS-KEY ((“pregnant women” OR “pregnant people” OR pregnan* OR “adolescent pregnan*” OR “adolescent mother*”)) AND TITLE-ABS-KEY (((knowledge OR attitude* OR awareness OR perception* OR belief*) W/3 (health OR care OR behavio*r))) AND TITLE-ABS-KEY ((“self care” OR “self-care” OR “self management” OR “self-management”)) AND TITLE-ABS-KEY (((counsel* OR educat* OR “health education” OR “patient education”) W/3 (program* OR intervention* OR support OR guidance)))
Web of Science 23 February 2026	TS=((“pregnant women” OR “pregnant people” OR pregnan* OR “adolescent pregnan*” OR “adolescent mother*”)) AND TS=((knowledge OR attitude* OR awareness OR perception* OR belief*) NEAR/3 (health OR care OR behavior*)) AND TS=((“self care” OR “self-care” OR “self management” OR “self-management”)) AND TS=((counsel* OR educat* OR “health education” OR “patient education”) NEAR/3 (intervention* OR program* OR guidance OR support))
Cinahl 23 February 2026	((MH “Pregnancy+”) OR (MH “Pregnant Women”) OR TI (pregnan* OR “pregnant women” OR “pregnant people”) OR AB (pregnan* OR “pregnant women” OR “pregnant people”)) AND ((MH “Health Knowledge, Attitudes, Practice”) OR TI ((knowledge OR attitude* OR awareness OR perception*) N3 (health OR care OR behavio*r)) OR AB ((knowledge OR attitude* OR awareness OR perception*) N3 (health OR care OR behavio*r))) AND ((MH “Self Care+”) OR TI (“self care” OR “self-care” OR (self N2 care) OR “self management”) OR AB (“self care” OR “self-care” OR (self N2 care) OR “self management”)) AND ((MH “Counseling+”) OR (MH “Health Education+”) OR TI ((counsel* OR educat* OR “health education”) N3 (program* OR intervention* OR support)) OR AB ((counsel* OR educat* OR “health education”) N3 (program* OR intervention* OR support)))
Cochrane Library 23 February 2026	(Pregnancy OR pregnan* OR “pregnant women” OR “pregnant people”): ti,ab,kw AND (“Health Knowledge” OR “Health attitudes” OR “Health belief”): ti,ab,kw AND (“self care” OR “self-care” OR “self management” OR “self-management”): ti,ab,kw AND (counsel* OR counselling OR educat* OR “health education” OR “patient education”): ti,ab,kw AND (“health behavior” OR “health behaviour” OR behavio*r OR practice*): ti,ab,kw

2.3. Inclusion and Exclusion Criteria

Randomized Controlled Trials (RCTs) and quasi-experimental studies involving pregnant or parenting adolescents (10 to 19 years) and young women (20 to 25 years) were included. Studies that did not exclusively focus on these age groups were also considered if adolescents or young women were part of the sample and the mean age of participants was below 26 years. This criterion was applied due to the limited literature specifically addressing pregnant and parenting adolescents and young women. However, no restrictions or subgroup analyses by age group were applied due to the expected limited availability of stratified data. Studies published in English or Spanish, were included in the review. No restrictions were applied regarding publication date. Studies employing other designs, such us systematic, scoping, or narrative reviews, observational studies, and case reports or gray literature were excluded.

2.4. Screening Process and Risk-of-Bias Assessment

After conducting the searches, all records were exported to Excel^®. Duplicates were removed, and the remaining were screened by title and abstract, and categorized as potentially eligible, uncertain eligibility, or excluded. Records classified as potentially eligible or uncertain eligibility were retrieved for full-text screening. The methodological characteristics of the full-text records were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for RCTs (13 items) and for quasi-experimental studies (9 items). The JBI tools were used descriptively to summarize the methodological quality of the included studies, and no studies were excluded based on a numerical JBI score or predefined threshold. The screening process was performed independently by two reviewers (CRS and CARS), with disagreements resolved by a third reviewer (HGT).

Risk-of-bias was assessed using the Cochrane Risk-of-Bias 2 (RoB 2) tool for RCTs [22] and the ROBINS-I V2 tool for quasi-experimental studies [23]. Each domain was rated as low risk-of-bias, some concerns, or high risk-of-bias. Two independent reviewers (CARS and SMP) conducted the assessments, and discrepancies were resolved by a third reviewer (CMDG). The robvis tool [24] was used for visualization of risk-of-bias assessments.

2.5. Data Extraction

The primary outcome of interest was self-care behaviors. Secondary outcomes included maternal health knowledge and other related maternal health outcomes, such as attitudes, preventive health behaviors, coping skills, and psychological well-being, regardless of whether these were reported as primary or secondary outcomes in the included studies.

