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Pregnancy in Adolescence

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Abstract

According to WHO, adolescence extends from ages 10 to 19. Adolescent pregnancies are mostly unplanned, with 16 million live births and five millions abortions a year worldwide. Ninety-five percent teenage pregnancies occur in poor countries, mainly in Africa. The USA shows the highest adolescent pregnancy rate in Western countries. 207,000 live births and 160,000 abortions occurred in EU teens in 2011. Low income family, low education, unemployment, disadvantaged neighborhood, poor school results, belonging to ethnic minorities, mental deficits promote teen pregnancy, with the bigger risks because of the lower socioeconomic level. The younger the girl, the worse the outcomes, with preterm delivery, preeclampsia, eclampsia, urinary infections, anemia, depression, school abandonment, unqualified jobs, social security needs, and early death. Newborns risk low birth weight, infections, IUGR, SIDS, and death. Typical teen risk factors are: still ongoing growth, still developing genitalia, low BMI, short cervix, inadequate pelvis, low central body fat, genital infections, stress, depression, poverty, black race, insufficient prenatal cares, smoking, alcohol, substance abuse, school dropout, sexual promiscuity, sexual abuse, and poor support. Still growing mothers and fetuses compete for nutrients with high maternal weight gain and low neonatal birth weight. Pregnant teens require close follow-up, adequate weight gain, possible cervical cerclage, screening of both STDs and sexual abuse, and psychosocial support. During labor, slow progression, dystocias, and neonatal complications often occur, so teens should deliver in high level hospitals. After delivery, promotion of breastfeeding, screening of depression, prevention of repeated pregnancy are mandatory. Specific features and proper management of adolescent pregnancy are discussed.

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Abbreviations

ADHS:

Attention deficit hyperactivity syndrome

BMI:

Body mass index

CNS:

Central nervous system

EU:

European Union

FASD:

Fetal alcohol spectrum disorders

GD:

Gestational diabetes

HCG:

Human chorionic gonadotrophin

IUD:

Intra uterine device

IUFD:

Intra uterine fetal death

IUGR:

Intra uterine growth retardation

LARC:

Long acting reversible contraception

LBW:

Low birth weight

NICU:

Neonatal intensive care unit

pPROM:

Preterm prelabor rupture of membranes

PTB:

Preterm birth

SCOG:

Canadian Society of Obstetrics and Gynaecology

SIDS:

Sudden infant death syndrome

UK:

United Kingdom

US:

United States

USD:

United States dollar

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Santa Maria Nuova Hospital—IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy

    Gabriele Tridenti M.D. & Cristina Vezzani M.D.

Authors
  1. Gabriele Tridenti M.D.
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  2. Cristina Vezzani M.D.
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Correspondence to Gabriele Tridenti M.D. .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy

    Anna Maria Fulghesu

Appendices

Appendix 1: WHO Guidelines for Developing Countries

Considering early childbearing mostly occurs in developing countries, it also reflects broader forms of social and economic marginalization of girls. To prevent early pregnancy, WHO suggests the following guidelines:

• Prevent early marriage

→ by extending school age for girls

→ by prohibiting marriages in under 18 year olds

• Foster prevention

→ with sex education in school

→ in connection with sexual health services

• Improve contraception

→ by including contraception in sex education

→ by organizing “youth friendly” health services

→ by supplying contraception after deliveries or abortions

→ by fostering tolerant laws and policies

• Punish forced sex

→ by banning it by law

→ by making the perpetrator punishable

• Reduce unsafe abortion

→ with educational campaigns

→ by admitting teens to family planning services

→ by providing post abortion care and contraception

• Supply proper pre- and post-natal cares

→ with laws taking care of adolescents

World Health Organization [81]

Appendix 2: SCOG Adolescent Pregnancy Guidelines

In August 2015, the Canadian Society of Obstetrics and Gynecology published a guideline about adolescent pregnancy which still may be considered the most comprehensive and updated one. Published on the Canadian Journal of Obstetrics and Gynaecology [12], it has been summarized in the following pictures:

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Tridenti, G., Vezzani, C. (2018). Pregnancy in Adolescence. In: Fulghesu, A. (eds) Good Practice in Pediatric and Adolescent Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-57162-1_15

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