Teenage pregnancy

Alternative names
Adolescent pregnancy; Pregnancy - teenage

Definition
Adolescent pregnancy is pregnancy occurring in women aged 19 or younger.

Causes, incidence, and risk factors

Each year, almost 1 million teenage women (10% of all women aged 15 to 19, and 19% of all those who have had sexual intercourse) become pregnant. The issues related to teenage pregnancy are politically controversial, emotionally charged, and numerous.

Many factors must be examined in addition to the obvious cause, which is that adolescents are having sexual intercourse without adequate contraception. Since no form of contraception is 100% effective, abstinence is the only sure way to prevent pregnancy.

Statistics show that 24% of girls and 27% of boys in the United States have had sexual intercourse by age 15. That figure grows to 66% of unmarried teens having sex by the age 19. Studies have shown that by age 20, 77% of American women and 85% of American men are sexually active. Why teenagers have sex, and do so without effective methods of contraception, is a topic of heated debate. Suggested reasons follow:

     
  • Adolescents become sexually mature (and fertile) approximately 4-5 years before they reach emotional maturity.  
  • Adolescents today are growing up in a culture in which peers, TV and motion pictures, music, and magazines often transmit either covert or overt messages that unmarried sexual relationships (specifically those involving teenagers) are common, accepted, and at times expected, behaviors.  
  • Education about responsible sexual behavior and specific, clear information about the consequences of sexual intercourse (including pregnancy, sexually transmitted diseases, and psychosocial effects) are frequently not offered in the home, at school, or in other community settings. Therefore, much of the “sex education” that adolescents receive filters through misinformed or uninformed peers.  
  • Adolescents who choose to be sexually active are frequently limited in their contraceptive options by peer, parental, financial, cultural, and political influences as well as their own developmental constraints (that is, achieving physical before emotional maturity).

The incidence of adolescent pregnancy has declined since reaching an all-time high in 1990, mostly due to an increase in the use of condoms. There were 506,800 live births to adolescent mothers in 1996 (compared with 521,826 live births in 1990).

This corresponds to 97 pregnancies per 1,000 women aged 15-19 in 1996, compared with 117 per 1,000 in 1990. Of those teen mothers, 25% will have a second child within 2 years of the first.

When compared with other industrialized nations, the United States has the highest rates of pregnancy, Abortion, and childbirth among teenagers, despite similar or higher rates of sexual activity in the other countries.

A sexually active teenager who does not use contraception has a 90% chance of becoming pregnant within 1 year. Of those pregnancies, 78% are unplanned, accounting for 25% of all unplanned pregnancies. It is estimated that in the U.S., 40% of white women and 64% of black women will have experienced at least one pregnancy by age 20.

Potential risk factors for a teenage girl becoming pregnant include: early dating behavior (dating at age 12 is associated with a 91% chance of being sexually involved before age 19, and dating at age 13 is associated with a 56% probability of sexual involvement during adolescence); early use of alcohol and/or other drugs, including tobacco products; dropping out of school; lack of a support group or few friends; lack of involvement in school, family, or community activities; perceiving little or no opportunity for success; living in a community or attending a school where early childbearing is common and viewed as the norm rather than as a cause for concern; growing up under impoverished conditions; having been a victim of sexual abuse or assault; or having a mother who was aged 19 or younger when she first gave birth.

Symptoms

Pregnancy symptoms include:

     
  • Missed period  
  • Fatigue  
  • Breast enlargement and breast tenderness  
  • Abdominal distention  
  • nausea/Vomiting  
  • Light-headedness or actual fainting

Signs and tests

The adolescent may or may not admit to being involved sexually. There are usually weight changes (usually a gain, but there may be a loss if nausea and Vomiting are significant). Examination may show increased abdominal girth, and the fundus (the top of the enlarged uterus) may be palpable.

Pelvic examination may reveal bluish or purple coloration of vaginal walls, bluish or purple coloration and softening of the cervix, and softening and enlargement of the uterus.

     
  • A pregnancy test of urine and/or serum HCG are usually positive.  
  • A Pregnancy ultrasound may be done to confirm or check accurate dates for pregnancy.