Sociodemographic and clinical variables were extracted from the included studies and summarized through narrative synthesis and tables. Data were collected on study characteristics (country, year, study design, primary and secondary outcomes, and instruments used), as well as on intervention characteristics (type of counseling or educational intervention, context, session duration, and participants involved). When studies did not report the mean and standard deviation (SD) of participants’ age but instead provided the median and interquartile range (IQR), these values were converted to approximate mean and SD estimates using established methods. Assuming an approximately normal distribution, the median was considered an estimate of the mean, and the SD was calculated as IQR/1.35, following the approaches described by Wan et al. [25] and Luo et al. [26]. Additional outcome variables were extracted when available. Data extraction was conducted independently by two blinded reviewers (CRS and SMP), with disagreements resolved by a third reviewer (CMDG). Where feasible, results were pooled in a meta-analysis.

2.6. Meta-Analysis

Meta-analyses were conducted using the online software Meta-Mar (meta-analysis calculator, version 4.0.2; no manufacturer address specified by the developer) for studies comparing two or more groups on outcomes such us knowledge and self-care. Post-intervention means, and standard deviations were used for the calculations. When studies reported multiple outcome measurements over time, the first post-intervention assessment was selected for pooling to ensure comparability across studies and to avoid double counting of follow-up measurements. Random-effects models were applied to account for heterogeneity across studies, which was assessed using the I² statistic. The standardized mean difference (SMD) was calculated using Hedges’ g. Variance was estimated using the inverse variance method, with restricted maximum likelihood. Forest plots were generated to present the SMDs, with their corresponding effect sizes and 95% confidence intervals (95%CI). Given the limited number of studies available for some outcomes and the variability in outcome measurement instruments, the pooled estimates should be interpreted with caution.

2.7. Certainty of Evidence

The certainty of evidence for the main outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [27,28]. The GRADE framework evaluates the overall certainty of evidence across studies for each outcome by considering five domains: risk of bias, inconsistency of results, indirectness of evidence, imprecision of effect estimates, and publication bias. Evidence from RCTs initially starts as high certainty, whereas evidence from non-randomized studies begins as low certainty and may be downgraded or upgraded depending on these domains.

For each outcome, the certainty of evidence was evaluated by three reviewers (CRS, CARS and HGT) based on the methodological quality of the included studies, the consistency of results across studies, the directness of the evidence in relation to the research question, the precision of the pooled or reported estimates, and the potential for publication bias. When serious or very serious concerns were identified in one or more domains, the certainty of evidence was downgraded accordingly. The final certainty of evidence was classified into four levels: high, moderate, low, or very low.

3. Results

3.1. Search Results

A total of 620 records were identified. After removing duplicates and grey literature, 377 records were screened by title and abstract. Following the screening process, 44 full-text records were assessed for eligibility. Of these, 37 records were excluded for reasons including absence of an intervention design, participants outside the defined age range, or insufficient methodological quality. Ultimately, seven (n = 7) studies met the inclusion criteria and were included in the review, as illustrated in the PRISMA [20] flow diagram in Figure 1.

Figure 1. PRISMA flow diagram of the included studies.

3.2. Study Characteristics

Overall, most studies demonstrated moderate to high methodological quality, although some limitations were identified in specific methodological domains. The included studies comprised RCTs and quasi-experimental studies conducted in several countries, including Thailand [29,30], Colombia [31], Spain [32], and Iran [33,34,35]. The critical appraisal of the included studies is presented in Supplementary Table S1.

The clinical settings included antenatal clinics, health centers, prenatal care services, hospital maternity units, and community prenatal programs. Table 2 summarizes the study designs, country, clinical settings, objectives, primary and secondary outcomes, and main conclusions of the included studies.

Table 2. General characteristics of included studies.

Author (Year) Design	Country; Setting	Type of Intervention	Provider	Delivery Format	Duration	Outcomes	Main Findings	JBI 1 Quality (%)
Chansiri et al., (2026) QE 2 [29]	Thailand; Antenatal clinics	mHealth self-efficacy program + prenatal education	Health professionals	Digital modules + orientation session	4 weeks	Pregnancy-related knowledge; Self-efficacy	Intervention improved knowledge and maternal self-efficacy compared with routine care.	9/9 (100)
Ulloa-Sabogal & Arias-Rojas, (2025) RCT 3 [31]	Colombia; Prenatal care services	Nursing educational counseling based on self-care theory	Nurses	Face-to-face sessions	4 sessions	Pregnancy-related knowledge; Self-care behaviors	Counseling improved maternal knowledge and self-care behaviors.	10/13 (76.9)
Díaz-Hurtado et al., (2024) QE [32]	Spain; Hospital maternity unit	Postpartum educational program on self-care	Healthcare professionals	Group sessions with printed materials	Not specified	Postpartum self-care knowledge	Educational intervention increased postpartum self-care knowledge among adolescent mothers.	6/9 (66.7)
Tavakoly-Sany et al., (2024) QE [33]	Iran; Health centers	Educational program based on self-efficacy and health literacy	Health educators	Group sessions and educational materials	6 sessions	UTI 4 preventive behaviors; Health literacy; Self-efficacy	Intervention improved preventive behaviors and increased health literacy and self-efficacy.	9/9 (100)
Gholami et al., (2022) RCT [34]	Iran; Health centers	Adlerian group counseling	Trained counselors	Group counseling sessions	4 sessions	Prenatal distress; Self-care behaviors	Counseling reduced prenatal distress and improved prenatal self-care.	11/13 (84.6)
Boobpa-mala et al., (2022) RCT [30]	Thailand; Prenatal clinics	Early depression prevention counseling program	Nurses/counselors	Group sessions	5 sessions	Depression symptoms; Coping skills	Intervention reduced depressive symptoms and improved coping skills.	12/13 (92.3)
Rezaie et al., (2021) RCT [35]	Iran; Health centers	Self-care counseling program during pregnancy	Midwives	Face-to-face counseling	6 sessions	Health practices; Attitudes toward motherhood	Counseling improved maternal health practices and attitudes toward motherhood.	12/13 (92.3)

