A proposal for obstetric and pediatric management of adolescent pregnancy

Gynecologic age is an important risk factor for obstetric and perinatal outcomes in adolescent pregnancies

BACKGROUND

Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity.

AIM

To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA.

METHODS

In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA≤3 years (101 women) and GA>3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period.

FINDINGS

Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA>3 years, adolescent pregnancies with GA≤3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU.

CONCLUSION

Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications.

[Teenage pregnancy and delivery: 276 cases observed at the Brazzaville University Hospital, Congo]

OBJECTIVE

To study sexuality, pregnancy and delivery in female teenagers.

MATERIALS AND METHODS

Cross-sectional prospective study from January 1(st), 1997 to May 31(st), 1998 concerning 276 female teenagers. The studied features were compared with a control group of 300 women aged more than 18 years chosen at random.

RESULTS

Among 5204 women who delivered during the study period, 5.30% were teenagers. Their mean age was 14 years five months; 84.06% were single; 2.90% were married and 13.04% were concubines. Analysis of social background showed that 41.66% had attended school, 51.10% had dropped out, and 7.24% were illiterate. Mean age at first sexual intercourse was 13 years 9 months. Only 14.13% practised contraception, none used a condom. Mean term of the first prenatal consultation was 26 weeks gestation. Predominant pathological conditions observed during pregnancy were infections, anemia and complications of high blood pressure. Mean term at delivery (generally vaginal) was 38 weeks gestation. The rates of perinatal mortality and referral to the department of neonatology were higher than in the control population.

CONCLUSION

Risk remains high for teenage pregnancy. Reduction of complication requires combined medical, psychological and social management.

Teen-focused care versus adult-focused care for the high-risk pregnant adolescent: an outcomes evaluation

The purpose of this retrospective, matched-case comparison study was to compare outcomes and cost-effectiveness of comprehensive, interdisciplinary teen-centered prenatal care clinics (Young Women's Clinic & Teen Pregnancy and Parenting Clinic) with "traditional" adult-centered obstetric services (University of Washington Medical Center & Group Health Cooperative) in a university medical center and a staff-model HMO. The sample (n = 106) included 27 index teens from Young Women's Clinic and matched cases from the other three clinics, matched on nine risk variables. Findings showed that teen-clinic clients missed fewer appointments (0.96 vs. 2.29, p < 0.05), were more likely to be enrolled in the supplemental Medicaid program First Steps (p < 0.001) and WIC (p < 0.01), were more likely to have vaginal deliveries (90% vs. 75%, p < 0.05) and higher birth weight infants (3330 vs. 3084 g, p < 0.05), and were more likely to attend 2-week (p < 0.001) and 6-week postpartum exams (p < 0.05). Postpartum data were missing for the majority of adult-clinic subjects; teen-clinic postpartum outcomes included high contraception rates (87.5%), breastfeeding (62%), school return postpartum (63%), and long-term follow-up. Costs were lower for teen clinics based on outcomes; cost savings related to preterm labor were similar.

Levonorgestrel contraceptive implants in female patients 14 to 21 years old

OBJECTIVE

To determine which factors are associated with duration of use of a levonorgestrel implant (Norplant) for contraception in adolescents and young adults.

DESIGN

We retrospectively studied 144 young women (14 to 21 years of age) who chose a levonorgestrel contraceptive implant at Mayo Clinic Rochester between April 1990 and December 1993.

MATERIAL AND METHODS

The following information was obtained at the time of insertion of the implant and from any follow-up visits: demographics, prior contraceptive experiences, frequency and management of complications, complications noted at removal of the implant, and subsequent contraceptive choice. The duration of use was examined.

RESULTS

Of the 144 young women who underwent insertion of a Norplant system, 75 telephoned or made a medical appointment because of implant-related side effects. During the follow-up period, 64 patients had the Norplant system removed. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83 % and for at least 24 months was 63 %. Duration of Norplant use was not found to differ with respect to age, prior contraceptive use, or timing of insertion, but it was significantly shorter among those with a prior pregnancy than in those who had never been pregnant.

CONCLUSION

These findings suggest that a group of young women who are likely to continue use of a contraceptive implant (with or without treatment for side effects) are those who have never been pregnant.

Young Moms' Clinic: a multidisciplinary approach to pregnancy education in teens and in young single women

STUDY OBJECTIVE

To study outcome of pregnant adolescents and single young women who attended and those who chose not to attend a nonurban, developmentally appropriate, pilot antenatal clinic called the "Young Moms' Clinic." To study "perceived" outcome among the Young Moms' Clinic participants.

METHODS

A multidisciplinary clinic was established to provide education about pregnancy, childbirth, infant care, contraception, and healthy lifestyles to young mothers with similar backgrounds. Over a 2-year period, all adolescents and single young mothers aged 13-23 years were invited to attend the Young Moms' Clinic after the first trimester. The Clinic group consisted of the first 101 young women who were invited and chose to attend. The nonclinic group consisted of the first 95 young women who were invited but declined to attend. Both groups had the same obstetric care givers, had a similar number of prenatal visits (median number, 12), and delivered in the same hospital. Univariate and multivariate analyses were performed to determine whether participation in the clinic was an independent factor in outcome.

RESULTS

Maternal weight gain and infant birth weight were significantly higher in the Clinic group. Pregnancy complications (preterm labor, intrauterine growth retardation, anemia) were significantly higher in the nonclinic group. Participants in the nonclinic group were almost three times as likely to have cesarean section delivery as those in the Clinic group. Neonatal intensive care unit transfer occurred only in infants of the control group.

CONCLUSIONS

Participation of pregnant adolescent and young adult women from a nonurban community in a developmentally targeted pilot, prenatal program resulted in fewer pregnancy complications and improved outcome in comparison with those who chose not to participate in the program. The results may be subject to bias because of self-selection among participants.

Mental health of adolescent mothers

OBJECTIVE

To propose an assessment and intervention model for adolescent mothers that evaluates the influence of physical, cognitive, affective, and interpersonal development on such areas of psychological dysfunction as unprotected sexual activity, substance abuse, and psychopathology.

METHOD

More than 100 studies were reviewed to identify correlations between discrete developmental events and evidence of psychological dysfunction in adolescent mothers.

RESULTS

The adolescent's nascent developmental skill in one domain of functioning (e.g., cognitive) frequently exerts a synergistic effect on other areas of functioning (e.g., affective). This synergy increases the likelihood of psychological dysfunction. In turn, psychological dysfunction affects the emerging relationship between the adolescent mother and her infant.

CONCLUSION

The interaction between the nascent developmental status of the adolescent caregiver and her psychosocial environment enhances the probability of a maladaptive exchange between mother and infant. A model designed to overcome the adolescent's developmental limitations and promote adaptive interaction with the infant may avert dyadic interpersonal failure.

Adolescent pregnancy: an intervention challenge

Even in the best of circumstances, pregnancy is a time of emotional upheaval. This is especially true for pregnant adolescents who are also attempting to adjust to pubertal status and to establish an identity independent from their family. Although research has focused on the etiology of teenage pregnancy, relatively few interventions consider the developmental obstacles encountered when treating pregnant teenagers. In particular, adolescents are cognitively unprepared to predict long-term outcomes, a skill essential for confronting the challenges of pregnancy. One new intervention, known as previewing, seeks to overcome this deficit. Previewing encourages expectant teenage mothers to represent future scenarios with the infant as a means of predicting and rehearsing adaptive outcomes.