Teenage pregnancy in perspective

Cognitive and Motor Development in Infants of Adolescent Mothers: A Longitudinal Analysis

A longitudinal study of cognitive and motor development among infants born to adolescent mothers was conducted with 58 adolescent mothers and a control group of 59 adult mothers. The experimental and control groups were matched on race (white/black), parity, prenatal care, and SES. Data were obtained on antepartum, delivery, and postpartum performance of the mothers, along with data on infant status within each maternal group. Additionally, infants from each maternal group were followed longitudinally over the first year of life. Measures of infant mental and motor development test performance on the Bayley Scales of Infant Development were obtained at six and 12 months of age. The HOME Inventory was also used to obtain ratings of the infant home environment at six and 12 months of age. No differences were observed in the incidence of infant or maternal complications between the adolescent and adult maternal groups. However, birthweight, cesarean section, and labor and delivery complications were significantly related to race, with black subjects experiencing less favorable outcomes on these variables. Infants born to adolescent mothers scored significantly lower on the Mental Development Index of the Bayley relative to controls. Black infants also performed significantly lower on this Index compared to white infants. Home environments of infants born to adolescents were found to be significantly less nurturant than those of controls, and the HOME ratings for black subjects were significantly lower than those for whites.

Associations between maternal age and infant health outcomes among Medicaid-insured infants in South Carolina: mediating effects of socioeconomic factors

OBJECTIVE

The objective of this study was to investigate whether infants who are born to adolescent mothers are at greater risk for health problems than those who are born to older mothers.

METHODS

Data represent all health care encounters for infants who were born in South Carolina between 2000 and 2002 and were healthy at birth and continuously enrolled in fee-for-service Medicaid (n = 41696). We separately examined in the first and second years of life use of preventive care doctor visits, sick-infant doctor visits, emergency department visits, hospital admissions, and both emergency department visits and hospitalizations for ambulatory care-sensitive conditions. We compared these outcomes for infants of adolescent mothers (aged 11-17 years) and older mothers (aged 18-47 years), adjusting for individual characteristics of mothers and infants.

RESULTS

In unadjusted results, infants of adolescent mothers used more health care in 9 of 12 use categories. For example, in year 1, they had an average of 1.71 emergency department visits and 1.39 hospitalizations, compared with 1.26 and 1.18, respectively, for infants of older mothers. In results that were adjusted only for infant and delivery characteristics, they similarly used more services in most categories. After adjustment for either mothers' characteristics alone or those of both the infant/delivery and mothers, there was evidence that they had modestly more sick-infant doctor visits and hospital admissions in year 1 and notably more hospital admissions for ambulatory care-sensitive conditions.

CONCLUSIONS

Infants of adolescent mothers are more likely than infants of older mothers to use a variety of health care services that suggest poorer health. A considerable proportion of this greater use seems to be attributable to specific characteristics of mothers, such as socioeconomic characteristics, rather than to an inability that is common among adolescents to promote infant health or to use health care appropriately.

Young women under 16 years with experience of sexual intercourse: who becomes pregnant?

BACKGROUND

The UK has the highest rate of teenage pregnancies in western Europe. Although there is a large body of literature focusing on predictors of conception among this age group, almost all the work compares those young women who have become pregnant with their peers, regardless of whether or not their peers have experienced sexual intercourse.

OBJECTIVE

To compare 16-year-old young women who have become pregnant with their peers who also have experience of sexual intercourse, but who have not conceived.

DESIGN

Analysis of data from the baseline and follow-up surveys conducted as part of a trial of sex education.

SETTING AND PARTICIPANTS

Female school students aged 14-16 years from the East of Scotland.

MAIN RESULTS

Young age of self and partner, and non-use of contraception, all at first intercourse, are most strongly associated with pregnancy.

CONCLUSIONS

Those who engage in sexual intercourse at a relatively young age will often have had more opportunity to become pregnant than those whose sexual debut comes later. Similarly, the fact that those who use contraception at first intercourse have been less likely to conceive than those who do not could reflect the overall patterns of contraceptive use: young women who have used contraception at each occasion of intercourse will have had less chance to conceive than those who have not. Having a young partner at first intercourse suggests that, if this pattern continues, the couple may lack the resources needed to prevent a pregnancy due to the immaturity of both partners.

Denial of pregnancy as a reproductive dysfunction: a proposal for international classification systems

OBJECTIVE

To propose a new Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD) category concerning reproductive dysfunctions not caused by organic disorder.

METHODS

Forensic (n=93) and obstetrical cases (n=78) of denied and concealed pregnancies are compared and discussed.

RESULTS

Denied pregnancies occur with a ratio of 1:475 births. An overwhelming phenomenological agreement is demonstrated between obstetrical and forensic cases. The findings were similar for denial and concealment of pregnancy, probably representing two different types of reproductive dysfunction that can be classified psychosocially together under the heading "negated pregnancy".