¹ JBI: Joanna Briggs Institute; ² QE: Quasi-experimental; ³ RCT: Randomized Clinical Trial; ⁴ UTI: Urinary tract infection.

Across the included studies (n = 776 participants), the weighted mean age of participants was 19.28 years (SD = 4.48).

The interventions consisted of educational or counseling programs delivered through face-to-face sessions, group discussions, or digital resources [30,33,34,35]. Most interventions included four to six sessions lasting approximately 60–120 min. Some studies used alternative delivery formats, such as a four-week mobile health self-efficacy program including educational modules and weekly reminders [29], or a four-session nursing educational intervention addressing hypertensive disorders of pregnancy and self-care determinants [31]. Additionally, Díaz-Hurtado et al. [32] implemented a postpartum educational program based on group talks and printed materials focused on self-care and warning signs.

A wide range of validated instruments was used to assess outcomes. These included knowledge and self-efficacy measures [29], the knowledge on hypertensive disorders of pregnancy scale and behavioral determinants questionnaire [31], a self-care knowledge questionnaire [32], the test of functional health literacy in adults, the general self-efficacy scale, and the urinary tract infection preventive behavior questionnaire [33]. Other studies used the quality of prenatal care questionnaire and the prenatal distress questionnaire [34], the coping skills scale and the antenatal depression scale [30], the health practices questionnaire II, the pregnancy questionnaire assessing maternal attitudes, and the pregnancy symptoms inventory [35]. Table 3 summarizes the characteristics of the participants and the clinical and statistical results.

Table 3. Clinical and statistical results of included studies.

