Adolescent pregnancy

• Alternative Names

  Teenage pregnancy; Pregnancy - teenage

• Causes, incidence, and risk factors

  The rate of adolescent pregnancy and the birth rate for adolescents have generally declined since reaching an all-time high in 1990, mostly due to the increased use of condoms.

  Adolescent pregnancy is a complex issue with many reasons for concern. Younger adolescents (12 - 14 years old) are more likely to have unplanned sexual intercourse and more likely to be coerced into sex. Adolescents 18 - 19 years old are technically adults, and half of adolescent pregnancies occur in this age group.

  Risk factors for adolescent pregnancy include:

  • Younger age
  • Poor school performance
  • Economic disadvantage
  • Single or teen parents
• Symptoms

  Pregnancy symptoms include:

  • Abdominal distention
  • Breast enlargement and breast tenderness
  • Fatigue
  • Light-headedness or actual fainting
  • Missed period
  • Nausea/vomiting
  • Frequent urination
• Signs and tests

  The adolescent may or may not admit to being involved sexually. If the teen is pregnant, there are usually weight changes (usually a gain, but there may be a loss if nausea and vomiting are significant). Examination may show increased abdominal girth, and the health care provider may be able to feel the fundus (the top of the enlarged uterus).

  Pelvic examination may reveal bluish or purple coloration of vaginal walls, bluish or purple coloration and softening of the cervix, and softening and enlargement of the uterus.

  • A pregnancy test of urine and/or serum HCG are usually positive.
  • A pregnancy ultrasound may be done to confirm or check accurate dates for pregnancy.
• Treatment

  All options made available to the pregnant teen should be considered carefully, including abortion, adoption, and raising the child with community or family support. Discussion with the teen may require several visits with a health care provider to explain all options in a non-judgmental manner and involve the parents or the father of the baby as appropriate.

  Early and adequate prenatal care, preferably through a program that specializes in teenage pregnancies, ensures a healthier baby. Pregnant teens need to be assessed for smoking, alcohol use, and drug use, and they should be offered support to help them quit.

  Adequate nutrition can be encouraged through education and community resources. Appropriate exercise and adequate sleep should also be emphasized. Contraceptive information and services are important after delivery to prevent teens from becoming pregnant again.

  Pregnant teens and those who have recently given birth should be encouraged and helped to remain in school or reenter educational programs that give them the skills to be better parents, and provide for their child financially and emotionally. Accessible and affordable child care is an important factor in teen mothers continuing school or entering the work force.

• Expectations (prognosis)

  Having her first child during adolescence makes a woman more likely to have more children overall. Teen mothers are about 2 years behind their age group in completing their education. Women who have a baby during their teen years are more likely to live in poverty.

  Teen mothers with a history of substance abuse are more likely to start abusing by about 6 months after delivery.

  Teen mothers are more likely than older mothers to have a second child within 2 years of their first child.

  Infants born to teenage mothers are at greater risk for developmental problems. Girls born to teen mothers are more likely to become teen mothers themselves, and boys born to teen mothers have a higher than average rate of being arrested and jailed.

• Complications

  Adolescent pregnancy is associated with higher rates of illness and death for both the mother and infant. Death from violence is the second leading cause of death durig pregnancy for teens, and is higher in teens than in any other group.

  Pregnant teens are at much higher risk of having serious medical complications such as:

  • Placenta previa
  • Pregnancy-induced hypertension
  • Premature delivery
  • Significant anemia
  • Toxemia

  Infants born to teens are 2 - 6 times more likely to have low birth weight than those born to mothers age 20 or older. Prematurity plays the greatest role in low birth weight, but intrauterine growth retardation (inadequate growth of the fetus during pregnancy) is also a factor.

  Teen mothers are more likely to have unhealthy habits that place the infant at greater risk for inadequate growth, infection, or chemical dependence. The younger a mother is below age 20, the greater the risk of her infant dying during the first year of life.

  It is very important for pregnant teens to have early and adequate prenatal care.

• Calling your health care provider

  Make an appointment with your health care provider if you have symptoms of pregnancy.

  Your health care provider can also provide counseling regarding birth control methods, sexually transmitted disease (STD) prevention, or pregnancy risk.

• Prevention

  There are many different kinds of teen pregnancy prevention programs.

  Abstinence education programs encourage young people to postpone sexual activity until marriage, or until they are mature enough to handle sexual activity, and a potential pregnancy, in a responsible manner.

  Knowledge-based programs focus on teaching adolescents about their bodies and their normal functions, as well as provide detailed information about contraceptives and preventing STDs. Research indicates that abstinence-only education without information about contraception does not decrease teen pregnancy rates, but knowledge-based programs do reduce rates.

  Clinic-focused programs provide easier access to information, counseling by health care providers, and contraceptive services. Many of these programs are offered through school-based clinics.

  Peer counseling programs typically involve older teens, who encourage other adolescents to resist peer and social pressures to become sexually involved. These programs tend to take a personal approach, helping teens understand their own risks. For teens who are already sexually active, peer counseling programs also provide negotiation skills for relationships and the information they need to get and successfully use contraceptives.

• References

  U.S. Teenage Pregnancy Statistics: Overall Trends, Trends by Race and Ethnicity and State-by-State Information. New York, NY: The Alan Guttmacher Institute; 2004.

  Eifenbein DS, Felice ME, Jenkins RR. Adolescent pregnancy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 117.

  Martin JA, Hamilton BE, Sutton PD, et al. Births. Final data for 2006. National Vital Statistics Reports. 2009;57(7).

  Klein JD and the committee on adolescence. Adolescent pregnancy: Current trends and issues. Pediatrics. 2005;116:281-286.

  Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health. 2008;42:344-351.

Review Date: 9/2/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.