CONCLUSIONS

Analogous to the phenomenology of "sexual dysfunctions", "reproductive dysfunctions" could be distinguished by the extraordinariness of both reproductive experience and behavior (as part of human sexuality) and psycho-physiological changes, which characterize the reproductive course of events and cause obvious suffering and interpersonal complications. It is therefore suggested to include these entities as categories in their own right under the appropriate existing headings in DSM and ICD.

Frequency of denial of pregnancy: results and epidemiological significance of a 1-year prospective study in Berlin

BACKGROUND

There has been an increasing number of reports on denial of pregnancy. However, only very few studies have involved a large number of patients. To date, no reliable calculation of this condition's general frequency, also from an epidemiological perspective, has been available.

METHODS

A prospective case sampling was performed between 1 July 1995 and 30 June 1996 in the metropolitan area of Berlin. All institutions in which deliveries have taken place were engaged. The lower limit for inclusion was the 20th week of gestation as the first physician's earliest diagnosis of pregnancy. Furthermore, the woman herself must not have had any subjective perception.

RESULTS

Recruited women were divided into three groups. Altogether 62 cases and 29 462 deliveries within the 1-year study period were valid for the frequency calculation, leading to a ratio of 1 : 475 (all cases) and of 1 : 2455 for totally unexpected births with a viable newborn (intrapartal diagnosis of the pregnancy).

CONCLUSIONS

This first prospective, population-based study has also certain epidemiological relevance. From projecting the ratio of 1 : 475 for all of Germany, approximately 1600 cases of denied pregnancies per year are diagnosed, at the earliest, from the 20th week of gestation. Totally unexpected deliveries of a viable fetus without any presumption of being pregnant with 300 projected yearly births would occur threefold more often than triplets. Occurrence of denied pregnancy seems yet to be similar across different socio-demographic conditions. The common view that denied pregnancies are exotic and rare events is no longer valid. More studies of similar design are needed.

Abortion among adolescents in Cuba

PURPOSE

To understand which adolescents in Havana, Cuba, seek abortions and reasons for pregnancy termination.

METHODS

The sample included all adolescents (n = 248) under the age of 20 years who sought pregnancy termination over a 1-month period in 1995. The participants completed a questionnaire exploring a range of issues including age of onset of sexual intercourse, pregnancy history, and reasons for pregnancy termination.

RESULTS

There was no difference in age of onset of sexual intercourse between pregnant adolescents who did and did not seek an abortion. Three fourths of all adolescents who aborted a pregnancy were students, and interruption of studies was a major reason for pregnancy termination. Other reasons included being a single mother and poor socioeconomic conditions. More than half of those who sought to terminate their pregnancy did so at a clinic outside of the community in which they lived.

CONCLUSION

As in other countries, in Cuba, concerns over education interruption remain the predominant reason for abortion. Likewise, while abortion has been legal and widely available in Cuba since 1969, there remains sufficient stigma so that over half of young women seek pregnancy termination outside their community of residence.

Colostrum composition in adolescent mothers

Colostrum of high and low (LSEL) socioeconomic level adolescent mothers was analyzed to determine the potential influence of adolescence on colostrum's chemical composition. Concentrations of total fat, energy, total protein, immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin G and fatty acids were compared to those of adult mothers. The colostrum of adolescent mothers showed significantly higher levels of IgA and IgM compared to that of adults. Concentrations of lauric, myristic, and palmitic acids were lower in the group of LSEL adolescents, when compared to those of adult mothers of the same socioeconomic level, probably due to lower lipogenic activity in the former. High levels of stearic and oleic acids were found in LSEL adolescents in comparison to LSEL adults, despite similar dietary habits. Our results show that breast-feeding by adolescent mothers of any socioeconomic level is as indicated as that by adult mothers.

Pregnancy outcomes among adolescent and older women receiving comprehensive prenatal care

This study compares three birth outcomes, gestational age, birthweight, and type of delivery, among adolescent and older mothers. Data were collected from 911 women who attended a comprehensive prenatal-care program in a large urban teaching hospital. Women aged 13-19 years were at increased risk for low-birth-weight babies (less than 2500 g) and for preterm infants of fewer than 38 weeks gestation, even with antenatal care, ethnicity, and other factors controlled. Results of bivariate analyses suggested that women aged 20-36 years are more likely than adolescent mothers to have a cesarean section; however, multivariate analyses suggested that maternal age was not an important factor in relation to type of delivery. Thus, even with similar comprehensive care, pregnant adolescents were at an increased risk of some adverse outcomes. However, the amount of antenatal care is a more important predictor of pregnancy outcome than is maternal age.