Author (Year)	Participants	Instruments	Outcomes and Statistical Data
Chansiri et al., (2026) [29]	N = 108 pregnant adolescents. IG 1 = 54 (Age M = 17.56, SD = 1.45); CG 2 = 54 (Age M = 17.91 (SD = 1.29) Total Age M = 17.73 (SD = 1.38). Gestational age ≥ 28 weeks.	Knowledge questionnaire; Self-efficacy scale.	Knowledge IG pre: M 3 =12.13 (SD 4 = 2.43); post: M = 17.46 (SD = 1.58) CG pre: M = 12.74 (SD = 3.65); post: M = 13.39 (SD = 3.79); p < 0.001 Self-efficacy IG pre: M = 85.09 (SD = 5.94); post: M = 91.24 (SD = 7.42) CG pre: M = 85.52 (SD = 5.97) post: M = 86.91 (SD = 4.88); p = 0.001
Ulloa-Sabogal & Arias Rojas (2025) [31]	N = 54 pregnant women. IG = 27 (Age M = 22.00, SD = 12.59); CG = 27 (Age M = 25.00, SD = 11.85). Total age M = 23.50 (SD = 12.21). Gestational age ≤ 24 weeks.	Knowledge on Hypertensive Disorders of Pregnancy Scale (CoNOCiTHE); determinants of behavior questionnaire.	Knowledge IG pre: median 25.0 (IQR 6 13.0; SD = 9.63); post: median 29.0 (IQR 5.0; SD = 3.70) CG pre: median 27.0 (IQR 10.0; SD = 7.41); post: median 26.00 (IQR 9.0; SD = 6.67); p < 0.0001 Self-care behaviors IG pre: median 42.0 (IQR 20.0; SD = 14.81); post: median 48.0 (IQR 12.0; SD = 8.89) CG pre: median 44.0 (IQR 18.0; SD = 13.33); post: median 44.00 (IQR 20.0; SD = 14.81); p < 0.0001 Total knowledge + self-care IG pre: median 68.0 (IQR 25.0; SD = 18.52); post: median 77.0 (IQR 14.0; SD = 10.37) CG pre: median 69.0 (IQR 21.0; SD = 15.56); post: median 69.0 (IQR 23.0; SD = 17.04) p < 0.0001
Díaz-Hurtado et al., (2024) [32]	N = 299 adolescent puerperal. No CG. Age M = 17.36 (SD = 1.35). Gestational age not reported. Primiparous (96.66%); eutocic delivery 69.23%.	Self-care knowledge questionnaire.	Knowledge of self-care pre: M = 21.0; 95%CI: 20.99–22.32; SD = 5.88 post: M = 27.74; 95CI%: 27.20–28.20; SD = 4.41 p < 0.0001
Tavakoly-Sany et al., (2024) [33]	N = 110 first pregnancy women. IG = 55 (Age M = 25.51; SD = 5.07); CG = 55 (Age M = 24.09; SD = 4.78). Total age M = 24.80 (SD = 4.92). Gestational age 12–18 weeks.	Test of Functional Health Literacy in Adults (TOFHLA); General Self-Efficacy Scale; Urinary Tract Infection (UTI) preventive behavior questionnaire.	Preventive behaviors IG pre: M = 64.0 (SD = 6.20); post: M = 85.0 (SD = 4.50); follow-up 3 month: M = 81.6 (SD = 4.0) CG pre: M = 64.10 (SD = 7.04); post: M = 65.10 (SD = 6.30); follow-up 3 month: M = 65.40 (SD = 6.30) p < 0.001 Health literacy IG pre: M = 55.80 (SD = 15.90); post: M = 59.90 (SD = 15.30); follow-up 3 month: M = 59.30 (SD = 15.40) CG pre: M = 56.30 (SD = 16.60); post: M = 56.90 (SD = 16.10); follow-up 3 month: M = 56.20 (SD = 15.90) p < 0.001 Self-efficacy IG pre: M = 55.80 (SD = 12.20); post: M = 62.10 (SD = 11.10); follow-up 3 month: M = 61.90 (SD = 12.10) CG pre: M = 55.80 (SD = 13.70); post: M = 56.60 (SD = 13.10); follow-up 3 month: M = 56.50 (SD = 13.00) p = 0.032 (post-intervention); p = 0.045 (follow-up).
Gholami et al., (2022) [34]	N = 79 pregnant women. IG = 40; CG = 39 Total age M = 23.39 (SD = 2.85). Gestational age 22–32 weeks.	Quality of Prenatal Care Questionnaire (QPCQ); Prenatal Distress Questionnaire (PDQ).	QPCQ Physical health IG pre: M = 27.28 (SD = 4.08); post: M = 29.08 (SD = 5.39); follow-up: M = 30.48 (SD = 5.88) CG pre: M = 29.00 (SD = 3.38); post: M = 29.15 (SD = 3.57); follow-up: M = 30.82 (SD = 2.79) p = 0.359 (inter-groups); p = 0.0001 (intra-groups) Behavior IG pre: M = 43.55 (SD = 5.85); post: M = 45.80 (SD = 6.14); follow-up: M = 46.60 (SD = 5.73) CG pre: M = 46.23 (SD = 6.29); post: M = 45.85 (SD = 6.08); follow-up: M = 47.08 (SD = 5.22) p = 0.243 (inter-groups); p = 0.001 (intra-groups) Relationship health IG pre: M = 52.13 (SD = 6.91); post: M = 55.75 (SD = 6.33); follow-up: M = 55.40 (SD = 6.64) CG pre: M = 55.92 (SD = 7.99); post: M = 54.38 (SD = 8.70); follow-up: M = 58.51 (SD = 3.55) p = 0.016 (inter-groups); p = 0.001 (intra-groups) Social health IG pre: M = 53.78 (SD = 6.04); post: M = 56.23 (SD = 4.67); follow-up: M = 54.33 (SD = 3.63) CG pre: M = 52.08 (SD = 8.67); post: M = 50.56 (SD = 8.87); follow-up: M = 54.87 (SD = 8.40) p = 0.007 (inter-groups); p = 0.001 (intra-groups) PDQ Neonatal care IG pre: M = 10.05 (SD = 4.04); post: M = 5.53 (SD = 2.85); follow-up: M = 5.73 (SD = 4.48) CG pre: M = 10.69 (SD = 3.07); post: M = 11.31 (SD = 2.53); follow-up: M = 11.67 (SD = 1.63) p = 0.0001 (inter-groups); p = 0.0001 (intra-groups) Body image and weight IG pre: M = 4.50 (SD = 2.50); post: M = 3.40 (SD = 2.02); follow-up: M = 3.30 (SD = 3.07) CG pre: M = 4.33 (SD = 2.09); post: M = 6.08 (SD = 1.51); follow-up: M = 6.72 (SD = 1.54) p = 0.0001 (inter-groups); p = 0.0001 (intra-groups) Feelings and interpersonal relationships IG pre: M = 4.30 (SD = 2.21); post: M = 2.08 (SD = 1.56); follow-up: M = 1.60 (SD = 1.58) CG pre: M = 4.00 (SD = 2.21); post: M = 4.38 (SD = 3.19); follow-up: M = 3.97 (SD = 1.75) p = 0.0001 (inter-groups); p = 0.0001 (intra-groups)
Boobpa-mala et al., (2022) [30]	N = 72 pregnant adolescents. IG = 36 (Age M = 17.44, SD = 1.46); CG = 36 (Age M = 17.81, SD = 1.24). Total age M = 17.63 (SD = 1.35). Gestational age 5–26 weeks.	Coping Skills Scale; Antenatal Depression Scale.	Coping Skills IG pre (T1): M = 64.94 (SD = 11.01); post (T2): M = 69.69 (SD = 9.84); follow-up 1 (T3): M = 70.56 (SD = 9.99); follow-up 2 (T4): M = 73.47 (SD = 9.14) CG pre (T1): M = 66.08 (SD = 10.42); post (T2): M = 68.33 (SD = 11.92); follow-up 1 (T3): M = 65.61 (SD = 12.32); follow-up 2 (T4): M = 64.39 (SD = 15.83) Between-group p values: T1 p = 0.654; T2 p = 0.599; T3 p = 0.066; T4 p = 0.004 Within-group change (Bonferroni): IG: T1–T2 MD 5 = −4.75 (p < 0.001); T2–T3 MD = −5.61 (p < 0.001); T3–T4 MD = −8.53 (p < 0.001) CG: T1–T2 MD = −2.25 (p = 0.121); T2–T3 MD = 0.47 (p = 0.779); T3–T4 MD = 1.69 (p = 0.432) Depression IG pre (T1): M = 7.03 (SD = 4.07); post (T2): M = 4.53 (SD = 2.60); follow-up 1 (T3): M = 4.00 (SD = 2.56); follow-up 2 (T4): M = 2.03 (SD = 2.13) CG pre (T1): M = 6.72 (SD = 4.04); post (T2): M = 6.39 (SD = 4.28); follow-up 1 (T3): M = 5.97 (SD = 4.02); follow-up 2 (T4): M = 6.56 (SD = 4.55) Between-group p values: T1 p = 0.750; T2 p = 0.029; T3 p = 0.015; T4 p < 0.001 Within-group change (Bonferroni): IG: T1–T2 MD = 2.50 (p < 0.001); T1–T3 MD = 3.03 (p < 0.001); T1–T4 MD = 5.00 (p < 0.001) CG: T1–T2 MD = 0.33 (p = 0.503); T1–T3 MD = 0.75 (p = 0.163); T1–T4 MD = 0.17 (p < 0.001)
Rezaie et al., (2021) [35]	N = 54 pregnant adolescents. IG = 27 (Age M = 17.96, SD = 1.05); CG = 27 (Age M = 18.07, SD = 0.96) Total age M = 18.02 (SD = 1.01). Gestational age 18–24 weeks.	Health Practices Questionnaire II (HPQ-II); Pregnancy Questionnaire assessing maternal attitudes toward pregnancy and motherhood (PRE-MAMA); Pregnancy Symptoms Inventory (PSI).	HPQ-II Total health practices score T0: IG 91.85 (5.83); CG 92.55 (3.88); MD = −0.70; 95%CI: −3.41–2.00; p = 0.604; T1: IG 129.74 (12.5); CG 93.85 (3.37); MD = 36.34; 95%CI: 36.34–37.98; p < 0.001 Balance between rest and exercise T0: IG 5.52 (0.97); CG 5.37 (1.08); MD = 0.15; 95%CI: −0.41–0.71; p = 0.599; T1: IG 9.67 (1.18); CG 4.81 (0.92); MD = 4.78; 95%CI: 4.26–5.30; p < 0.001 Diseases and injury prevention T0: IG 14.78 (1.98); CG 15.23 (1.69); MD = −0.55; 95%CI: −1.56–0.45; p = 0.273; T1: IG 22.18 (1.07); CG 15.89 (1.39); MD = 6.54; 95%CI: 6.02–7.07; p < 0.001 Nutrition and diet care T0: IG 22.26 (1.98); CG 22.44 (2.41); MD = −0.18; 95%CI: −1.47–1.10; p = 0.774; T1: IG 36.00 (2.15); CG 22.59 (1.91); MD = 13.49; 95%CI: 12.53–14.44; p < 0.001 Avoidance of harmful drugs and narcotics T0: IG 13.15 (1.75); CG 13.59 (1.47); MD = −0.44; 95%CI: −1.33–0.44; p = 0.317; T1: IG 18.00 (1.57); CG 13.22 (1.60); MD = 5.04; 95%CI: 4.34–5.71; p < 0.001 Knowledge about pregnancy and childbirth T0: IG 16.15 (2.44); CG 15.81 (2.52); MD = 0.33; 95%CI: −0.78–1.44; p = 0.550; T1: IG 23.89 (1.89); CG 17.33 (1.41); MD = 6.37; 95%CI: 5.69–7.05; p < 0.001 PRE-MAMA T0: IG 32.26 (4.57); CG 31.48 (3.98); MD = 0.78; 95%CI: −1.56–3.12; p = 0.508; T1: IG 33.92 (3.16); CG 32.44 (3.08); MD = 1.01; 95%CI: 0.06–1.96; p = 0.038 PSI T0: IG 30.78 (10.54); CG 29.55 (7.98); MD = 1.22; 95%CI: −3.89–6.33; p = 0.633; T1: IG 25.92 (6.51); CG 27.15 (4.14); MD = −1.37; 95%CI: −4.32–1.58; p = 0.354

