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Health Topic:  ADOLESCENT PREGNANCY

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ADOLESCENT PREGNANCY


  DESCRIPTION
 
Adolescent pregnancy is pregnancy in a woman age 19 or younger.  Adolescent pregnancy is the result of sexual activity at an early age and the nonuse or improper use of contraceptives.
 
  OVERVIEW
 
In the United States, adolescent pregnancy rates have been declining for the past 50 years, but are still much higher than in other industrialized countries.  About half of adolescent pregnancies result in live births.  Most of the pregnancies are unintended, and many are voluntarily terminated.  Teenage girls who are at greatest risk of becoming pregnant often have matured early and are antisocial.  Other risk factors for adolescent pregnancy include:

  *    Residence in homes that have parental instability
*    Maternal history of early motherhood, by age 19
*    Lower socioeconomic status
*    Early dating and initiation of sexual activity
*    Use of alcohol, drugs, or tobacco
*    School dropout
*    Few friends and no support group
*    Not involved in school, family, or community activities
*    No perception of an opportunity for success
*    School or community where early childbearing is common and acceptable
*    Victim of sexual assault or abuse
 
Adolescent pregnancy usually occurs to girls who have been in relationships for 6 months or more but are not married.  The girl's pregnancy does not usually lead to marriage.  The father may have started another sexual liaison during the pregnancy, but will often be present in the delivery room, or visit the mother and baby in the hospital.  As the child grows, the father often decreases his involvement with the mother and child and becomes more involved with other sexual partners.

  CLINICAL PRESENTATION
 
Adolescents have normal symptoms of pregnancy, such as morning sickness, swollen tender breasts, weight gain, and amenorrhea, but the symptoms are often vague.  The adolescent may not admit to being sexually active.  Headache, fatigue, and abdominal pain are common.  Scanty or irregular menses may make it difficult for the adolescent to know if she is pregnant.  Pregnancy is the most common diagnosis when an adolescent has secondary amenorrhea.

  DIAGNOSIS
 
Many adolescent girls will deny any sexual activity or menstrual irregularities, even though they have asked to see the healthcare provider.  Diagnosis of pregnancy can be made from the usual signs of an enlarged uterus, cervical cyanosis, soft uterus or soft cervix.  A pregnancy test positively confirms the pregnancy, along with all the signs and symptoms of pregnancy.

  MANAGEMENT
 
The adolescent should be informed that her pregnancy will be kept confidential, but must be encouraged to talk with her parents or a trusted adult.  The healthcare provider should give the adolescent the options available to manage the pregnancy, including abortion and adoption.  The pregnant teen is often in denial, is fearful and indecisive.  For these reasons she may not want to talk with her parents or another adult.

If the adolescent decides to go through with the pregnancy, prenatal care is of utmost importance.  As many as 20% of girls under 15, and 12% of all teenagers receive only third trimester care or no prenatal care at all.  The adolescent needs strong encouragement to continue to obtain the care necessary for an uneventful pregnancy and delivery.

The pregnant adolescent needs to follow the healthy behaviors of older pregnant women.  This includes avoiding (and stopping, if necessary), use of alcohol, drugs and tobacco; adequate nutrition, adequate sleep and appropriate exercise.  The pregnant adolescent may need guidance in terminating unhealthy behaviors.  Information and guidance on caring and providing for an infant should be provided, in addition to the work and responsibility that is required in caring for an infant.

Education about the importance of getting adequate nutrition, exercise and sleep is essential.  The teen needs to be encouraged to stay in school, and strongly encouraged to resume school once she has delivered.  Some schools provide a school for teen mothers, where childcare is also offered.  An education or specific job training will help the teen to have a better job in the future, and able to support her child.

  POTENTIAL COMPLICATIONS/RISKS
 
The pregnant adolescent is not emotionally or physically ready to have a healthy baby.  For this reason, there is an increased risk of medical complications including: maternal problems such as toxemia, dystocia (abnormal or difficult labor), and hypertension; and newborn problems such as prematurity and low birth weight.  Many of these complications are the result of little or no prenatal care and poverty.

Depression is common, occurring in nearly half of adolescent mothers.  It may be associated with low self-esteem, poor achievement, and increased substance abuse.  This risk is compounded, in the young mother, as there may be negative maternal-child interactions, with resulting behavioral abnormalities such as disruptive behavior in young children.

Infants born to adolescent mothers are at risk of cognitive and behavioral problems.  About 10% of these children will be diagnosed with mental retardation. 

