Journal of pediatric and adolescent gynecology最新文献

{"title":"Has the COVID-19 pandemic affected Vulvovaginitis in Prepuberty and Adolescent Females in China? A retrospective study of 4 644 cases during 2018-2021.","authors":"Huihui Gao, Sunyi Wang, Mingming Zhou, Yuchen Zhang, Charleen Cheung, Symphorosa S C Chan, Changzheng Yuan, Liying Sun","doi":"10.1016/j.jpag.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.06.006","url":null,"abstract":"<p><strong>Objective: </strong>Vulvovaginitis (VV) is one of the most common gynecologic complaints in prepubertal and adolescent girls. However, data on the impact of the COVID-19 pandemic on VV in this population are limited. This study aimed to explore changes in the epidemiology, pathogenic patterns, and antibiotic susceptibility of VV in girls before and during the COVID-19 pandemic in China.</p><p><strong>Methods: </strong>A retrospective study was conducted in girls aged 0-18 years who were diagnosed with VV from January 2018 to December 2021.</p><p><strong>Results: </strong>A total of 4 644 cases of VV were identified, including 2 427 cases from 2018-2019 (before the COVID-19 pandemic) and 2 217 cases from 2020-2021 (during the COVID-19 pandemic). The proportion of VV cases in the 0-6-year age group decreased significantly from 40.2% to 31.3%, whereas the proportion in the 10-18-year age group increased from 30.1% to 39.6%. The major pathogens identified from 2020-2021 were similar to those detected from 2018-2019. The detection rates of Haemophilus influenzae, Streptococcus pyogenes, and Streptococcus pneumoniae decreased during the COVID-19 pandemic. In contrast, the detection rates of Escherichia coli, Klebsiella pneumoniae, and Candida albicans increased. Antibiotic susceptibility testing revealed that the sensitivity of Haemophilus influenzae to ampicillin/sulbactam and amoxicillin/clavulanate increased by 5.6% and 13.4%, respectively, after the pandemic. In contrast, levofloxacin sensitivity in Escherichia coli decreased by 20.3% after the pandemic.</p><p><strong>Conclusion: </strong>Our findings provide evidence-based guidance for appropriate antibiotic use and facilitate the optimization of therapeutic strategies and lifestyle recommendations for prepubertal and adolescent girls with VV.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Complexity: Advanced Visualization for Müllerian Anomalies and its implications for diagnoses and surgical planning.","authors":"Anat From, Tania Dumont, Sukhbir Singh, Shauna Duigenan, Teresa Flaxman","doi":"10.1016/j.jpag.2025.06.005","DOIUrl":"10.1016/j.jpag.2025.06.005","url":null,"abstract":"<p><strong>Background: </strong>Obstructive Müllerian anomalies present diagnostic and surgical-planning challenges, often requiring multiple imaging studies and prolonged medical management. Three-dimensional (3-D) modelling and virtual-reality (VR) visualization may improve anatomic understanding, counselling, and operative safety.</p><p><strong>Case: </strong>A patient first evaluated at 15 years of age for primary amenorrhoea and cyclic pain underwent eight MRIs and six ultrasounds over seven years. Imaging progressively clarified complete proximal vaginal agenesis, a left unicornuate uterus with functioning endometrium, a non-communicating right rudimentary horn, bilateral hydrosalpinges, and, ultimately, obstructive haematometra. Despite sequential hormonal suppression (combined oral contraceptives, depot-medroxyprogesterone acetate, dienogest, norethindrone acetate) and vaginal dilation, pain recurred. Multidisciplinary consultations explored fertility-preserving reconstruction versus definitive surgery. At 23 years of age, severe acute pelvic pain, and a 12 cm haematometra led to admission.</p><p><strong>Intervention: </strong>High-resolution T2-weighted MRI obtained one week before surgery was segmented post-operatively with ElucisNext to create a patient-specific 3-D model. Definitive management, selected because of intractable pain and complex congenital heart disease (repaired double-outlet right ventricle with Glenn shunt), was total abdominal hysterectomy, left salpingo-oophorectomy, right salpingectomy, bilateral ureterolysis, adhesiolysis, and cystoscopy.</p><p><strong>Outcomes: </strong>VR review highlighted a blind cervix, absent proximal vagina, and ureters coursing in close proximity to the dilated horn. These findings underscored the prudence of prophylactic ureterolysis and illustrated anatomical barriers to creating a functional neovaginal-cervical connection. Although the model was constructed post-operatively, prospective use could have enhanced fertility counselling, guided earlier surgical decisions, and served as a rehearsal tool for trainees.