¹ IG: Intervention Group; ² CG: Control Group; ³ M: Mean; ⁴ SD: Standard deviation; ⁵ MD: Mean Difference; ⁶ IQR: interquartile range.

3.3. Risk-of-Bias Assessment

The risk-of-bias assessment of the included studies showed that three studies were rated as having a low risk of bias, three as having some concerns, and one as having a high risk of bias in the overall judgment (Figure 2). The main concerns were related to limitations in the randomization process or the use of non-randomized study designs, while most studies showed a low risk of bias in domains related to deviations from intended interventions, outcome measurement, and missing outcome data.

Figure 2. Risk-of-bias domains in each included study [29,30,31,32,33,34,35].

As shown in Figure 3, most studies presented a low risk of bias regarding intervention implementation, outcome measurement, and management of missing data. However, some concerns were identified mainly in the randomization process or study design, particularly in quasi-experimental studies. Overall, approximately half of the studies were rated as having some concerns, while one study presented a high risk of bias due to the absence of a control group.

Figure 3. Risk-of-bias in all included studies.

3.4. Preliminary Meta-Analysis

3.4.1. Pregnancy-Related Health Knowledge

A meta-analysis including three studies [29,31,35] evaluated the effect of counseling and educational interventions on pregnancy-related health knowledge. The pooled analysis showed a large effect favoring the intervention (SMD = 1.90), although the CI crossed the null value (95%CI: −0.02 to 3.83; p = 0.05). Substantial heterogeneity was observed across studies (I² = 95%; τ² = 2.77; χ² = 36.78, p < 0.001), indicating considerable variability in the magnitude of intervention effects. Although all studies favored the intervention, the effect sizes differed markedly. Therefore, while the results suggest a potential benefit of counseling and educational interventions on maternal health knowledge during pregnancy, the findings should be interpreted with caution, as illustrated in Figure 4.

Figure 4. Forest Plot for the variable “pregnancy-related health knowledge” [29,31,35].

3.4.2. Self-Care Behaviors

A meta-analysis including three studies [31,33,35] evaluated the effect of the intervention on the self-care behaviors. The pooled analysis showed a large effect favoring the intervention (SMD = 2.39; 95%CI: 0.29 to 4.49; p = 0.03). However, substantial heterogeneity was observed across studies (I² = 97%; τ² = 3.32; χ² = 66.76, p < 0.001), indicating considerable variability in the magnitude of the intervention effects. Although most studies favored the intervention, the effect sizes differed markedly, with one study showing a small and non-significant effect while the others reported very large effects. Therefore, while the results suggest a potential benefit of the intervention, the findings should be interpreted with caution due to the high heterogeneity and wide prediction interval, as illustrated in Figure 5.

Figure 5. Forest Plot for the variable “self-care behaviors” [31,33,35].

3.5. Certainty of Evidence Results

Table 4 presents a summary of the number and design of studies contributing to each outcome, the estimated effect when available, and the corresponding assessment of risk of bias, inconsistency, indirectness, imprecision, and publication bias. Overall, the certainty of evidence ranged from low to very low across outcomes, mainly due to methodological limitations of the included studies, substantial heterogeneity between interventions and outcome measures, and the limited number of studies available for several outcomes.

Table 4. Summary of findings and certainty of evidence.

Outcome	Number of Studies (Design)	Participants	Estimated Effect	Risk of Bias	Inconsistency	Indirectness	Imprecision	Publication Bias	Certainty of Evidence
Pregnancy-related health knowledge.	3 (2 RCT 1, 1 QE 2)	216	SMD 3 = 1.90 (95%CI −0.02 to 3.83)	S 4	VS 5	NS 6	S	UD 7	Very low ⊕◯◯◯
Self-care behaviors.	3 (2 RCT, 1 QE)	218	SMD = 2.39 (95%CI 0.29 to 4.49)	S	VS	S	S	UD	Very low ⊕◯◯◯
Self-efficacy.	2 (QE)	218	Interventions improved self-efficacy compared with usual care.	S	NS	NS	S	UD	Very low ⊕◯◯◯
Psychological outcomes (coping skills, depression, prenatal distress).	2 (RCT)	151	Counseling interventions improved coping and reduced depressive symptoms and distress.	S	NA 8	NS	S	UD	Low ⊕⊕◯◯
Maternal health practices and attitudes.	1 (RCT)	54	Counseling intervention improved health practices and attitudes toward motherhood.	S	NA	NS	S	UD	Low ⊕⊕◯◯
Postpartum self-care knowledge.	1 (QE)	299	Educational intervention improved postpartum self-care knowledge.	VS	NA	NS	S	UD	Very low ⊕◯◯◯

¹ RCT: Randomized Clinical Trial; ² QE: Quasi-experimental; ³ SMD: Standardized Mean Difference; ⁴ S: Serious limitations; ⁵ VS: Very Serious limitations; ⁶ NS: Not serious limitations; ⁷ UD: Undetected limitations; ⁸ NA: Not applicable.

