1. family and parenting
2. motherhood
3. pregnancy

Pregnancy in adolescents
Pregnancy in adolescents

Updated 2011 Oct 10 12:53:00 PM: combination intervention focused on sexual risk
behaviors and psychosocial factors might increase contraceptive use in adolescent girls (J
Adolesc Health 2011 Aug) view updateShow more updates
Related Summaries:
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Pregnancy
Contraception overview
Emergency contraception
Abortion
Overview:
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about 900,000 teenagers become pregnant each year in United States
2006 teenage birth rate up 3% from 2005, following long-term decline from 1991-2005
pregnancy in adolescents associated with some increased risks
o teenage pregnancy associated with increased neonatal and infant mortality (level 2
[mid-level] evidence)
o adolescents may be at increased risk for suicide during pregnancy and first
postnatal year compared to other pregnant women (level 2 [mid-level] evidence)
o younger age associated with increased risk of low birth weight, premature, and
small for gestational age infants (level 3 [lacking direct] evidence)
counseling considerations include
o confidential diagnosis until patient consent obtained
o discussion of expectations and feelings about pregnancy
o sensitivity to possibility of incest or abuse
o encouragement of inclusion of parents or trusted adults in decision-making
process
o encouragement of inclusion of father of infant when appropriate
o options of adoption and abortion
o prenatal care
Incidence/Prevalence
Trends in adolescent pregnancy:

about 900,000 teenagers become pregnant each year in United States(1)
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> 4 of 10 adolescent girls have been pregnant at least once before age 20 years(1)
adolescent pregnancy outcomes(1)
o 51% live births
o 35% induced abortion
o 14% miscarriage or stillbirth
up to 83% of adolescents who give birth and 61% who have abortions are from poor or
low-income families(1)
among births in United States in 2006, 84.2% of women aged 15-19 years were
unmarried
o 38.5% women (all ages) were unmarried
o 96.8% of women aged 15 years
o 93.3% of women aged 16 years
o 90% of women aged 17 years
o 84.4% of women aged 18 years
o 77.8% of women aged 19 years
o Reference - Natl Vital Stat Rep 2009 Jan 7;57(7):1 PDF
Birth/pregnancy rates:



2007 birth rate for adolescents in United States
o based on preliminary data covering 98.7% of United States births in 2007
o birth rate up about 1% from 2006 (to 69.5 births per 1,000 women aged 15-44
years)
o birth rates per 1,000 women
 42.5 births to adolescents aged 15-19 years (increased about 1% from
2006)
 22.2 births to adolescents aged 15-17 years
 73.9 births to adolescents aged 18-19 years
 0.6 births to adolescents aged 10-14 years (unchanged from 2006)
o Reference - Natl Vital Stat Rep 2009 Mar 18;57(12):1 PDF
2006 birth rate for adolescents in United States
o birth rate up 3% from 2005, following long-term decline from 1991-2005
o birth rates per 1,000 women
 41.9 births to adolescents aged 15-19 years
 22 births to adolescents aged 15-17 years
 73 births to adolescents aged 18-19 years
 0.6 births to adolescents aged 10-14 years
o birth rates by state
 vary widely by geographic region
 generally lower rates in north and northeast, higher rates in south and
southwest
 range from 18.7 births per 1,000 adolescents in New Hampshire to 68.4 in
Mississippi
o Reference - Natl Vital Stat Rep 2009 Jan 7;57(7):1 PDF
2004 pregnancy/birth rates for adolescents in United States
o pregnancy rate (includes live births, abortions, and fetal losses)


