Teenage pregnancy.

BACKGROUND: Teenage pregnancy rates are falling in many high-resource settings, but for those who do conceive, the socioeconomic and educational disadvantage that ensues is often long lasting and intergenerational. The adverse maternal and neonatal outcomes can be ameliorated through antenatal and postnatal care that attends to the special needs of this group. OBJECTIVE: The aim of this article is to provide an overview of the social, obstetric and medical complications of teenage pregnancy and the role of the general practitioner (GP) in mitigating adverse outcomes. DISCUSSION: Management and prevention of teenage pregnancy requires broad efforts that involve schools, health services and the community. The GP has a key role in providing supportive continuity of care that spans the antenatal and crucial postnatal periods.

Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children's hospitals.

BACKGROUND: Adolescents with cancer engage in sexual behaviors and are exposed to teratogenic chemotherapy. There are no data regarding pregnancy screening patterns for adolescents before chemotherapy exposure. METHODS: A cross-sectional study of leukemia and emergency room (ER) admissions in the Pediatric Health Information System from 1999 to 2011 was conducted. Females who were 10 to 18 years old and 1) had newly diagnosed acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) or 2) had ER visits with computed tomography (CT) of the abdomen/pelvis were included. The exposure was a hospital visit with either chemotherapy or an abdominal/pelvic CT scan. The main outcome was a pregnancy test billed on the same day or before the teratogenic exposure within the same index admission. Log-binomial regressions were used to compute prevalence ratios and 95% confidence intervals comparing pregnancy screening in the leukemia and ER cohorts. RESULTS: A total of 35,650 admissions were identified. The proportion of visits with an appropriately timed pregnancy test was 35%, 64%, and 58% in the ALL (n = 889), AML (n = 127), and ER cohorts (n = 34,634), respectively. Patients with ALL were significantly less likely to have a pregnancy test than the ER cohort (adjusted prevalence ratio, 0.71; 95% confidence interval, 0.65-0.78), but there was no significant difference between the AML and ER cohorts (adjusted prevalence ratio, 1.12; 95% confidence interval, 0.99-1.27). There was substantial hospital-level variation in pregnancy screening patterns. CONCLUSIONS: Adolescents with acute leukemia and ER visits have low rates of pregnancy screening before teratogenic exposures. Standardized practice guidelines for pregnancy screening among adolescents may improve screening rates. Cancer 2016;122:3394-3400. © 2016 American Cancer Society.

The impact of using emergency contraception on reproductive health outcomes: a retrospective review in an urban adolescent clinic.

The effort to make emergency contraception (EC) more easily available has been challenged by concerns that prescribing EC may tempt adolescents to have unprotected intercourse, resulting in higher rates of pregnancy and sexually transmitted infections (STIs). This study examined differences in reproductive health history and outcomes among girls who were prescribed EC compared with those seeking other reproductive health care. In a retrospective chart review, the subjects (182 total: 92 EC, 90 control) were girls aged 13 to 21 years, 63% black and 31% white, in an urban, hospital-based adolescent outpatient clinic. Pregnancies, STIs, and visits for first pelvic examination and Pap smear were compared for the 12 months before the identifying visit (IDV) and for up to 2 years after the IDV (mean: 10.9 months+/-8.2 months). Twenty-six subjects became pregnant with no significant difference between groups. Control subjects were found to have a higher incidence of chlamydia. Before the IDV, EC users were more likely than controls to have never had a pelvic examination (23% vs. 6%, P<0.002) or a Pap smear (24% vs. 6%, P<0.002). However, 80% of EC subjects who had never had a pelvic examination received one as a result of the initial visit and follow-up related to receiving EC. Using EC is not associated with increased risk for future STIs and pregnancy among adolescent girls. Requesting EC may initiate routine gynecologic care.

Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies.

