The adolescent pregnancy

Brenda Dawley M.D.
Why high –risk?
 Unplanned
 Unwanted
 Substance abuse
 Lack prenatal care
 Increased risk certain pregnancy complications
Unplanned
 78% pregnancies for age 15-19 unplanned
 In 2000, 30% teen pregnancies end in elective
termination of pregnancy
 Up to 42% will have repeat pregnancy within 24
months
 Higher risk if drops out of school after first pregnancy
CDC Births: prelim data 2006, national vital
statistics report 2007
Delay in prenatal care
 Denial to themselves and health care workers
 <10% pregnant adolescents <16 who presented to ED
with abdominal complaints admitted pregnancy
possibility
 Present later for care
 More likely to smoke (60% in WV)
 More likely to suffer from poor nutrition
 More likely to have anemia
 More likely to have STDs diagnosed with pregnancy
Up-To-Date Pregnancy in adolescents
Pregnancy Outcome
 Low birth weight infants increased : RR 1.57
 Preterm delivery increased
 Preeclampsia increased?- highest risk is with first
pregnancy but young age not as important
 Increased risk of both neonatal and postneonatal
death (up to 25% increased)
 Increased rate post-partum depression(57%)
Reichman NE, et al. Maternal age and birth
outcomes: data from New Jersey. Fam Plann
Perspect.1997 Nov-Dec;29(6):269-72.
Social impact
 Less likely to receive high school diploma
 More likely to live in poverty
 At risk for intimate-partner violence
 More likely to receive long-term public assistance
 More like to have experienced child sexual abuse
Outcome for child
 More likely to have health and cognitive disorders
 More likely to experience neglect and abuse
 Females more likely to experience adolescent
pregnancy
 Males have higher rate of incarceration
 More likely to be low birth weight or preterm with 40X
increased risk mortality compared to full-term AGA
infant
Long-term health consequences
 Increased risk premature death for mom
 Increased risk lung and cervical cancer
 Increased risk ischemic heart disease
 Increased risk suicide or suffer homicide
 Increased risk alcohol and substance abuse
Prevention of second pregnancy
 Discuss contraception at adolescent’s health visits
 Encourage use of emergency contraception
 Long-acting contraception such as Depo-Provera or
Implanon associated with lowest repeat pregnancy
rates(25% for OCPs versus 3% for Depo-Provera)
 Flexible hours to encourage teen to stay in school
 Trained personnel able to discuss the “tough”
subjects: sex, birth control, domestic violence, etc.
Omar, H.A.,Fowler A., et al: Significant reduction
of repeat Teen pregnancy in a comprehensive
Young Parent Program.J Ped Adol
Gynec(2008)21:283-7.
Comprehensive Young Parent
Program
 1386 teen mothers between ages 11-19 enrolled in
Young Parent Program University of Kentucky
 Comprehensive care for infant and her teen parent
 Flexible hours to allow teen to attend school or work
 Free of charge for non-insured teens
 Extensive contraceptive counseling at every clinic visit
 Routine telephone and mail reminders of
appointments
 Only .79% had repeat pregnancy in three years
Smoking cessation
 Pregnant women more likely to quit than non-
pregnant
 Emphasize positive results if stops smoking and
encourage family members to be supportive
 Address at every prenatal visit
 Question her on why she smokes, what triggers, etc..
 Encourage family and friends to quit with her; more
successful as a team
5 “As of smoking cessation
 Ask about smoking –amount pre and post pregnancy
 Assess her willingness to quit
 Advise her to quit
 Assist her to quit-information, pharmaceutical
options, Free and Clear
 Arrange followup
 “Y-Not –Quit”
Post delivery
 Encourage patient to use effective long-term
contraception- IUD, Implanon, Depo-Provera
 Assess for signs post-partum depression
 Adequate Nutritional status especially if breastfeeding
 Encourage breastfeeding
Barriers to breast-feeding
 693 adolescents surveyed
 They compared teens who thought about breast-feeding





and ultimately chose bottle feeding to teens who chose
breast feeding
More likely to be impoverished OR 4.8
Delayed decision until end of pregnancy OR 4.6
Low support from their families OR 1.6
Less likely to believe bottle feeding healthier for infant OR
0.3
More likely to cite barriers when returning to work or
school OR 2.0
Wiemann CM, et al. Strategies to promote breastfeeding among adolescent mothers. Arch Pediatr
Adolesc Med. 1998 Sept;152(9): 862-9.
Breast-feeding
 Adolescents have very low rate of initiation or
continuing breast-feeding
 Emphasize nutritional benefits for infant
 Emphasize weight loss to adolescent
 Increased nutritional needs to maintain her own bone
health and milk supply
 Encourage partner and family support
 Help overcome perceived barriers when returning to
school or work