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Pregnancy in adolescents

Mariam R Chacko, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Charles J Lockwood, MD, MHCM
Deputy Editor
Mary M Torchia, MD


The topic of adolescent pregnancy arises in pediatric practice during discussions of sexual activity/contraception and during diagnostic evaluations for problems such as menstrual irregularities, gastrointestinal complaints, or pelvic mass. Adolescents may seek information regarding pregnancy directly from their healthcare provider. Laws regarding confidential pregnancy testing and counseling vary from state to state. (See "Confidentiality in adolescent health care" and "Consent in adolescent health care", section on 'Consent for specific services'.)

The diagnosis and early clinical management of adolescent pregnancy relevant to the pediatric healthcare provider will be discussed here. The prevention of pregnancy, contraceptive issues, and an overview of the diagnosis and clinical manifestations of early pregnancy are discussed separately. Prenatal and postpartum care, pregnancy complications, and labor and delivery issues also are reviewed separately. (See "Contraception: Issues specific to adolescents" and "Clinical manifestations and diagnosis of early pregnancy".)


The teenage birth rate in the United States declined continuously between 1991 and 2005 [1]. Although it increased transiently between 2005 and 2007, it decreased to historic lows between 2007 and 2015 (figure 1) [1], largely related to increased contraceptive use and increased use of highly effective methods of contraception [2]. (See "Contraception: Issues specific to adolescents", section on 'Choosing a method'.)

In 2015, the birth rates among teenagers aged 10 to 14 years and 15 to 19 years were 0.2 and 22.3 per 1000, respectively [1]. The overall birth rate for teenagers 15 to 19 years of age fell by 8 percent between 2014 and 2015; 9 percent for those 15 to 17 years of age and 7 percent for those 18 to 19 years of age. Adolescents with mental health symptoms or major mental illness (eg, major depression, bipolar disorder, psychotic disorders) appear to be at increased risk of pregnancy [3,4].

Approximately 10 percent of all women aged 15 to 19, and 19 percent of those who have sexual intercourse, become pregnant. Most pregnancies among teenagers are unintended [5-7]. Among 15- to 19-year-old females with unintended pregnancies resulting in live births between 2004 and 2008, 50 percent were not using any method of contraception before the pregnancy (24 percent because their partner did not want to use contraception), 31 percent believed they could not get pregnant at the time, 13 percent had trouble getting contraception, and 22 percent did not mind if they got pregnant [8]. Surveillance data from 2007-2010 indicate that nearly one in five births to teenagers 15 to 19 years in the United States of age were repeat births [9].

