Efficacy of innovative models of maternity care for young women and their infants: A systematic review and meta-analysis

Problem Pregnant adolescents are a vulnerable group who face barriers to accessible, acceptable, and comprehensive maternity care, contributing to poorer perinatal outcomes. Background There is a gap in the evidence on maternity models of care for young women. Three relevant quantitative reviews were published (2012, 2018, 2023). Two reviews examined antenatal interventions for the population without conducting quantitative data synthesis. Two reviews included a mix of interventions to address social determinants of health which were not limited to the antenatal period. Aim To determine the risk of preterm birth for young women aged ≤ 25 years in innovative models of care with a midwife, compared with routine care. Method This review synthesises evidence from randomised controlled and observational studies that met inclusion criteria. Searches were conducted across four databases from inception to November 2025. Meta-analysis was conducted where sufficient data were available; otherwise, narrative synthesis was used. Researchers assessed methodological quality and risk of bias; publication bias; certainty of evidence; and heterogeneity. Findings From 2389 records, two randomised controlled trials and 10 observational studies involving 6227 participants were included. Overall, innovative models significantly lowered the risk of preterm birth (RR:0.62, 95% CI: 0.49–0.80; I2 =44.3%). Discussion Innovative models of care that include a midwife, designed to meet the specific needs of young women, may reduce preterm birth. This should be interpreted with caution due to potential confounding in non-randomised studies. Conclusion Future research should prioritise adequately powered, randomised studies to definitively establish causal effects and inform clinical practice. Copyright © 2026. Published by Elsevier Ltd.