The United Kingdom has the highest rate of teen pregnancyin Western Europe.
While there is copious data in the literature on teen pregnancy, many of the studies are somewhat dated. Furthermore, many originatein the USA and caution is required when extrapolating this datato the UK situation.
In recent years the rate of teen conception has fallen steadily in the USA and Europe. In 2004 the conception rate in Englandwas 41.5 per 1000 girls aged 15?17 years, representingan overall decline of 11.1% since 1998. However, the UK stillhas the highest rate of teen pregnancy in Western Europe,while the USA possesses the highest rate in the world at 43.0per 1000.
Teen Pregnancy Statistics
Teen pregnancy statistics are shown in Figure 1
Teen pregnancy, birth and pregnancy termination rates in the USA (www.cdc.gov)
It is important to recognise that teen pregnancy can be a positive life choice for some young women, particularly those from certain ethnic or social groups. In some South Asian ethnic groups in the UK, rates of teen pregnancy within marriageare high. Ethnicity and culture play a role and are an important consideration for healthcare professionals and for statisticalpurposes.
The higher rates of teen pregnancy tend to be concentratedin inner cities and are linked to poverty. Multiple socioeconomic risk factors have been identified.
Teens from unskilled manual backgrounds (social class V)are 10 times more likely to become teen mothers than thosefrom professional backgrounds (social class I). Teens fromsocially deprived areas are up to six times more likely to becomepregnant than teens from other areas and are much less likelyto opt for a termination.
Young people scoring below average on measures of educational achievement at ages 7 and 16 years have been found to be at significantly increased risk of becoming teen parents, especially those whose performance declines between these ages.
Women who were themselves children ofteen mothers are more likely to have a teen pregnancycompared with those born to older mothers and the offspringare at risk for becoming teenaged mothers or fathers themselves. 2003-01
Risk of Teen Pregnancy
The risks of teen pregnancy including premature delivery, infants being small for gestational age, low birthweight and increased neonatal mortality, anaemia and pregnancy-induced hypertension.1994-01, 1995-01, 1996-01, 1999-01
In the long termthe offspring of adolescents have poorer cognitive development,lower educational attainment, more frequent criminal activityand a higher risk of abuse, neglect and behavioural problemsduring childhood. 2002-01
Despite the magnitude of the problem, it is unknown whetherthe poor outcomes of teen pregnancy are partly attributableto the biological challenges presented by young maternal ageor whether they are solely the consequence of sociodemographicfactors. Sociodemographic variables associated with teenpregnancy undoubtedly increase the risk of adverse outcomes.However, recent studies have demonstrated that the relativerisk remains significantly elevated for both younger and olderteen mothers after adjustment for marital status, level ofeducation and adequacy of prenatal care. 2001-01
The high risk of adverse pregnancy outcome in the adolescenthas been attributed to gynaecological immaturity and the growthand nutritional status of the mother. Gynaecological immaturity undoubtedly predisposes adolescent girls to poor pregnancy outcomein that the rates of spontaneous miscarriage and of very pretermbirth (<32 weeks of gestation) are highest in girls aged 13?15 years. However, maternal growth and nutritionalstatus during pregnancy also appear to play a potentially modifiable role. Many adolescent girls retain the potential to grow while pregnant. Data from a study from Camden, New Jersey, 1990-01 one ofthe poorest cities in the USA, has shown that almost 50% ofadolescents continue to grow while pregnant. This growth isassociated with larger pregnancy weight gains, increased fatstores and greater postpartum weight retention than in non-growingadolescents and mature women. Paradoxically, in spite of thechanges typically associated with increased fetal size (largerpregnancy weight gains, increased fat stores), the offspringare smaller in growing than non-growing adolescents. This significantreduction in fetal growth rate is attributed to a competitionfor nutrients between the maternal body and the gravid uterus.Clearly, there is a complex interplay between socioeconomic and biological factors that influences the outcome of teen pregnancy.
Interestingly, while the incidenceof teen pregnancy is declining in the UK, the proportionof teen girls smoking has remained unchanged and in someareas is increasing.1995-02 This is an important clinical problemas smoking compounds the potential for adverse outcomes of adolescentpregnancy, particularly intrauterine growth restriction. Thebirthweight-for-gestational-age curves of smoking adolescentsshow a marked fall-off in weight from 36 weeks of gestation.Furthermore, at least 10% of adolescent smokers have pregnanciesaffected by severe early onset (before 32 weeks of gestation)fetal growth restriction.2006-01
Smoking during pregnancy is also known to be associated withan increased risk of placental abruption, preterm prematurerupture of membranes, preterm birth, stillbirth and sudden infantdeath syndrome. Research has shown that prenatal exposure totobacco smoke is a risk factor for respiratory infections, asthma, allergy, childhood cancer and adverse neurobehavioural development. 2004-01
The Centers for Disease Control and Prevention (CDCs) in theUSA analysed state-specific trends in maternal smoking during 1990?2002. 2004-02 This report indicated that participatingareas observed a significant decline in maternal smoking duringthe surveillance period while 10 states reported recent increasesin smoking by pregnant teens. The widespread public health messageto abstain during pregnancy has helped decrease maternal smoking.To reduce prevalence further, implementation of additional interventionsis required.