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118.6 per 1,000 adolescents aged 18-19 years
41.5 per 1,000 adolescents aged 15-17 years
o birth rate
 70 per 1,000 adolescents aged 18-19 years
 22.1 per 1,000 adolescents aged 15-17 years
o Reference - Natl Vital Stat Rep 2008 Apr 14;56(15):1 PDF
1992 birth rate per 1,000 adolescents aged 15-19 years(1)
o 61 births in United States
o 41 births in Canada
o 33 births in United Kingdom
o 8 births in Netherlands
o 4 births in Japan
Outcomes

adolescent pregnancy associated with(1)
o more than double adult rate of birth to low birth weight infant (< 2,500 g)
o almost 3 times adult rate of neonatal death within 28 days of birth
o double adult rate of mortality for mother
o adolescent pregnancy also associated with
 pregnancy-induced hypertension
 sexually transmitted diseases
 poor maternal weight gain
Mortality outcomes:

teenage pregnancy associated with increased neonatal and infant mortality (level 2
[mid-level] evidence)
o based on 2 retrospective cohort studies
o teenage pregnancy associated with increased neonatal and infant mortality
 based on retrospective cohort study of 4,037,009 nulliparous pregnant
women < 25 years old from United States who had live singleton birth
 neonatal mortality defined as death < 28 days; postneonatal or infant
mortality defined as death between 28-265 days

Neonatal and Infant Mortality Comparing Teen Mothers to Mothers Aged
20-24 Years:
Maternal Age
10-15
16-17
18-19
10-19
Years
Years
Years
Years
Neonatal mortality
1.7
1.25
1.09
1.2
(OR)
Infant mortality (OR) 2.05
1.63
1.3
1.47
Abbreviation: odds ratio, OR.

Gestational Age at Birth :
Maternal Age
10-15
16-17
18-19
Years
Years
Years
Gestational age < 32 weeks
4.1
2.5
1.86
(%)
Gestational age 32-36
14.03
10.79
9.04
weeks (%)
Gestational age ≥ 37 weeks
81.87
86.71
89.1
(%)
20-24
Years
1.43
7.76
90.81
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
no difference in neonatal mortality risk when adjusted for gestational age
at birth
 increased risk of infant mortality remains significant (OR 1.76, 95% CI
1.63-1.91) adjusting for gestational age at birth
 Reference - J Clin Epidemiol 2008 Jul;61(7):688
o adolescent pregnancy associated with increased neonatal mortality
 based on nested cohort study of 10,745 live-born singletons born to
mothers in rural Nepal < 25 years of age with parity of 0 or 1
 higher risk of neonatal mortality in infants born to mothers aged 12-15
years vs. aged 20-24 years (OR 2.24)
 Reference - Arch Pediatr Adolesc Med 2008 Sep;162(9):828
adolescents may be at increased risk for suicide during pregnancy and first
postnatal year compared to other pregnant women (level 2 [mid-level] evidence)
o based on retrospective population data analysis
o women aged 15-44 years in England and Wales between 1973-1984 who
committed suicide during pregnancy or 1st postnatal year were analyzed
o adolescents at lower risk for suicide compared to non-pregnant adolescent
population, but higher risk for suicide within pregnant population
o comparing observed vs. expected numbers of suicides during pregnancy
 14 vs. 281.5 for all women (standardized mortality ratio [SMR] 0.05)
 5 vs. 17.4 for adolescents aged 15-19 years (SMR 0.28)
st
o comparing observed vs. expected numbers of suicides during 1 postnatal year
 76 vs. 449.6 for all women (SMR 0.17)
 7 vs. 19.6 for adolescents aged 15-19 years (SMR 0.357)
o Reference - BMJ 1991 Jan 19;302(6769):137 PDF
Obstetric outcomes:

younger mothers have higher rates of anemia, fetal distress, and prematurity
o comparing mothers < 20 years old vs. mothers > 40 years old, incidence of
anemia was 36 vs. 19.8 per 1,000 live births
o
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