These infants have an increased risk of death from intentional injury.  This is a risk for any infant born into poverty, especially when there are increased social stressors, unrelated caretakers, unrealistic expectations of child behavior, substance abuse, unemployment, and low parental education.  The infant of a teenage mother has a three to six times risk of being a victim of homicide, with the greatest risk in the first three months.

Adolescent mothers often are authoritative and punitive when disciplining their children.  They may be distracted from their children by their own needs.  They may also have unrealistic expectations of normal child development, or may over estimate their infant's developmental stage.
 
Thirty percent of teenage mothers become pregnant again within two years of delivery of the first child.  A large number of these repeat pregnancies are terminated.  The second child of a teenage mother has a higher risk than the first child of prematurity, infant homicide, and early death.

Having a first child in adolescence is more likely to lead to increased childbearing and more births.  The adolescent mother is less likely to receive financial assistance from the biological father.  She usually does not finish her education or have a vocation meaning that she is less likely to be financially independent enough to provide for herself and her infant.  Divorce is more likely for married adolescent mothers than those who postpone pregnancy until their 20's.

  PREVENTION/SCREENING
 
Teenage girls who are more likely to avoid pregnancy have scholastic achievement, higher socioeconomic class, an intact family, and attend religious services.  Children may avoid adolescent pregnancy if they have parents who maintain a strong close relationship from an early age.  Other ways parents can be influential with their children include:

  *    Being clear about their (the parents) sexual values and attitudes
*    Having age appropriate conversations with children about sex
*    Supervising and monitoring children and adolescents
*    Knowing children's friends and their families
*    Discouraging early, frequent or steady dating
*    Setting a maximum two to three year age difference on boys the girl may date
*    Helping children to set goals for their future, and options that are available
*    Encouraging and supporting education, including higher education
*    Knowing what the children are watching, reading and listening to
 
The reduction in adolescent pregnancy rates has been attributed to an increase in contraceptive use at first intercourse.  One of the reasons for the increase use of contraceptives is the long-lasting contraceptives such as the injectable depo-medroxyprogesterone and levonorgestrel implants.  Contraceptive counseling immediately following delivery, or even before the teen delivers may deter future unwanted pregnancies.

Many programs have been used to lower the rate of adolescent pregnancy.  It is suggested that a combination program works best.  A combination program consists of sexuality education paired with youth development activities at an early adolescent age.  Some programs may focus on abstinence until marriage, or at least until mature the adolescent is mature enough to handle sexual activity and a potential pregnancy in a responsible manner.  Other programs are knowledge based so the adolescent learns about her body and the normal functions in addition to contraceptive information, clinic programs provide information counseling from healthcare providers about contraceptives, and peer programs involve older respected teenagers who help the younger teen to resist peer and social pressures to become sexually active.

Secondary prevention refers to preventing a second pregnancy to an adolescent mother.  Programs that are successful are long-term programs that provide services for both the mother and the child.  These programs follow adolescent mothers and their children for two years or more, and some include the fathers in their services.

  REFERENCES/BIBLIOGRAPHY
 
Behrman. (2004). Nelson textbook of pediatrics. (17 th ed.). Retrieved October 29, 2003 from www.mdconsult.com

Committee on Adolescence, 2000-2001. (2001, February). Care of adolescent parents and their children. Pediatrics. 107(2). Retrieved September 28, 2003 from www.mdconsult.com

National Institutes of Health. MEDLINEplus Health Information. (2002, January 21). Medical Encyclopedia: Adolescent pregnancy. Retrieved February 5, 2004 from www.nlm.nih.gov

Woodward, L. (2003, March). There is no evidence that primary prevention programs reduce unintended teenage pregnancies. Evidence-based Healthcare: A Scientific Approach to Health Policy. 7(1). Retrieved February 5, 2004 from www.mdconsult.com

Elfenbein, D. S. & Felice, M.E. (2003, August). Adolescent pregnancy. Pediatric Clinics of North America. 50(4). Retrieved February 5, 2004 from www.mdconsult.com

National Institutes of Health. MEDLINEplus Health Information. (2005, March 29). Medical Encyclopedia: Adolescent pregnancy. Retrieved October 17, 2005 from www.nlm.nih.gov

Nemours Foundation. (2005, August). When your teen is having a baby. Retrieved October 17, 2005 from kidshealth.org

American College of Obstetricians and Gynecologists (ACOG). (2004-2005). Especially for teens: Having a baby. Retrieved October 17, 2005 from www.medem.com


Orig. Date: 5/93
Rev. Date: 2/01, 2/04, 10/05
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