Since its introduction in Sweden in 1994, emergency contraception has become a welcome addition to the campaign against unwanted pregnancy. In addition to an unplanned pregnancy, unprotected sexual intercourse may also involve the risk of contracting sexually transmitted diseases (STD). The aim of this study was to assess the short- and long-term risk of unintended pregnancy and to determine the frequency of chlamydia infections in women receiving emergency contraception. Between September 1998 and February 1999 young women aged 15-25 years had the opportunity to obtain emergency contraception (Yuzpe method) at a youth clinic in the city of Orebro where the opening hours were extended to include Saturdays and Sundays. A follow-up visit 3 weeks after treatment, which included contraceptive counseling, was offered to all participants. At both visits, a pregnancy test and a chlamydia test were performed, and the women completed a questionnaire. After the initial visit, the young women where monitored for new pregnancies during the following 12 months. One pregnancy occurred in the 134 young women who received emergency contraception during the study period. None of the women had a positive chlamydia test. Of those requesting emergency contraception, 54% did so because no contraception was used, 32% because of a ruptured condom, 11% because of missed oral contraceptives (OC), and 5% had mixed reasons. At long-term follow-up 1 year after the initial visit, 10 of the 134 young women had experienced an unplanned pregnancy that terminated in legal abortion in 9 women. All these women had either started and terminated OC or had never commenced the prescribed OC. Young women who request emergency contraception are, despite a planned follow-up with contraceptive counseling, a high risk group for new unintended pregnancies. In Sweden they do not seem to be a high risk group for STD.

The apparent effect of iron supplementation on serum selenium levels in teenage pregnancy.

Numerous studies have suggested a significant role of selenium in the prevention of gynecological carcinoma. These were epidemiological and prospective in humans and therapeutic in laboratory animals. However, no studies have been reported regarding the normal serum selenium levels during pregnancy. The maternal total blood volume increases 30-50% during the second and third trimesters, resulting in lower measured serum levels for those metabolites, which are not increased significantly during pregnancy. A longitudinal study of the serum selenium levels in teenage pregnancy during the last two trimesters and 3 mo postpartum showed progressive elevation from 49 +/- 7 microg/dL after the 32nd week of pregnancy to 114 +/- 7 microg/dL at term, which was statistically significant (p < or = 0.001). Prenatal supplementation with 18 mg of iron per day prevented this elevation. The results of this study suggest that serum selenium levels in women normally double during pregnancy and this doubling is prevented by the minimal daily supplementation of 18 mg of iron, which may be due to increased absorption of selenium into the erythrocytes and incorporation into the glutathione peroxidase enzyme.

La inhalación deliberada de hidrocarburos aromáticos durante el embarazo de adolescentes consideradas como "de la calle" / Deliberate inhaling of petroleum derivates during pregnancy among \"street\" adolescents

En virtud de los vacíos existentes en el conocimiento de la situación vivida por las adolescentes embarazadas que usan inhalables, se presentan los resultados de una investigación cuyo objetivo es conocer, desde el punto de vista de dichas mujeres, cómo viven la inhalación deliberada de hidrocarburos aromáticos; las prácticas sexuales, el embarazo y el parto; la autoatención y el apoyo institucional. Para tal efecto, se privilegiaron técnicas de exploración profunda, como la entrevista y los grupos focales, que indagan con detalles, las particularidades de ciertos fenómenos específicos y significativos. De los considerados "niños de la calle", se seleccionaron cuatro grupos porque incluían a miembros del sexo femenino que estaban o habían estado embarazadas y habían usado inhalables durante este tiempo. Los miembros de los grupos seleccionados sumaron 84, de éstos 66 eran hombres y 18 eran mujeres. De estas 18, 10 estaban o habían estado embarazadas. Estas tenían entre 15 y 22 años de edad, y 5 tenían una pareja viviendo con ellas (familias nucleares), mientras las otras 5 no (familias matrifocales). Ocho ya tenían hijos y dos se encontraban embarazadas por primera vez. Los resultados obtenidos, indican que las llamadas niñas "de la calle" forman parte de grupos domésticos de carácter complejo; es decir, de agrupaciones con unidades de amigos (familia nucleares, matrifocales, de personas solas) que se caracterizan por residir en el mismo espacio, compartir recursos y procuran convivir amistosamente entre ellos. A través de la medicación sociocultural de estos grupos domésticos, las adolescentes aquí citadas, experimentan diferentes fenómenos: el uso de inhalables como un gusto irresistible y la adicción entendida como una costumbre; las prácticas sexuales sin ningún tipo de protección; el embarazo no planeado; los antecedentes de violencia en los abortos; los partos riesgosos; la autoatención; la ayuda institucional como un medio para obtener un servicio médico; entre otros. La conjugación de estos fenómenos los hace sumamente complejos, de forma tal que estas jóvenes los experimentan como tradictorio, confuso, incierto, misterioso, ambivalente, fatal y paradójico...