However, it is important to note that not all teen pregnancies are unplanned. In fact, the Millennium Cohort Study suggested 15% of teens planned their pregnancy (Bradshaw 2006). Similarly, a Canadian study found that 15% of adolescents presenting to an abortion clinic had initially intended to conceive (Goltset al. 2003), while 33% of teens presenting to youth pregnancy clinic reported a desire to become pregnant (Kives and Jamieson 2001). Efforts to promote and offer effective contraception for this group of teens would not have prevented these pregnancies (Black et al. 2012).
Abortion
In 2011, 21% of all pregnancies in the USA ended in abortion [5]. In 2014, 12% of the US abortions were in teenagers: 8%, 3%, and <0.2% in the 18–19 years, 15–17 years, and <15 years age groups, respectively [5]. In 2011, the abortion rate in the 15–19 years was 13.5/1000 women, a significant decrease since its peak in 1988 (Fig. 17.2) (Kost and Isaac 2016).
Fig. 17.2
US Abortion Rates (15–19 years) 1973–2011 (Kost and Isaac 2016)
Many reasons may explain this decline, including an increase in effective contraception utilization and a decrease in the unintended pregnancy rates [6].
In Canada , a decline was also seen in the abortion rate to teens (age 15–19) reaching 14.7/1000 women in 2010 compared to 19.4 in 2001 [4].
Adoption
Adoption rates have also seen a steady and continuous decline since the 1960s. Less than 5% of US pregnant teens chose adoption [7]. This important reduction is most likely explained by the legalization of abortion and greater social acceptance of nonmarital childbearing and family support programs. Also, the fall in teen pregnancy rates over the last 15 years is likely a contributor [7].
Risk Factors
There are many risk factors for a teen to become pregnant. Young women living in poverty, experiencing violence, and having lower educational attainment are particularly at risk. [8]. Teens with earlier sexual debut and more lifetime sexual partners are also associated with increased risk of pregnancy [9]. Other risks include girls who are part of ethnic minority groups, as well as those with mental health problems [10].
In addition, teens who use drugs and alcohol, have low self-esteem, and experience significant peer pressure to engage in sexual activity are at significant risk. Finally, youth who lack access to contraception or do not correctly or consistently use reliable methods of contraception will have a higher likelihood of experiencing an unintended pregnancy (Black et al. 2012).
Conversely, close family relationships, religious beliefs, knowledge of sexuality, strong academic performance, and involvement in extracurricular activities appear to be protective against early sexual activity (Black et al. 2012), hence unintended pregnancy.
Presenting Symptoms of Teen Pregnancy
Teens are highly fecund and have a 90% likelihood of becoming pregnant within a year without using contraception [3].
They can present with a variety of symptoms such as abdominal pain, nausea, vomiting, vaginal bleeding, amenorrhea, and irregular periods [10]. One should have a low threshold for pregnancy testing in this age group.
In addition, it is important to ensure that the teen is not a victim of sexual abuse or sexual exploitation, especially in the preteen and early teen years [11].
Pregnancy Options
Every teen should have access to counseling regarding their pregnancy options [8]. It is important to discuss every option in a clear, concise, and nonjudgmental manner, with complete up-to-date information provided on all the available options to the patient and other concerned persons [12, 13]. Three options are available [12, 13] :
- 1.
Parenting: Carrying the pregnancy to delivery and raising the baby
- 2.
Adoption: Carrying the pregnancy to delivery and placing the baby for adoption
- 3.
Termination of pregnancy
Every healthcare provider (HCP) should be familiar with the laws in their state or country and available services in their community to provide the best counseling to their patients.
Decision-Making in Teens
Taking a decision about the future of the pregnancy can be a difficult moment for the pregnant teen. It is possible that they may not have all the necessary cognitive abilities, due to normal development process, to make a rational decision (Loke and Lam 2014). They frequently turn to their partner and also their mother for support (Loke and Lam 2014). To make their decision, teens take into account multiple factors, such as their relationship with their boyfriend, family advice/support, practical considerations, their personal values, and their views on adoption (Loke and Lam 2014). Bender elaborated a model of decision-making in an unplanned pregnancy. The five stages include acknowledging the pregnancy, formulation of alternative outcomes , consideration of options, commitment to one choice, and finally adhering to the decision. Ambivalence is an important but normal process in teens [14].
