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Adolescent pregnancy

Definition

Adolescent pregnancy is pregnancy in girls age 19 or younger.

Causes, incidence, and risk factors

The rate of adolescent pregnancy has steadily declined since reaching an all-time high in 1990, mostly due to an increase in the use of condoms. In fact, the birth rate among girls ages 10-14 has fallen to the lowest level in almost 50 years.

Since no form of contraception is completely effective, abstinence (not having sexual intercourse) is the only sure way to prevent pregnancy. A sexually active teenager who does not use contraception has a 90% chance of becoming pregnant within a year.

Why teenagers have sex, and do so without effective methods of contraception, is a topic of debate. Suggested reasons include:

Adolescents become sexually mature (and fertile) approximately 4-5 years before they reach emotional maturity.
Adolescents today are growing up in a culture in which peers, TV and movies, music, and magazines transmit subtle and obvious messages that unmarried sexual relationships (specifically those involving teenagers) are common, accepted, and even expected.
Education about responsible sexual behavior and specific, clear information about the consequences of sexual intercourse (including pregnancy, sexually transmitted diseases, and psychosocial effects) are frequently not offered. Therefore, much of the "sex education" that adolescents receive filters through misinformed or uninformed peers.

When compared with other industrialized nations, the United States has the highest rates of pregnancy, abortion, and childbirth among teenagers, despite similar or higher rates of sexual activity in the other countries.

Teens are more likely to become pregnant if they:

Begin dating early (dating at age 12 is associated with a 91% chance of being sexually involved before age 19, and dating at age 13 is associated with a 56% probability of sexual involvement during adolescence)
Use alcohol and/or other drugs, including tobacco products
Drop out of school
Have no support system or have few friends
Lack involvement in school, family, or community activities
Think they have little or no opportunity for success
Live in a community or attend a school where early childbearing is common and viewed as normal rather than as a cause for concern
Grow up in poverty
Have been a victim of sexual abuse or assault
Have a mother who was 19 or younger when she first gave birth

Symptoms

Pregnancy symptoms include:

Missed period
Fatigue
Breast enlargement and breast tenderness
Abdominal distention
Nausea/vomiting
Light-headedness or actual fainting

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 fundus (the top of the enlarged uterus) may be palpable.

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 reviewed thoroughly.

Abortion is a potential option, but state laws vary regarding whether an unmarried teen can get an abortion legally without parental consent. In the case of married teens, the husband's consent may be required. Giving the infant up for adoption is another option.

The the majority of pregnant teens choose to continue their pregnancies and keep their infants.

Early and adequate prenatal care, preferably through a program that specializes in teenage pregnancies, ensures a healthier baby. Smoking, alcohol use, and drug use should be strongly discouraged, and support should be offered to help the teen stop such behaviors.

Adequate nutrition must be encouraged through education and community resources. Appropriate exercise and adequate sleep should also be emphasized. Contraceptive information and services are important, following delivery, to deter 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 targeting skills that will enable them to provide for their child financially, emotionally, and with appropriate parenting. 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. Such women are also less likely to receive child support from biological fathers, less likely to complete their education, and less likely to establish independence and financial security that enables them to provide for herself and her children without outside assistance.

Married teen mothers are more likely to get divorced than married women who postpone childbearing until their 20s.

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.

Pregnant teens are at much higher risk of dying or having serious medical complications such as toxemia, pregnancy-induced hypertension, significant anemia, premature delivery, or placenta previa.

Infants born to teens are 2 to 6 times more likely to have low birth weight than those born to mothers age 20 or older. Prematurity plays the greatest role in this, 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 symptoms of pregnancy occur.

Your health care provider can also provide counseling regarding birth control methods or pregnancy risk.

Prevention

There are many different kinds of teen-pregnancy prevention programs.

Abstinence education programs encourage postponing sexual involvement until marriage or until a person is 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 normal functions as well as providing detailed information about contraceptives.

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

Peer counseling programs typically involve older and respected teens who encourage other teens to resist peer and social pressures to become sexually involved. These programs tend to take more of an experiential approach, helping teens to personalize risks. Peer counseling programs also provide, for those teens already involved in sexual activities, the skills to negotiate within relationships and the information needed to obtain 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