Pregnancy in adolescents
- Mariam R Chacko, MD
Mariam R Chacko, MD
- Professor of Pediatrics/Adolescent & Sports Medicine
- Baylor College of Medicine
- Section Editors
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
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: Overview of 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 . Although it increased transiently between 2005 and 2007, it decreased to historic lows between 2007 and 2015 (figure 1) . 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 . 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 [2,3].
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 [4-6]. 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 . 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 .
About one in five infants born to adolescents is fathered by men five or more years older than the mother. In a large observational study, 36 percent of adolescents with first pregnancy before age 15 years and 17 percent of adolescents with first pregnancy between 15 and 19 years reported that their sexual partner was ≥6 years older than they were at the time of their first sexual encounter .
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- DIAGNOSIS OF PREGNANCY
- Physical examination
- Laboratory evaluation
- - Pretest counseling
- - Posttest counseling
- CLINICAL MANAGEMENT OF EARLY PREGNANCY
- Pregnancy counseling
- Pregnancy outcome
- - Subsequent pregnancies
- Postpartum depression
- Long-term effects
- Social impact
- INFORMATION FOR PATIENTS