The adolescent pregnancy

1. The adolescent pregnancy 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% 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

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%)

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 and long-acting forms contraception • Comprehensive appointment with flexible hours; multidisciplinary approach • Follows mother and child to age 5 • Financial incentive: free contraception and visits • <1% repeat pregnancy rate in 3 years 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. 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..

11. 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

12. Post delivery • Encourage patient to use effective contraception- IUD, Implanon, Depo-Provera lower failure rate • Assess for signs post-partum depression • Nutritional status especially if breast-feeding

13. 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