comparing mothers < 20 years old vs. mothers aged 25-29 years, incidence of
fetal distress was 43.4 vs. 36.8 per 1,000 live births
o Reference - Natl Vital Stat Rep 2002 Dec 18;51(2):1 PDF
younger age associated with increased risk of low-birth-weight, premature, and
small-for-gestational-age infants (level 3 [lacking direct] evidence)
o based on cohort study without clinical outcomes
o 134,088 women of white race in Utah aged 13-24 years who delivered singleton,
first-born children between 1970-1990 were evaluated
o comparisons included married mothers with age-appropriate education and
adequate prenatal care
o comparing mothers aged 13-17 years vs. mothers aged 20-24 years, younger age
associated with increased risk of
 low-birth-weight infant (relative risk [RR] 1.7, 95% CI 1.5-2, p < 0.001)
 premature infant (RR 1.9, 95% CI 1.7-2.1, p < 0.001)
 small for gestational age infant (RR 1.3, 95% CI 1.2-1.4, p < 0.001)
o older adolescent mothers (aged 18-19 years) also had significantly increased risks
for these factors
o Reference - N Engl J Med 1995 Apr 27;332(17):1113 full-text, editorial can be
found in N Engl J Med 1995 Apr 27;332(17):1161, commentary can be found in
N Engl J Med 1995 Sep 21;333(12):800
incidence of prematurity reported to be 14% in mothers ≤ 17 years old compared to 6% in
mothers aged 25-29 years(1)
overweight/obesity in teen mothers associated with increased risk of gestational
diabetes and cesarean delivery compared to normal-weight teen mothers (level 2
[mid-level] evidence)
o based on retrospective cohort of 712 deliveries in nulliparous teens ≤ 18 years old
2
o 60% were normal weight (body mass index [BMI] < 25 kg/m ), 40% were
2
overweight or obese (BMI ≥ 25 kg/m )
o compared with teen mothers of normal weight, obese teen mothers had higher risk
of
 gestational diabetes (adjusted odds ratio 4.2, p < 0.05)
 cesarean delivery (adjusted odds ratio 4.3, p < 0.05)
o Reference - Obstet Gynecol 2009 Feb;113(2 Pt 1):300
ectopic pregnancy(3)
o more common in women aged > 35 years, but adolescents have highest rate of
mortality from ectopic pregnancy
o higher mortality rate likely because adolescents tend to present later in pregnancy
o higher risk for those using progestin-only methods of contraception
Medical Considerations
Medical conditions:
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medical conditions that may affect pregnancy in adolescents(3)
o diabetes in pregnancy
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o
o
o
o
o
diabetes mellitus type 1
diabetes mellitus type 2
epilepsy
cardiac disease
sickle cell trait
use of isotretinoin (Accutane) for acne
cancer
Screening before medical interventions:

screening for pregnancy may be prudent for adolescents receiving(3)
o anesthesia or other preoperative medications
o diagnostic radiographs
o radiation therapy or chemotherapy
o measles, mumps, rubella; polio; and varicella vaccines
o isotretinoin (Accutane) for acne
Tobacco use during pregnancy:
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smoking rates highest for pregnant adolescents aged 18-19 years (19%)
smoking rates by race and ethnicity in adolescents aged 15-17 years
o non-Hispanic white 28.6%
o American Indian 20.4%
o Hawaiian 14.2%
o Cuban 8.7%
o Filipino 8%
o Puerto Rican 7.9%
o Japanese 7.7%
o non-Hispanic black 5.4%
o Mexican 2.6%
o Central and South American 1.7%
Reference - Natl Vital Stat Rep 2002 Dec 18;51(2):1 PDF
Pre-Test Considerations
Clinical considerations:

clinical considerations for pediatric health professionals(1)
o obtain medical history including sexual, contraceptive, and menstrual history
o offer confidential screenings as part of routine care
o recommend folic acid supplementation for all women of childbearing age who are
capable of becoming pregnant
(2)
o become familiar with local resources available to pregnant adolescents
 local funding resources
 adoption resources
 community support programs
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local or federal laws regarding parental notification, consent, and
availability of services
confidentiality laws regarding diagnosis and treatment of pregnancy
Counseling:
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discuss adolescent's expectations and feelings regarding possible pregnancy(2)
be sensitive about possibility of incest or abuse in young or developmentally delayed
adolescent(2)
encourage adolescents to include parents or other trusted adults in decision-making
process(2)
Diagnosis of Pregnancy
Initial evaluation:
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thorough medical history, especially with regard to(3)
o sexual history
o contraceptive history
o menstrual history (but only 68% of pregnant adolescents report missed menses)
pregnancy symptoms may be nonspecific and vague, especially in younger adolescents(2)
psychological denial may exist(2)
abdominal and pelvic examination(3)
Diagnostic testing:
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diagnosis usually made by monoclonal human chorionic gonadotropin (hCG) urine
pregnancy test(2)
physical diagnosis made by enlarged softened uterus during pelvic examination 6 weeks
after last menstrual period(2)
test for sexually transmitted diseases at same time as pregnancy evaluation(2)
see Pregnancy testing for more details on diagnosing pregnancy
Dating of pregnancy:
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ask about date of last menstrual period and confirm whether adolescent is certain of date
(used to calculate gestational age)(3)
adolescents who are infrequently sexually active may be more certain of conception date
than date of last menses(3)
sonographic dating may be more accurate(3)
o correct within 3-5 days in first trimester
nd
rd
o margin of error about 1 week in 2 trimester and 2-3 weeks in 3 trimester
see Dating of Pregnancy for more details
Post-Test Counseling
Informing adolescent about test results:
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provide test results to adolescent alone in private setting(2)
confidential diagnosis until patient consent obtained, except in cases of suspected abuse,
suicide, or homicide(2)
use negative test result as opportunity for further counseling(2)
Assessment:
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assess adolescent ability to care for her child and have resources available for referral(1)
respect adolescent's personal decision regarding her pregnancy(2)
estimate gestational age to set time frame for decision-making(3)
suspect possibility of sexual abuse, assault, or incest if adolescent reluctant to reveal
identity of father(2)
Counseling:
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discuss prenatal care, adoption, and abortion, or refer patient for counseling(1,2)
counsel adolescent to consider all options available(2)
advocate for inclusion of father of child when appropriate(1,2)
address co-existing medical conditions(2)
encourage adolescent to continue her education(2)
Follow-up:
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follow-up to ensure(2)
o successful referral
o adequate social supports in place
o discuss prevention of further unintended pregnancies
o remain available as resource for duration of pregnancy
Pregnancy Management
Prenatal care:

if adolescent decides to continue pregnancy(2,3)
o refer for prenatal care
o consider referral to comprehensive adolescent pregnancy program if available
o encourage family and social support systems
o schedule postpartum visit within 2 weeks postpartum
Nutritional considerations:
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
see Nutrition in pregnancy for issues not specific to adolescents
daily nutritional requirements for pregnant adolescents
additional 300 kilocalories per day for adults and adolescents ≥ 14 years old
during 2nd and 3rd trimester
nd
o additional 500 kilocalories per day for adolescents < 14 years old during 2 and
rd
3 trimester
o Adequate Intake (AI) for calcium 1,300 mg per day for women aged 14-18 years
o 3-4 servings of milk, cheese, or yogurt per day
o Recommended Dietary Allowance (RDA) 600 mcg dietary folate equivalents
during pregnancy (tolerable upper limit 800 mcg per day for adolescents aged 1418 years)
o Reference - J Am Diet Assoc 2002 Oct;102(10):1479 full-text
counsel on prenatal vitamins
o
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Additional information:
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counsel on smoking cessation if appropriate

self-hypnosis preparation for labor and delivery may reduce complications and
surgery in pregnant adolescents (level 2 [mid-level] evidence)
o based on small randomized trial
o 47 teenage patients enrolled before 24 weeks gestation were randomized to
childbirth preparation in self-hypnosis vs. control group with supportive
counseling and similar amount of social contact
o comparing self-hypnosis vs. control
 22 vs. 20 patients completed the research protocol
 1 vs. 8 had hospital stay > 2 days (p = 0.008)
 0 vs. 12 had surgical intervention (p < 0.001, NNT 2)
 12 vs. 17 had complications (p = 0.047)
o Reference - J Fam Pract 2001 May;50(5):441
Postpartum management