Teen pregnancy nutrition
Teens may have poor eating habits and neglect to take their vitamin supplements and even in teen pregnancy nutrition is poor. They are less likely than older women tobe of adequate pre-pregnancy weight or to gain an adequate amountof weight during pregnancy. 2003-02 Low weight gain increases therisk of having a low birthweight baby. This is frequently compoundedby adverse social circumstances.
Postnatal depression and difficulties with breastfeeding.
There is evidence that teen mothers are more likelyto suffer from postnatal depression than older mothers. 1998-01 Furthermore, one study reported a 37?54% reduction in milkproduction 6 months after childbirth in adolescents comparedwith older mothers. 1997-01
While there is no evidence, to date, of medical interventions that can specifically improve pregnancy outcome, we must ensure that teen mothers receive supportive care and are directed towards the social support they need. Smoking cessation shouldbe targeted and attendance at an antenatal clinic encouraged.In addition, effective postnatal counselling, particularly regarding contraception, can help prevent subsequent pregnancies and STIs.
Termination of pregnancy and adoption
Teen pregnancy is often viewed as unplanned and unwanted. However, the reality is more complex. Although approximately40% of teens in the UK terminate their pregnancies, themajority choose to continue. Over 25% will become pregnant againduring their teen years, including 18% of those who terminatetheir first pregnancy. These figures suggest that many teensbecome pregnant by design rather than by accident.
While termination and adoption are options that are availableand should be presented to the pregnant teen, the realityis that most girls choose to continue with their pregnanciesand keep their infants. It is, therefore, imperative that everyeffort is made to encourage pregnant teens to access antenatalcare and that the care they subsequently receive is tailoredto the unique needs of this age group. The healthcare professionalmust be aware of the potential complications and the opportunitiesfor intervention that exist.
Adolescents should be encouraged to attend for antenatal care from an early stage as attendance is frequently poor. Gestational age should be confirmed with early ultrasound wherever possible, although many teens present late. This is an opportunityto offer advice on nutrition and adverse habits such as smokingand alcohol use. Social support is important and many teensmay benefit from an early referral to a specialist midwife orsocial worker. Information regarding antenatal care and labourshould be provided in a format that is accessible and easilyunderstood. Caregivers should be sensitive to the potentialchallenges presented by written information, as a significantnumber of teens have literacy difficulties.
Care during labour and delivery
Where age is the only risk factor, management is usually thesame as for other labouring women. However, in very young adolescents there is an increased likelihood of obstructed labour becauseof a small, immature pelvis.
The postnatal period provides an opportunity for counsellingand education from the obstetrician, midwife, general practitioner, health visitor and social worker. Teen mothers are more likelyto have unhealthy habits that place the infant at greater riskof inadequate growth, infection and chemical dependence. Belowthe age of 20 years, the younger the mother, the greater therisk of her infant dying during the first year of life. Infantfeeding, growth and safety need to be observed. Having her firstchild during adolescence makes a woman more likely to have more children overall. Women in this group are also less likely to receive child support from the biological fathers: over 50%of children of adolescent mothers never live with their biological father. 1999-02 They are less likely to complete their education andestablish the independence and financial security that enablethem to provide for themselves and their children without outside assistance. There are, therefore, some areas that need special attention, particularly discussion regarding financial issues, returning to school and contraceptive advice.
Links to reference abstracts.
- Obstetric outcome of teenage pregnancies compared with adult pregnancies.(2008-01)
- Adolescent smoking in pregnancy and birth outcomes. (2006-01)
- Obstetric and perinatal outcomes in pregnancies associated with illicit substance abuse.(2004-01)
- Smoking during pregnancy--United States, 1990-2002. (2004-02)
- Adolescent pregnancy. (2003-01)
- Impact of maternal age and maternal somatic characteristics on newborn size.(2003-02)
- Teen-aged mothers in contemporary Britain.(2002-01)
- Does the increased risk of preterm delivery in teenagers persist in pregnancies after the teenage period?(2001-01)
- Teenage pregnancies and risk of late fetal death and infant mortality.(1999-01)
- The problem of teenage pregnancy.(1999-02)
- Young maternal age and depressive symptoms: results from the 1988 National Maternal and Infant Health Survey.(1998-01)
- Lactational performance of adolescent mothers shows preliminary differences from that of adult women.(1997-01)
- Adolescence and very low birth weight infants: a disproportionate association.(1996-01)
- Association of young maternal age with adverse reproductive outcomes.(1995-01)
- Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis.(1994-01)
- Maternal growth during pregnancy and decreased infant birth weight.(1990-01)