Predictors of repeat pregnancy in a program for pregnant teens.

STUDY OBJECTIVE: To describe repeat pregnancy among adolescents and to compare those who experienced a repeat pregnancy to those who did not. DESIGN, SETTING, PARTICIPANTS: Retrospective case control of all adolescents who entered and exited the Teen Mother & Child Program, a multidisciplinary clinic for pregnant and parenting teens and their children, between 1985 and 2000. MAIN OUTCOME MEASURE: Repeat pregnancy. RESULTS: Over the 16-yr study period, 1838 teens entered and exited the program with the mean time in the program of 1.9 yrs. 194 (10.6%) teens went on to have a second pregnancy, and 4 of those had a third pregnancy. Ninety-two percent (n=175) of these pregnancies resulted in a live birth. The mean interval between delivery of the initial child and delivery of the second child was 21.8 months (range 5.4-53.2). Teens repeating (R) were compared to those who did not repeat (NR). R were younger at entry and older at exit from the program (both P<0.0001). R were more likely to be Hispanic (P=0.009) or have a partner who was Hispanic (P=0.02). R were more likely to have experienced a poor initial pregnancy outcome (miscarriage, stillbirth) (P=0.03). R were more likely than NR to be in a stable relationships with the father of the baby (i.e., married or engaged) (P=0.03). Self-report of physical and sexual abuse, depression, and substance abuse were common, but did not differ between R and NR. However, R were more likely than NR to self-report suicide gestures/attempts and to have a significant psychiatric history (P=0.01, P=0.004). Only 24% of R and 26% of NR had completed high school by the time of exit from the program. CONCLUSIONS: Ten percent of adolescents served by comprehensive multidisciplinary teen pregnancy program experienced a repeat pregnancy while in the program. Compared to nonrepeaters, adolescents who experienced a repeat pregnancy were younger, were more frequently Hispanic, and were more likely to be in a stable relationship with the baby's father. Many of the program's clients have psychosocial factors reported in the literature to be associated with repeat pregnancy. A history of suicide gestures/attempts and a significant psychiatric history were more common in those who had a repeat pregnancy. Disappointingly, only about 25% of the adolescents completed high school by the time they exited the program whether they experienced a repeat pregnancy or not. Although directing interventions (e.g., mental health services, counseling those who miscarried) to teens who appear to be at highest risk for a repeat pregnancy may decrease their risk of repeating, all teens in our program would likely benefit from such services.