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Literature review current through: Oct 2017. | This topic last updated: Oct 27, 2017.
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  1. Martin JA, Hamilton BE, Osterman MJ, et al. Births: Final Data for 2015. Natl Vital Stat Rep 2017; 66:1.
  2. Lindberg L, Santelli J, Desai S. Understanding the Decline in Adolescent Fertility in the United States, 2007-2012. J Adolesc Health 2016; 59:577.
  3. Hall KS, Kusunoki Y, Gatny H, Barber J. The risk of unintended pregnancy among young women with mental health symptoms. Soc Sci Med 2014; 100:62.
  4. Vigod SN, Dennis CL, Kurdyak PA, et al. Fertility rate trends among adolescent girls with major mental illness: a population-based study. Pediatrics 2014; 133:e585.
  5. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84:478.
  6. Smid M, Martins S, Whitaker AK, Gilliam M. Correlates of pregnancy before age 15 compared with pregnancy between the ages of 15 and 19 in the United States. Obstet Gynecol 2014; 123:578.
  7. Finer LB, Zolna MR. Declines in Unintended Pregnancy in the United States, 2008-2011. N Engl J Med 2016; 374:843.
  8. Centers for Disease Control and Prevention (CDC). Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births - Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008. MMWR Morb Mortal Wkly Rep 2012; 61:25.
  9. Centers for Disease Control and Prevention (CDC). Vital signs: Repeat births among teens - United States, 2007-2010. MMWR Morb Mortal Wkly Rep 2013; 62:249.
  10. Hornberger LL, COMMITTEE ON ADOLESCENCE. Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient. Pediatrics 2017; 140.
  11. Stevens-Simon C, Roghmann KJ, McAnarney ER. Early vaginal bleeding, late prenatal care, and misdating in adolescent pregnancies. Pediatrics 1991; 87:838.
  12. Causey AL, Seago K, Wahl NG, Voelker CL. Pregnant adolescents in the emergency department: diagnosed and not diagnosed. Am J Emerg Med 1997; 15:125.
  13. Stewart F. Pregnancy testing and early management of early pregnancy. In: Contraceptive Technology, 17th ed, Hatcher RA, Trussell J, Stewart F, et al (Eds), Irwington Publishers Inc, New York 1998. p.635.
  14. Bastian LA, Piscitelli JT. Is this patient pregnant? Can you reliably rule in or rule out early pregnancy by clinical examination? . JAMA 1997; 278:586.
  15. Unger JB, Molina GB, Teran L. Perceived consequences of teenage childbearing among adolescent girls in an urban sample. J Adolesc Health 2000; 26:205.
  16. Rosengard C, Pollock L, Weitzen S, et al. Concepts of the advantages and disadvantages of teenage childbearing among pregnant adolescents: a qualitative analysis. Pediatrics 2006; 118:503.
  17. Lau M, Lin H, Flores G. Pleased to be pregnant? Positive pregnancy attitudes among sexually active adolescent females in the United States. J Pediatr Adolesc Gynecol 2014; 27:210.
  18. Stevens-Simon C, Kelly L, Singer D, Cox A. Why pregnant adolescents say they did not use contraceptives prior to conception. J Adolesc Health 1996; 19:48.
  19. Rubin V, East PL. Adolescents' pregnancy intentions: relations to life situations and caretaking behaviors prenatally and 2 years postpartum. J Adolesc Health 1999; 24:313.
  20. Wiemann CM, Rickert VI, Berenson AB, Volk RJ. Are pregnant adolescents stigmatized by pregnancy? J Adolesc Health 2005; 36:352.e1.
  21. Hornberger LL, COMMITTEE ON ADOLESCENCE. Options Counseling for the Pregnant Adolescent Patient. Pediatrics 2017; 140.
  22. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 2005; 8:77.
  23. Czeizel AE, Tímár L, Susánszky E. Timing of suicide attempts by self-poisoning during pregnancy and pregnancy outcomes. Int J Gynaecol Obstet 1999; 65:39.
  24. Wagner BM, Cole RE, Schwartzman P. Psychosocial correlates of suicide attempts among junior and senior high school youth. Suicide Life Threat Behav 1995; 25:358.
  25. Dobkin LM, Perrucci AC, Dehlendorf C. Pregnancy options counseling for adolescents: overcoming barriers to care and preserving preference. Curr Probl Pediatr Adolesc Health Care 2013; 43:96.
  26. Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014; 63:1.
  27. Pazol K, Creanga AA, Burley KD, et al. Abortion surveillance - United States, 2010. MMWR Surveill Summ 2013; 62:1.
  28. Pazol K, Creanga AA, Burley KD, Jamieson DJ. Abortion surveillance - United States, 2011. MMWR Surveill Summ 2014; 63:1.
  29. Pazol K, Creanga AA, Jamieson DJ, Centers for Disease Control and Prevention (CDC). Abortion Surveillance - United States, 2012. MMWR Surveill Summ 2015; 64:1.
  30. Jatlaoui TC, Ewing A, Mandel MG, et al. Abortion Surveillance - United States, 2013. MMWR Surveill Summ 2016; 65:1.
  31. Kost K, Maddow-Zimet I, US teenage pregnancies, births and abortions, 2011: National trends by age, race, and ethnicity. Available at: https://www.guttmacher.org/report/us-teen-pregnancy-trends-2011 (Accessed on August 17, 2017).
  32. Barbieri RL. Population density and teen pregnancy. Obstet Gynecol 2004; 104:741.
  33. Teagle SE, Brindis CD. Perceptions of motivators and barriers to public prenatal care among first-time and follow-up adolescent patients and their providers. Matern Child Health J 1998; 2:15.
  34. Debiec KE, Paul KJ, Mitchell CM, Hitti JE. Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol 2010; 203:122.e1.
