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The adolescent pregnancy- risks and complications

The adolescent pregnancy- risks and complications. 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

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The adolescent pregnancy- risks and complications

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  1. The adolescent pregnancy- risks and complications Brenda Dawley M.D.

  2. Why high –risk? • Unplanned • Unwanted • Substance abuse • Lack prenatal care • Increased risk certain pregnancy complications

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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”

  13. 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 breast-feeding • Encourage breastfeeding

  14. 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 breast-feeding among adolescent mothers. Arch Pediatr Adolesc Med. 1998 Sept;152(9): 862-9.

  15. 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

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