</p><p><strong>Conclusions: </strong>Post-operative VR reconstruction of pre-operative MRI demonstrated tangible educational and planning value. Routine prospective VR adoption for complex Müllerian anomalies may optimize counselling, resident education, and surgical safety.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Primary Ovarian Failure in an Adolescent Associated with a Homozygous Pathogenic Variant in the Mitochondrial Poly-A-Polymerase Gene (MTPAP).","authors":"Jessy Epstein, Simrat Veera, John Pappas, Bina Cherryl Shah","doi":"10.1016/j.jpag.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.06.001","url":null,"abstract":"<p><strong>Background: </strong>Primary ovarian insufficiency (POI) is ovarian dysfunction that leads to suboptimal estrogen production and irregular or absent menses. Many causes of POI are idiopathic. Genetic testing may help identify novel causes of POI.</p><p><strong>Case presentation: </strong>An adolescent female presented with primary ovarian insufficiency. Her hormonal workup was significant for hypergonadotropic hypogonadism. She was found to have a likely pathogenic variant in the MTPAP gene on whole exome sequencing. This nuclear gene encodes a polymerase that affects mitochondrial mRNA degradation.</p><p><strong>Conclusion: </strong>Ovarian tissue is highly reliant on mitochondria for steroidogenesis. A genetic variant that affects mitochondrial function, such as the one in our patient, is likely to have profound effects on ovarian function. We hypothesize that this patient's variant in the MTPAP gene caused POI.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FSH Receptor Variant: An Unusual Cause of Secondary Amenorrhea.","authors":"Oluwatosin O Cooper, Elisabeth H Quint, Yolanda R Smith, Melina L Dendrinos","doi":"10.1016/j.jpag.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.06.002","url":null,"abstract":"<p><strong>Introduction: </strong>Secondary amenorrhea with high Follicle Stimulating Hormone (FSH) levels and low estradiol is typically diagnosed as primary ovarian insufficiency (POI) in individuals under the age of 40. Low anti-mullerian hormone (AMH) levels support the diagnosis of POI, but normal AMH levels warrant additional evaluation.</p><p><strong>Case presentation: </strong>A 19-year-old female with menarche at age 12 experienced secondary amenorrhea at age 14.5. Initial evaluation showed elevated gonadotropins and low estradiol, which were confirmed on repeat testing. Normal karyotype, no FMR1 repeat expansion, negative autoimmune markers, and normal AMH levels were found. Genetic testing revealed two Follicle Stimulating Hormone Receptor (FSHR) gene variants with high suspicion of pathogenicity.</p><p><strong>Discussion: </strong>Pathogenic variants in the FSHR gene are an uncommon cause of secondary amenorrhea. Atypical POI cases with a normal AMH level should be evaluated with a genetic consultation.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the dedicated teenage pregnancy service in a tertiary Obstetric unit in the Republic of Ireland from 2005-2022.","authors":"Eimer G O'Malley, Tara Ibrahim, Deborah Browne, Geraldine Connolly, Nikita Deegan","doi":"10.1016/j.jpag.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.05.007","url":null,"abstract":"<p><strong>Study objective: </strong>This study aimed to evaluate teenage pregnancy rates, outcomes, and demographic shifts from 2005 to 2022 in a large, tertiary maternity hospital with a dedicated teen pregnancy service, considering evolving ethnic profiles, changing parity, and national developments in reproductive healthcare.</p><p><strong>Methods: </strong>Prospectively gathered data from annual reports, medical records, and the teenage pregnancy service included maternal age, ethnicity, parity, chlamydia screening, delivery mode, birth weight, and neonatal outcomes. Descriptive statistics and comparative analyses were performed.</p><p><strong>Results: </strong>Teenage pregnancy declined from 3.3% (2005) to 1.8% (2022), mirroring national trends. However, the proportion of Roma mothers rose from 11.5% in 2015 to 43.5% in 2022. Delivery outcomes were stable, with higher spontaneous vaginal delivery rates compared to the general obstetric cohort delivering an infant >/=500g. Neonatal outcomes, including preterm birth, low birth weight, and stillbirth, remained consistently low. Despite targeted measures, attendance at the six-week postnatal clinic remained poor, signalling ongoing challenges in postpartum engagement and follow-up for this cohort overall.