Parenting
Being pregnant in the teenage years involves risks for the young mother, and these risks can be potentiated by multiple social aspects frequently encountered in teen pregnancy. Generally, teen pregnancies have higher maternal, obstetrical, and neonatal risks, those being higher in younger girls (≤15 years) [8].
Pregnant teens are more likely than their nonpregnant peers to have lower educational attainment, to drop out of school, and to have a lower socioeconomic status which can perpetuate the cycle of poverty [8, 10]. Furthermore, their children are also more likely to have lower educational attainment, to grow up in a single mother household, to be involved in alcohol and drugs, and to become pregnant as a teen themselves [8].
Indeed, poverty, lower educational level, and inadequate family support contribute to the adverse health outcomes in the pregnant mother and her child [11].
In addition, stigmatization of teenage mothers is frequently seen. Indeed, 40% of teen moms feel stigmatized by their pregnancy. Some are more likely to suffer such as those who are unmarried, are socially isolated, have aspirations to finish college, and experience verbal abuse and family criticism [10].
Even though there may be several negative consequences, other protective factors have been associated with improved outcomes in teen mothers: optimal social support, completing the education before getting pregnant, being part of programs for teen mothers, and continuing school without a repeat pregnancy in the 24 months after a pregnancy [11]. Indeed, family factors are important to optimize the outcomes for the mother and her child. These include early child care provided by the family of the baby, support that allows the teen mother to complete school, lively and adequate interaction between the child and father, and stable relationships [11]. Paternal involvement is important, as there are multiple benefits for the child [10].
Prenatal Care
Many studies have described that teens delay accessing prenatal care services [8]. Reasons vary but include ambivalence toward their pregnancy options, late diagnosis, desire to hide the pregnancy, fear of apprehension of their child, being victims of violence, and being unaware of the importance of prenatal care. Other reasons include concerns with judgmental attitudes of healthcare providers and financial barriers [8]. However, prenatal care for teens is of utmost importance as a lack or delay in care is associated with adverse maternal, obstetrical, and neonatal outcomes [8]. In addition, multidisciplinary teen-focused prenatal care leads to better outcomes than traditional prenatal care, such as reduction in preterm birth (PTB), low birth weight (LBW) and neonatal intensive care unit (NICU) admission, increase in spontaneous vaginal delivery, and reduction in operative delivery rates [8]. Furthermore, these specialized programs have the potential to lead to significant healthcare cost savings by reducing these complications.
There are specifics elements that should be considered in teen pregnancy (Table 17.1), including the adverse perinatal outcomes (Table 17.2).
Elements to consider | Facts | Adverse outcomes | Prevention and treatment |
|---|---|---|---|
Sexually transmitted infections | Less likely to use condoms Prevalence of chlamydia at initial visit 11.1–31% High recurrence rate during the pregnancy (22.1%) Concomitant infections | PTB PPROM Chorioamnionitis Postpartum infection Vertical transmission/infection in neonate | Education Encouragement to use condom Screening upon presentation for prenatal care, third trimester, and postpartum Treatment and test of cure (as per national guidelines) |
Bacterial vaginosis | Teens should be considered high risk, i.e., inherently high risk of PPROM, PTL, and PTB | PTL PTB PPROM | Screening upon presentation for prenatal care, third trimester, and postpartum Treatment (as per national guidelines) |
Smoking, substance abuse, and alcohol abuse | Higher rates of smoking and substance abuse than adults Pregnancy is a powerful incentive to cut down or stop | SA PTL PROM Placenta previa Placental abruption IUGR LBW IUFD Maternal hypertension Congenital anomalies Neurobehavioral effects on baby NAS ADHD (long term) | Education Encouragement toward reduction of smoking, substance abuse, and alcohol consumption Cessation programs Routine and repeat screening |
Violence and coercion | Increased risk of violence (1.8 times) IPV in pregnant teens is between 26 and 31% At risk of sexual coercion | Late prenatal care LBW PTB IUFD Postpartum depression | Routine and repeat screening Questions about all types of violence (sexual, physical, psychological)
 Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
|