Brenda Dawley M.D.

Why high –risk? Unplanned Unwanted Substance abuse Lack prenatal care Increased risk certain pregnancy complications

Unplanned 78% pregnancies for age 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):

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 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 Sept;152(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