  35. Cox JE. Teen pregnancy. In: Emans, Laufer, Goldstein's Pediatric & Adolescent Gynecology, 6th, Emans SJ, Laufer MR (Eds), Lippincott Williams & Wilkins, Philadelphia 2012. p.474.
  36. Hampton HL, Powell RH. Obstetrical outcome in the very young adolescent. J Miss State Med Assoc 1999; 40:411.
  37. Guttmacher Institute. Parental involvement in minors' abortions. Available at: www.guttmacher.org/sections/adolescents.php (Accessed on May 13, 2008).
  38. COMMITTEE ON ADOLESCENCE. The Adolescent's Right to Confidential Care When Considering Abortion. Pediatrics 2017; 139.
  39. Lenders CM, McElrath TF, Scholl TO. Nutrition in adolescent pregnancy. Curr Opin Pediatr 2000; 12:291.
  40. Kingston D, Heaman M, Fell D, et al. Comparison of adolescent, young adult, and adult women's maternity experiences and practices. Pediatrics 2012; 129:e1228.
  41. Bachrach CA, Stolley KS, London KA. Relinquishment of premarital births: evidence from national survey data. Fam Plann Perspect 1992; 24:27.
  42. Chandra A, Abma J, Maza P, Bachrach C. Adoption, adoption seeking, and relinquishment for adoption in the United States. Adv Data 1999; :1.
  43. Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995; 332:1113.
  44. Olausson PM, Cnattingius S, Goldenberg RL. Determinants of poor pregnancy outcomes among teenagers in Sweden. Obstet Gynecol 1997; 89:451.
  45. Rees JM, Lederman SA, Kiely JL. Birth weight associated with lowest neonatal mortality: infants of adolescent and adult mothers. Pediatrics 1996; 98:1161.
  46. Phipps MG, Blume JD, DeMonner SM. Young maternal age associated with increased risk of postneonatal death. Obstet Gynecol 2002; 100:481.
  47. Paranjothy S, Broughton H, Adappa R, Fone D. Teenage pregnancy: who suffers? Arch Dis Child 2009; 94:239.
  48. Malabarey OT, Balayla J, Klam SL, et al. Pregnancies in young adolescent mothers: a population-based study on 37 million births. J Pediatr Adolesc Gynecol 2012; 25:98.
  49. Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 Suppl 1:40.
  50. Traisrisilp K, Jaiprom J, Luewan S, Tongsong T. Pregnancy outcomes among mothers aged 15 years or less. J Obstet Gynaecol Res 2015; 41:1726.
  51. Brosens I, Muter J, Gargett CE, et al. The impact of uterine immaturity on obstetrical syndromes during adolescence. Am J Obstet Gynecol 2017; 217:546.
  52. Salihu HM, Emusu D, Aliyu MH, et al. Low maternal age and neonatal survival of extremely preterm twins (20-28 weeks of gestation). Obstet Gynecol 2004; 103:1246.
  53. Ekwo EE, Moawad A. Maternal age and preterm births in a black population. Paediatr Perinat Epidemiol 2000; 14:145.
  54. Reichman NE, Pagnini DL. Maternal age and birth outcomes: data from New Jersey. Fam Plann Perspect 1997; 29:268.
  55. Konje JC, Palmer A, Watson A, et al. Early teenage pregnancies in Hull. Br J Obstet Gynaecol 1992; 99:969.
  56. Moerman ML. Growth of the birth canal in adolescent girls. Am J Obstet Gynecol 1982; 143:528.
  57. Smith GC, Pell JP. Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study. BMJ 2001; 323:476.
  58. Olausson PO, Cnattingius S, Haglund B. Does the increased risk of preterm delivery in teenagers persist in pregnancies after the teenage period? BJOG 2001; 108:721.
  59. Siegel RS, Brandon AR. Adolescents, pregnancy, and mental health. J Pediatr Adolesc Gynecol 2014; 27:138.
  60. Lloyd T, Lin HM, Eggli DF, et al. Adolescent Caucasian mothers have reduced adult hip bone density. Fertil Steril 2002; 77:136.
  61. Otterblad Olausson P, Haglund B, Ringbäck Weitoft G, Cnattingius S. Premature death among teenage mothers. BJOG 2004; 111:793.
  62. Maynard RA. Kids having kids: economic costs and social consequences of teen pregnancy, Urban Institute Press, Washington, DC 1997.
  63. Nord CW, Moore KA, Morrison DR, et al. Consequences of teen-age parenting. J Sch Health 1992; 62:310.
  64. Wiemann CM, Agurcia CA, Berenson AB, et al. Pregnant adolescents: experiences and behaviors associated with physical assault by an intimate partner. Matern Child Health J 2000; 4:93.
  65. Harrykissoon SD, Rickert VI, Wiemann CM. Prevalence and patterns of intimate partner violence among adolescent mothers during the postpartum period. Arch Pediatr Adolesc Med 2002; 156:325.
  66. Moffitt TE, E-Risk Study Team. Teen-aged mothers in contemporary Britain. J Child Psychol Psychiatry 2002; 43:727.
  67. Assini-Meytin LC, Green KM. Long-term consequences of adolescent parenthood among African-American urban youth: a propensity score matching approach. J Adolesc Health 2015; 56:529.
  68. Lavin C, Cox JE. Teen pregnancy prevention: current perspectives. Curr Opin Pediatr 2012; 24:462.
  69. Suellentrop K. What Works 2011-2012: Curriculum-Based Programs that Help Prevent Teen Pregnancy. The National Campaign to Prevent Teen and Unplanned Pregnancy, Washington, DC, 2011.
  70. Oringanje C, Meremikwu MM, Eko H, et al. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database Syst Rev 2016; 2:CD005215.
  71. Brinkman SA, Johnson SE, Codde JP, et al. Efficacy of infant simulator programmes to prevent teenage pregnancy: a school-based cluster randomised controlled trial in Western Australia. Lancet 2016; 388:2264.
  72. Herrman JW, Waterhouse JK, Chiquoine J. Evaluation of an infant simulator intervention for teen pregnancy prevention. J Obstet Gynecol Neonatal Nurs 2011; 40:322.
  73. Kralewski J, Stevens-Simon C. Does mothering a doll change teens' thoughts about pregnancy? Pediatrics 2000; 105:E30.