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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 breast-
feeding
 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 breast-
feeding 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