4. Discussion

Adolescent and young women’s pregnancy may involve important health, social, and educational support needs, particularly in resource-limited settings [4,6]. Evidence consistently shows that morbidity and mortality associated with pregnancy are higher among adolescents than among adult women, highlighting the potential value of targeted counseling and educational interventions for adolescents and young women who may experience social or healthcare vulnerability [4,22]. Socioeconomic determinants such as low educational attainment, limited access to reproductive health services, and social vulnerability may contribute substantially to contexts in which adolescent pregnancy is associated with poorer maternal and neonatal outcomes. Previous research conducted in low- and lower-middle-income countries has also identified structural factors such as poverty, limited educational opportunities, and restricted access to reproductive health services as key determinants associated with adolescent pregnancy [34].

The findings of this review suggest that educational and counseling interventions may improve several health-related outcomes among pregnant adolescents and young women. Overall, the included studies showed improvements in pregnancy-related health knowledge, self-care practices, preventive behaviors, self-efficacy, coping skills, and psychological well-being. For example, a nursing educational intervention aimed at improving knowledge and self-care behaviors related to hypertensive disorders during pregnancy demonstrated significant improvements in knowledge and self-care behaviors compared with routine prenatal care, while also showing high acceptability and feasibility among participants [29]. Similarly, a self-care counseling intervention in adolescent pregnant women significantly improved overall health practices and all their subdomains, and also enhanced attitudes toward motherhood and pregnancy, although it did not significantly reduce pregnancy symptoms [33]. These findings reinforce the relevance of structured counseling as a strategy to strengthen both behavioral and attitudinal dimensions of maternal health among pregnant adolescents and young women. These findings are consistent with previous evidence indicating that counseling-based educational programs can enhance maternal self-efficacy and health-related behaviors among adolescent mothers, including breastfeeding practices and other aspects of maternal care [35,36].

Theory-based educational interventions also are particularly useful when they target key behavioral determinants on maternal health. In this context, approaches grounded in constructs such as self-efficacy and health literacy have been associated with improvements in preventive health behaviors during pregnancy [31]. These findings suggest that interventions informed by behavioral theory may facilitate more sustained changes in health-related practices among pregnant women.

Digital and technology-based interventions may provide additional opportunities to reach adolescents and young women in a scalable and accessible way. In this context, mobile health approaches have been associated with improvements in pregnancy-related knowledge, self-efficacy, and maternal health behaviors among pregnant adolescents [27]. These findings suggest that digital formats may contribute not only to strengthening educational and psychosocial outcomes, but also to supporting positive maternal health experiences during pregnancy and early motherhood. Such approaches may be particularly relevant for adolescent populations, for whom mobile-based interventions are often more acceptable and easier to integrate into everyday life. The growing use of digital health technologies in maternal care has also been highlighted in recent systematic reviews, which report that mobile health tools may support monitoring and self-management of pregnancy-related conditions such as gestational diabetes [37].

The review also highlights the importance of psychosocial interventions during pregnancy. Evidence suggests that counseling-based approaches may contribute to improving coping abilities and emotional well-being among pregnant adolescents [28]. Likewise, counseling strategies focusing on interpersonal relationships and emotional support have been associated with improvements in several dimensions of prenatal well-being and self-care [32]. Taken together, these findings suggest that counseling interventions during pregnancy should not be limited to knowledge transmission alone, but should also address emotional adaptation, interpersonal relationships, and women’s confidence in managing pregnancy-related demands. This perspective aligns with broader evidence indicating that psychosocial interventions during pregnancy can support behavioral change and reduce health risks, including smoking cessation and other modifiable behaviors that influence maternal and neonatal outcomes [38,39,40,41].

Another relevant finding is that educational interventions may also be beneficial during the postpartum period. Educational support provided to adolescent mothers has been associated with improvements in self-care knowledge following childbirth, highlighting the continued importance of maternal education beyond pregnancy [30]. Although this evidence relates to the postpartum stage, it reinforces the broader idea that adolescent and young mothers benefit from structured educational support during key maternal transitions.

An important aspect highlighted by this review is the need to differentiate counseling approaches according to age group. Adolescent pregnant women often experience a dual transition involving both developmental and maternal challenges, frequently in a context in which they may experience lower health literacy, reduced autonomy, or greater social vulnerability depending on the social and healthcare context [10,33]. In this context, counseling interventions may need to be more structured, supportive, and tailored to promote understanding, emotional adaptation, and empowerment. In contrast, young adult women may have different contextual characteristics, including, on average, greater access to social, educational, or economic resources, which could influence their experience of the transition to motherhood [10,19]. However, these differences are not uniform and may vary depending on individual and contextual factors. Importantly, the current evidence does not allow definitive conclusions regarding how these factors translate into differences in maternal or neonatal outcomes. It is important to note that the included studies did not allow for stratified analyses by age group, which limits the ability to draw conclusions about differential effectiveness between adolescents and young adult women. Future research should specifically explore age-stratified effects of counseling interventions to better understand the distinct needs of these populations.