parenting programs may improve teenage parent and child interactions (level 2
[mid-level] evidence)
o based on Cochrane review of trials with methodologic limitations
o systematic review of 8 randomized trials evaluating parenting programs in 513
teenage parents
o methodologic limitations included unclear or inadequate allocation concealment
and blinding of outcome assessors
o parenting programs addressed parenting attitudes, practices, skills/knowledge or
well-being
o comparing parent training to control (no-treatment, waiting list or treatment-asusual)
 parent training associated with
 increased parental responsiveness to child postintervention (p =
0.04) in analysis of 2 trials with 46 teenage parents

o
increased infant responsiveness to mother at follow-up (p = 0.03)
in analysis of 2 trials with 47 teenage parents
 increased combined parent-child interactions postintervention and
at follow-up (p < 0.05) in analysis of 2 trials with 46 teenage
parents
Reference - Cochrane Database Syst Rev 2011 Mar 16;(3):CD002964
Prevention
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

responsibilities of pediatric health professionals(1)
o ensure adolescents have knowledge of and access to contraception
o encourage adolescents to postpone early sexual activity
o encourage parents to educate children and adolescents on responsible sexuality
most successful pregnancy-prevention programs include(1)
o contraception information and availability
o abstinence promotion
o sex education
o job training
o school-completion strategies
both primary and secondary prevention programs should focus on highest risk
adolescents and include males(1)
combination educational and contraceptive interventions might lower unintended
pregnancy rate among adolescents (level 2 [mid-level] evidence)
o based on Cochrane review of trials with methodologic limitations and borderline
statistical significance
o systematic review of 41 individually- and cluster- randomized trials evaluating
interventions to improve knowledge of risk reduce unintended pregnancies in
95,662 adolescents aged 10-19 years
o most trials had unclear or inadequate allocation concealment and unclear
randomization sequence generation; 6 trials had blinding of outcome assessor
o follow-up ranged 3 months to 4.5 years
o heterogeneity in trial populations, interventions, and outcomes precluded metaanalysis for most comparisons
o comparing combination of education and contraceptive interventions to control
 trend toward lower rate of unintended pregnancy with in analysis of 2
individually randomized trials (p = 0.069) and of 4 cluster randomized
trials (p = 0.083)
 significant reduction in unintended pregnancy in 2 of 6 trials that could not
be included in meta-analysis
o inconclusive evidence for effect on
 initiation of sexual intercourse
 use of birth control
 abortion
 childbirth
 sexually transmitted diseases
o insufficient evidence to compare different interventions
o

Reference - Cochrane Database Syst Rev 2009 Oct 7;(4):CD005215
comprehensive sex education (but not abstinence-only education) might reduce risk
for teen pregnancy (level 2 [mid-level] evidence)
o based on retrospective survey
o 1,719 never-married heterosexual adolescents aged 15-19 years reported on
formal sex education received before first sexual intercourse
o teen pregnancy rates were lower in adolescents who received comprehensive sex
education compared to no formal sex education (adjusted odds ratio 0.4, 95% CI
0.22-0.69)
o abstinence-only education not associated with significant reduction in teen
pregnancy rates (adjusted odds ratio 0.7, 95% CI 0.38-1.45)
o no significant differences comparing either type of formal sex education with no
formal sex education for
 reporting having engaged in vaginal intercourse (although marginal
associated with lower risk with comprehensive sex education)
 reported sexually transmitted disease diagnoses
o Reference - J Adolesc Health 2008 Apr;42(4):344

combination intervention focused on sexual risk behaviors and psychosocial factors
might increase contraceptive use in adolescent girls (level 2 [mid-level] evidence)
o based on randomized trial without attention control
o 253 adolescent girls aged 13-17 years at high-risk for pregnancy and seeking
clinic services randomized to intervention program plus usual clinic services vs.
usual clinic services alone for 18 months
o intervention included one-on-one case management with monthly visits focused
on sexual risk behaviors and psychosocial factors, peer leadership components,
and self evaluations
o intervention associated with increased self-reported
 condom use consistency (p < 0.001)
 hormonal contraception use consistency (p = 0.0001)
 dual method use consistency (p = 0.01)
 stress management skills (p = 0.0001)
o Reference - Prime Time trial (J Adolesc Health 2011 Aug;49(2):172)