Treatment

Review pregnancy options thoroughly and make them known and available to pregnant teens. Abortion is a potential option, but states vary regarding an unmarried adolescent’s ability to legally obtain this means of terminating a pregnancy without parental consent.

In the case of married teens, consent of the husband may be required. Giving up infants for adoption after delivery is another option, but the majority of pregnant teens choose to continue their pregnancies and keep their infants.

Early and adequate prenatal care, preferably through a program that specializes in teenage pregnancies, ensures a healthier baby. Smoking, alcohol use, and drug abuse should be strongly discouraged, and support methods should be offered to assist the pregnant teen in terminating such behaviors.

Adequate nutrition must be assured through both education and the availability of community resources. Appropriate exercise and adequate sleep should also be emphasized. Contraceptive information and services are important, following delivery, to deter adolescents from becoming pregnant again.

Pregnant teens and those who have recently given birth should be encouraged and helped to remain in school or reenter educational programs targeting skills that will enable them to provide for their child financially, emotionally, and with appropriate parenting. Accessible and affordable child care is an important factor in teen mothers continuing school and/or entering the work force.

Expectations (prognosis)

Women having a first child during adolescence are more likely to have an increased overall rate of childbearing and more total births. They are less likely to receive child support from biological fathers, less likely to complete their education or work in some type of vocation, and less likely to establish independence and financial security adequate to provide for themselves and their children without outside resources.

Married teen mothers are more likely to experience divorce (80% or greater chance) than those married women who postpone childbearing until their 20s.

Complications

Adolescent pregnancy is associated with higher rates of illness and death for both the mother and infant. Teenage girls are not only less ready than older women EMOTIONALLY to have a baby, they are less ready PHYSICALLY to have a health baby.

Pregnant teens are at much higher risk of having serious medical complications such as toxemia, pregnancy-induced hypertension, significant anemia, premature delivery, and/or placenta previa. The maternal death rate for mothers age 15 or younger is 60% greater than for women in their 20s.

Infants born to teens are 2-6 times more likely to have low birth weight than those born to mothers age 20 or older. Prematurity plays the greatest role in this, but intrauterine growth retardation (inadequate growth of the fetus during pregnancy) is also a factor.

Teenage mothers are more likely to demonstrate behaviors such as Smoking, alcohol use, or drug abuse; poor and inconsistent nutrition; or multiple sexual partners. This may place the infant at greater risk for inadequate growth, infection, or chemical dependence. The younger a mother is below age 20, the greater the risk of her infant dying during the first year of life.

Thus, it is VITALLY important for pregnant teens to have EARLY and ADEQUATE prenatal care!

Calling your health care provider

Call for an appointment with your health care provider if symptoms of pregnancy occur in a teen.

Call for an appointment with your health care provider if counseling regarding birth control methods or other information is desired, particularly if a teen exhibits behaviors or has a history associated with higher risk for adolescent pregnancy, if a teen is confronted with peer pressure or is having personal thoughts to engage in sexual activity, or if a teen is already involved in sexual activity, with or without using contraception.

Prevention

Various models for the prevention of adolescent pregnancy currently exist. Programs tend to focus on a particular approach to the issue of teen pregnancy or use a combination of approaches. The majority of adolescent pregnancy prevention programs utilize methods that typically fall into the following categories.

Abstinence education programs encourage postponing sexual involvement until marriage or until a person is mature and skilled enough to handle sexual activity in a responsible manner and able to manage and be responsible for a potential pregnancy.

Knowledge-based programs focus upon teaching adolescents about their bodies and normal functions as well as providing detailed information about contraceptives.

Clinic-focused programs provide easier access to information, counseling by health care providers, and contraceptive services. Many of these are through school-based clinics that offer a full range of ambulatory health care services.

Peer counseling programs typically involve older, well-known, and respected teens to facilitate discussions that explore the feelings and attitudes about managing the physical urges confronted in relationships, then encourage other teens to resist peer and social pressures to become sexually involved.

These programs tend to take more of an experiential approach, helping teens to personalize risks. They also teach skills, through role playing and other methods, to confront the pressure to become sexually involved.

Peer counseling programs also provide, for those teens already involved in sexual activities, the skills to negotiate within relationships and the information needed to obtain and successfully use contraceptives.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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