There are several problems associated with teenage pregnancy including social, economic, cultural, educational and political issues. Both pregnancy and adolescence are times of emotional upheaval and when the two are combined there is need for support and counselling. When an adolescent becomes a parent her education will, at best, be delayed but more usually it will be discontinued. Her employment opportunities are reduced, her income is likely to be low, long-lasting relationships are infrequent and there is often need for prolonged welfare support. Many adolescent mothers, whilst aware of their own needs, may be less sensitive to the needs of their child.

Teenage pregnancy is becoming a serious public health problem, particularly in less developed countries where obstetric facilities are limited. Teenage pregnancies are associated with increased risks of miscarriage, premature labour, blood pressure problems (pre-eclampsia), small-for-dates babies and perinatal mortality (death of the baby before birth or in the first week of after delivery) is increased.

Prevention of unplanned pregnancy in adolescents has become an international medical priority.

 The United Kingdom has the highest rate of teen pregnancyin Western Europe.While there are plentiful figures in the literature on teen pregnancy,many of the studies are somewhat dated. Furthermore, many originatein the USA and caution is required when extrapolating this datato the UK situation. The UK government has issued a national target of halving the rate of conception in under18-year-olds by 2010. This is part of a broader government strategyfor improving sexual health in the UK. In recent years the rate of teenage conception has fallen steadilyin the USA and Europe. In 2004 the conception rate in Englandwas 41.5 per 1000 girls aged 15–17 years, representingan overall decline of 11.1% since 1998. However, the UK stillhas the highest rate of teen pregnancy in Western Europe, while the USA possesses the highest rate in the world at 43.0per 1000.

 
It is important to recognise that teen pregnancy can be apositive life choice for some young women, particularly thosefrom certain ethnic or social groups. In some South Asian ethnicgroups in the UK, rates of teen pregnancy within marriageare high. Ethnicity and culture play a role and are an important consideration for healthcare professionals.   The higher rates of teen pregnancy tend to be concentratedin inner cities and are linked to poverty. Multiple socioeconomicrisk factors have been identified.Teenagers from unskilled manual backgrounds (social class V)are 10 times more likely to become teenage mothers than thosefrom professional backgrounds (social class I). Teenagers fromsocially deprived areas are up to six times more likely to becomepregnant than teenagers from other areas and are much less likelyto opt for a termination.

 Young people scoring below average on measures of educationalachievement at ages 7 and 16 years have been found to be atsignificantly increased risk of becoming teenage parents, especiallythose whose performance declines between these ages. Wellings 2001-01  surveyed over 11000 males and females aged 16–44 years across the UK. They found that 29% of sexually activeyoung women who left school at 16 years of age without any qualificationshad a child before the age of 18 years, compared with 14% ofthose who left at 16 with qualifications and 1% of those wholeft at age 17 years or over.

 Women who were themselves children ofteenage mothers are more likely to have a teen pregnancycompared with those born to older mothers and the offspring are at risk for becoming teenaged mothers or fathers themselves. 2003-01 Girls who have had a teen pregnancy are more likely to have smoked than those who havenot conceived as teenagers. 1998-01  This is an important clinical problemas smoking compounds the potential for adverse outcomes of adolescentpregnancy, particularly intrauterine growth restriction. Thebirthweight-for-gestational-age curves of smoking adolescentsshow a marked fall-off in weight from 36 weeks of gestation. Furthermore, at least 10% of adolescent smokers have pregnanciesaffected by severe early onset (before 32 weeks of gestation) fetal growth restriction. 2006-12   Smoking during pregnancy is also known to be associated withan increased risk of placental abruption, preterm prematurerupture of membranes, preterm birth, stillbirth and sudden infantdeath syndrome. Research has shown that prenatal exposure totobacco smoke is a risk factor for respiratory infections, asthma, allergy, childhood cancer and adverse neurobehavioural development.

Teenagers may have poor eating habits and neglect to take theirvitamin supplements. They are less likely than older women tobe of adequate pre-pregnancy weight or to gain an adequate amountof weight during pregnancy. Low weight gain increases therisk of having a low birthweight baby. This is frequently compoundedby adverse social circumstances.

 While there is no evidence, to date, of medical interventionsthat can specifically improve pregnancy outcome, we must ensurethat teenage mothers receive supportive care and are directedtowards the social support they need. Smoking cessation shouldbe targeted and attendance at an antenatal clinic encouraged.In addition, effective postnatal counselling, particularly regardingcontraception, can help prevent subsequent pregnancies and STIs.

Termination of pregnancy and adoption
Teen pregnancy is often viewed as unplanned and unwanted.However, the reality is more complex. Although approximately40% of teenagers in the UK terminate their pregnancies, themajority choose to continue. Of those with a history of teen pregnancy, over 25% will become pregnant againduring their teenage years, including 18% of those who terminate their first pregnancy. These figures suggest that many teenagersbecome pregnant by design rather than by accident. Nevertheless,termination is very commonly performed in these circumstances.Teenagers are more likely to have later terminations, are morelikely to resort to unskilled practitioners and dangerous methodsand, when complications do arise, they are more likely to presentlate. 2001-02    While termination and adoption are options that are availableand should be presented to the pregnant teenager, the realityis that most girls choose to continue with their pregnanciesand keep their infants. It is, therefore, imperative that everyeffort is made to encourage pregnant teenagers to access antenatalcare and that the care they subsequently receive is tailoredto the unique needs of this age group. The healthcare professionalmust be aware of the potential complications and the opportunitiesfor intervention that exist.

The postnatal period provides an opportunity for counsellingand education from the obstetrician, midwife, general practitioner,health visitor and social worker. Teenage mothers are more likelyto have unhealthy habits that place the infant at greater riskof inadequate growth, infection and chemical dependence. Belowthe age of 20 years, the younger the mother, the greater therisk of her infant dying during the first year of life. Infantfeeding, growth and safety need to be observed. Having her firstchild during adolescence makes a woman more likely to have morechildren overall. Women in this group are also less likely to receive child support from the biological fathers: over 50%of children of adolescent mothers never live with their biologicalfather. 1991-01   They are less likely to complete their education and establish the independence and financial security that enablethem to provide for themselves and their children without outsideassistance. There are, therefore, some areas that need specialattention, particularly discussion regarding financial issues,returning to school and contraceptive advice.

Preventing teen pregnancy


There are many different kinds of teen pregnancy preventionprogrammes. Studies in pregnancy prevention have attempted toaddress the many facets of adolescent sexual activity, contraceptiveuse and pregnancy. Kirby  has identified five main categoriesof teen pregnancy prevention programmes: education, improvingaccess to contraception, education for parents and their families,multi-component prevention and youth development.

 Increasing the availability of contraceptive clinic servicesfor young women is associated with reduced pregnancy rates.The role of the general practitioner is paramount: over 70%of consultations for contraception in the UK occur in generalpractice. In the UK, 91% of teenagers who become pregnant havehad at least one visit to their general practitioner withinthe previous year – 71.3% of them specifically for contraceptiveadvice. 2000-02  Location of services is also very important. Accordingto adolescents, there are several factors that determine whetherthey use the services or not. These include: confidentiality,a non-judgmental approach, accessibility and whether they aretreated by a male or female clinician. Contraceptive servicesshould be easily accessible, confidential, cheap or free and safe. They also benefit from having close links with associatedservices such as STI clinics, smoking cessation programmes,substance abuse clinics, social services, maternity hospitalsand termination services.

 
 

 
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

Acne





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