The preliminary meta-analyses conducted in this review suggest that counseling and educational interventions may be associated with improvements in pregnancy-related health knowledge and self-care behaviors among pregnant adolescents and young women. However, these findings should be interpreted with caution, as the certainty of the evidence was low to very low across outcomes, and a serious or very serious risk of bias was identified in most studies. In addition, considerable heterogeneity was observed across interventions and outcome measures. Therefore, the results should be considered exploratory, and no firm conclusions can be drawn regarding the effectiveness of these interventions, particularly regarding potential differential effects across adolescent and young adult populations. Consistent with these findings, the GRADE assessment indicated that the certainty of evidence ranged from low to very low across all outcomes, mainly due to methodological limitations, risk of bias, and heterogeneity among studies.

Several contextual factors may influence the effectiveness of these interventions. Educational level, socioeconomic status, access to healthcare services, and social support were repeatedly identified in the included studies as relevant background factors. For example, previous research has highlighted that interventions grounded in behavioral theory may remain effective even in populations with relatively limited educational or socioeconomic resources [31]. In addition, counseling approaches that promote communication, emotional support, and social relationships during pregnancy may be particularly beneficial for women experiencing uncertainty or distress during the transition to motherhood [32]. These findings suggest that effective interventions should be sensitive to the social, emotional, and healthcare contexts in which pregnancy and early motherhood occur among adolescents and young women. Furthermore, other maternal health behaviors and contextual conditions may influence pregnancy outcomes. For example, studies have reported that pregnant women often experience uncertainty or negative perceptions regarding weight management during antenatal care, which may affect engagement with health recommendations [42]. Additionally, the practice of self-medication during pregnancy has been identified as a widespread concern globally, often associated with limited access to healthcare services and insufficient health literacy [43,44]. In addition, broader structural and policy changes affecting access to contraception and reproductive health services at the global level may influence adolescent pregnancy trends and should be considered when interpreting these findings.

From a policy and practice perspective, the findings of this review have important implications at multiple levels. At the individual (micro) level, counseling and educational interventions may support pregnant adolescents in developing self-care skills, improving health literacy, and enhancing psychological well-being, thereby facilitating a more positive transition to motherhood. At the interpersonal and healthcare (meso) level, these findings highlight the need for healthcare professionals to adopt structured, age-sensitive, and person-centered counseling approaches that address not only clinical aspects but also emotional and social needs. At the system and policy (macro) level, the results support the integration of counseling and health education strategies into maternal and reproductive health programs, particularly in settings where adolescents and young women may experience social or healthcare vulnerability during pregnancy and early motherhood. Policymakers should consider incorporating these interventions into routine antenatal and postnatal care, as well as into community-based and school-based programs, to reduce health inequalities and promote long-term well-being among adolescent mothers and their children.

Nevertheless, this review has several limitations. First, the limited availability of studies specifically targeting pregnant adolescents restricted the ability to draw strong conclusions for this age group. Several included studies involved mixed samples of pregnant women or young adults, which may affect the generalizability of findings. Second, methodological heterogeneity across studies, including differences in intervention content, delivery formats, outcome measures, and follow-up periods, limited the possibility of conducting more robust quantitative analyses. Third, publication bias could not be formally assessed due to the small number of studies included in the meta-analyses. Finally, the quantitative synthesis should be considered exploratory because only a limited number of studies reported sufficiently comparable outcomes and substantial heterogeneity was observed across pooled estimates. In this sense, the current evidence should be interpreted with caution due to the small number of studies included in the meta-analyses, the methodological heterogeneity across studies, and the variability in outcome measurement. Additionally, the inclusion of heterogeneous age groups limited the possibility of identifying differential intervention effects according to developmental stage.

Despite these limitations, the findings highlight the importance of integrating educational, psychosocial, and technology-supported interventions into maternal health programs for adolescents and young women, particularly when tailored to the developmental and contextual needs of different populations. Comprehensive strategies that combine health education, counseling, behavioral support, and digital tools may help strengthen pregnancy-related knowledge, self-care capacity, preventive health behaviors, and psychological adaptation during pregnancy and the transition to motherhood.

5. Conclusions

Counseling and educational interventions during pregnancy may contribute to improvements in pregnancy-related health knowledge and self-care behaviors among pregnant adolescents and young women; however, the current evidence is limited and of low certainty.

Overall, the available findings suggest possible benefits of counseling-based strategies for strengthening maternal knowledge, preventive health behaviors, and psychosocial adaptation during pregnancy. Nevertheless, further research using more rigorous and standardized study designs is required to confirm the effectiveness of these interventions, particularly regarding knowledge, self-efficacy, mental health, and healthy practices among adolescents and young women during pregnancy and early motherhood.

Future studies should also include more diverse geographical and sociocultural contexts in order to improve the generalizability of the findings. In addition, stronger evidence is needed on the social and healthcare resources available to support pregnant and parenting adolescents and young women, particularly within maternal health services and community-based programs.

Given the heterogeneity of developmental stages and social contexts represented in the included studies, the findings should be interpreted cautiously. These findings also suggest that counseling and educational interventions may need to be adapted according to the developmental and social characteristics of adolescent and young adult women, highlighting the potential relevance of context-sensitive and developmentally appropriate approaches in maternal health programs.