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Significance Seagrasses are important for ecosystem services, including climate regulation and fisheries production. But they are threatened by multiple pressures including poor water quality and coastal development. Seagrass extent is not monitored in many places, so areas at most risk of decline and the management actions needed in these places are largely unknown. We examine associations between change in seagrass meadow area and key pressures globally, helping predict the trajectory of meadows in unmonitored regions. We find rapidly shrinking seagrass meadows in areas where water quality is poor and destructive fishing occurs. Trajectories of change also vary with seagrass life-history strategy. Finally, we identify several unmonitored locations at risk of decline, highlighting where urgent monitoring and management are required., Seagrass meadows are threatened by multiple pressures, jeopardizing the many benefits they provide to humanity and biodiversity, including climate regulation and food provision through fisheries production. Conservation of seagrass requires identification of the main pressures contributing to loss and the regions most at risk of ongoing loss. Here, we model trajectories of seagrass change at the global scale and show they are related to multiple anthropogenic pressures but that trajectories vary widely with seagrass life-history strategies. Rapidly declining trajectories of seagrass meadow extent (>25% loss from 2000 to 2010) were most strongly associated with high pressures from destructive demersal fishing and poor water quality. Conversely, seagrass meadow extent was more likely to be increasing when these two pressures were low. Meadows dominated by seagrasses with persistent life-history strategies tended to have slowly changing or stable trajectories, while those with opportunistic species were more variable, with a higher probability of either rapidly declining or rapidly increasing. Global predictions of regions most at risk for decline show high-risk areas in Europe, North America, Japan, and southeast Asia, including places where comprehensive long-term monitoring data are lacking. Our results highlight where seagrass loss may be occurring unnoticed and where urgent conservation interventions are required to reverse loss and sustain their essential services.