abstinence-only intervention may decrease sexual activity (level 3 [lacking direct]
evidence)
o based on randomized trial without clinical outcomes
o 662 African American students (mean age 12.2 years old) randomized to 1 of 4
groups and followed for 24 months
 abstinence-only intervention for 8 hours
 safer sex-only intervention encouraging condom use for 8 hours
 combination abstinence and safer sex intervention for 8 or 12 hours
 health-promotion control targeting issues unrelated to sexual behavior for
8 hours
o abstinence-only intervention associated with (vs. health promotion control)

o
o



decreased risk of having intercourse if had not already (relative risk [RR]
0.67, 95% CI 0.48-0.96)
 decreased risk of intercourse in last 3 months (RR 0.94, 95% CI 0.9-0.99)
 no change in consistent condom use or unprotected sexual intercourse
no significant differences compared to health promotion control in any other
groups
Reference - Arch Pediatr Adolesc Med 2010 Feb;164(2):152
multidimensional treatment foster care may reduce pregnancy risk in teens in
juvenile justice system (level 2 [mid-level] evidence)
o based on cohort of 116 girls aged 13-17 years with history of criminal referrals
randomized to multidimensional treatment foster care vs. group care
o 26.9% of girls in multidimensional treatment foster care became pregnant
compared to 46.9% of girls in group care (p < 0.05)
o Reference - J Consult Clin Psychol 2009 Jun;77(3):588
early childhood interventions and youth development programs appear to reduce
teenage pregnancy (level 2 [mid-level] evidence)
o based on systematic review of trials of low to moderate quality
o systematic review of 10 controlled trials and 5 qualitative studies of early
childhood interventions or youth development programs and subsequent rates of
teenage pregnancy
o overall pooled teenage pregnancy reduced with any intervention vs. no
intervention (relative risk 0.61 [95% CI 0.48-0.77])
o main themes associated with teenage pregnancy based on qualitative studies
 dislike of school
 poor material circumstances and unhappy childhood
 low expectations for the future
o Reference - BMJ 2009 Nov 12;339:b4254 full-text
see Contraception overview or related summaries
o Emergency contraception
o Oral contraceptives
o Contraceptive patch and vaginal rings
o Injectable contraceptives
o Implantable contraceptive devices
o Intrauterine device (IUD)
o Tubal sterilization
o Vasectomy
Subsequent pregnancies:

depressive symptoms may be risk factor for subsequent pregnancy in teenager
o based on secondary analysis of cohort study with borderline statistical
significance
o 269 teens in prenatal care (mostly African American with low income) completed
follow-up questionnaires 1-2 years postpartum
o 46% had depressive symptoms at baseline
o
o

49% had subsequent pregnancy at mean 11.4 months
depressive symptoms associated with subsequent pregnancy (hazard ratio 1.44, p
= 0.05 in adjusted analysis)
o Reference - Arch Pediatr Adolesc Med 2008 Mar;162(3):246
motivational interventions may not substantially reduce subsequent births in teens
(level 2 [mid-level] evidence)
o based on randomized trial with allocation concealment not stated
o 235 pregnant teenagers aged 12-18 years who were > 24 weeks gestation
randomized to 1 of 3 treatments and followed to 24 months after index birth
 computer-assisted motivational intervention plus enhanced home visit
 computer-assisted motivational intervention
 usual care
o repeat birth rate (p vs. usual care)
 13.8% for computer-assisted motivational intervention plus enhanced
home visit (p = 0.08)
 17.2% for computer-assisted motivational intervention (not significant)
 25% for usual care
o Reference - Ann Fam Med 2009 Sep-Oct;7(5):436
Guidelines and Resources
Guidelines:

American Academy of Pediatrics (AAP) Committee on Adolescence
o policy statement on contraception and adolescents can be found in Pediatrics 2007
Nov;120(5):1135 full-text
o guideline on adolescent pregnancy can be found in Pediatrics 2005
Jul;116(1):281 full-text, summary can be found in Am Fam Physician 2005 Oct
1;72(7):1398
o policy statement on emergency contraception can be found in Pediatrics 2005
Oct;116(4):1026 full-text, commentary can be found in Pediatrics 2006
Apr;117(4):1448 full-text
o guideline on condom use by adolescents can be found in Pediatrics 2001
Jun;107(6):1463 full-text or at National Guideline Clearinghouse 2002 Jul 8:3083
(reaffirmed 2004 Oct)
o guideline on counseling adolescents about pregnancy options can be found in
Pediatrics 1998 May;101(5):938 full-text
o statement on confidentiality regarding abortion can be found in Pediatrics 1996
May;97(5):746
o statement on condom availability for youth can be found in Pediatrics 1995
Feb;95(2):281

American Academy of Pediatrics (AAP) policy statement on healthcare for youth in
juvenile justice system can be found in Pediatrics 2011 Dec;128(6):1219







Faculty of Family Planning and Reproductive Health Care (FFPRHC) guidance on
contraceptive choices for young people can be found in J Fam Plann Reprod Health Care
2004 Oct;30(4):237 or at National Guideline Clearinghouse 2005 Sep 5:7096
National Commission on Adolescent Sexual Health guideline on adolescent sexuality and
teen pregnancy prevention can be found in J Pediatr Adolesc Gynecol 1999
Nov;12(4):185
Society for Adolescent Medicine position paper on reproductive health care for
adolescents can be found in J Adolesc Health 1991 Dec;12(8):649
American College of Obstetricians and Gynecologists (ACOG) Committee Opinion 448
on menstrual manipulation for adolescents with disabilities can be found in Obstet
Gynecol 2009 Dec;114(6):1428
American Dietetic Association (ADA) position paper on nutrition and lifestyle for
healthy pregnancy outcome can be found in J Am Diet Assoc 2008 Mar;108(3):553
Mexican College of Obstetrics and Gynecology (Colegio Mexicano de Especialistas en
Ginecologa y Obstetricia) guidelines on prenatal monitoring in adolescents can be found
in Ginecol Obstet Mex 2009 May;77(5):S129 [Spanish]
Haute Autorité de Santé conseils pour grossesses à risque: orientation des femmes
enceintes entre les maternités en vue de l'accouchement se trouvent sur le site Haute
Autorité de Santé 2009 Dec [French]
Review articles:




review of pregnancy prevention in adolescents can be found in Am Fam Physician 2004
Oct 15;70(8):1517 full-text, editorial can be found in Am Fam Physician 2004 Oct
15;70(8):1457 full-text
review of teen pregnancy prevention can be found in J Pediatr Adolesc Gynecol 1999
Nov;12(4):185
review of contraception for adolescents can be found in Pediatrics 2001
Mar;107(3):562 full-text
review of contraception for adolescents can be found in West J Med 2000
Mar;172(3):166 full-text
Patient Information
Patient information:

handout on adolescent pregnancy from American College of Obstetricians and
Gynecologists
ICD-9/ICD-10 CodesReferences
General references used:

1. Klein JD, American Academy of Pediatrics Committee on Adolescence. Adolescent
pregnancy: current trends and issues. Pediatrics. 2005 Jul;116(1):281-6. full-text,
summary can be found in Am Fam Physician 2005 Oct 1;72(7):1398


2. Counseling the adolescent about pregnancy options. American Academy of Pediatrics.
Committee on Adolescence. Pediatrics. 1998 May;101(5):938-40. full-text
3. Polaneczky M, O'Connor K. Pregnancy in the adolescent patient. Screening, diagnosis,
and initial management. Pediatr Clin North Am. 1999 Aug;46(4):649-70
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