</p><p><strong>Conclusions: </strong>Teenage pregnancy rates fell alongside improved contraception access, education, and socioeconomic factors. Yet, the increasing representation of Roma mothers underscores the need for culturally appropriate interventions to address healthcare inequities. Stable obstetric outcomes suggest effective antenatal care, but poor postnatal attendance highlights an area for improvement. Strengthened postpartum support and tailored services are essential to ensure optimal outcomes for teenage mothers, particularly those from marginalised ethnic backgrounds. Expanding immediate postpartum contraception services, reinforcing mental health support, and fostering community partnerships may further enhance outcomes for adolescent parents.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstrual Dysphoria and Preferences for Menstrual Suppression in Transgender and Gender-Diverse Youth.","authors":"Öykü Sarıkaya, Melis Pehlivantürk Kızılkan, Zeynep Tüzün, Koray Başar, Zeynep Alev Özön, Orhan Derman, Sinem Akgül","doi":"10.1016/j.jpag.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.05.006","url":null,"abstract":"<p><strong>Introduction: </strong>Menstruation can present a significant challenge for transgender and gender-diverse (TGD) individuals. While menstrual suppression can help alleviate this experience, research on the topic remains scarce. This study aimed to assess menstruation-related discomfort experienced by TGD individuals and to identify their preferences for menstrual suppression methods MATERIAL AND METHOD: This cross-sectional study was conducted between December 2021 and September 2023 with a sample of TGD individuals (n=21) aged 12-24, experiencing menstrual dysphoria. Participants completed an initial questionnaire assessing menstruation-related discomfort, followed by counseling on menstrual suppression options, including combined oral contraceptives, progestin-only pills, depot medroxyprogesterone acetate injection, levonorgestrel-releasing intrauterine device, and the etonogestrel implant. A second questionnaire evaluated factors influencing method preferences and documented the chosen suppression method. Descriptive statistical analyses were performed, with continuous variables presented as mean ± standard deviation and ordinal variables as numbers and percentages.</p><p><strong>Results: </strong>The conditions most frequently associated with severe discomfort related to menstruation were gender incongruence (81%), the carrying and use of menstrual products (95.2%), and the purchase of menstrual products (85.7%). The most popular method of menstrual suppression was combined oral contraceptives (63.1%). Several factors were identified as influencing the choice of method, including the estrogen content, frequency of use, and the necessity of a gynecological examination or visiting a different health facility.</p><p><strong>Conclusions: </strong>The study underscores the considerable distress that menstruation can cause in TGD youth. Moreover, the importance of personalized, patient-centered counseling is emphasized, with the objective of empowering individuals to make decisions based on their specific needs.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Impact of the Affordable Care Act on the Teen Birth Rate, Access to Care, and Cesarean Section Births in Pennsylvania.","authors":"John Omole-Matthew, Heather B Edelblute, Zeinab Baba","doi":"10.1016/j.jpag.2025.05.005","DOIUrl":"10.1016/j.jpag.2025.05.005","url":null,"abstract":"<p><strong>Study objective: </strong>The teen birth rate in the United States has been relatively higher than in other developed countries. Given the complexity of this issue, this study aimed to use state-level birth data to examine changes in teen birth rates, access to care, and birth outcomes in pregnant teenagers before and after implementation of the Affordable Care Act (ACA).</p><p><strong>Methods: </strong>This is a retrospective cross-sectional study of births to mothers aged 13-19 in Pennsylvania between 2008 and 2012 (pre-ACA) and 2015 and 2018 (post-ACA).</p><p><strong>Results: </strong>A total of 52,180 pre-ACA and 21,994 post-ACA births were included in this study. The mean age at birth increased from 17.9 years to 18.0 years from the pre- to post-ACA period. The overall teen birth rate declined from 10.0% to 5.0%, a 50% reduction. The largest decrease in teen births from pre-ACA to post-ACA was seen in the non-Hispanic Black population, whose teen birth rate declined by 55%. There was also an increase in Medicaid-paid births and in first trimester prenatal care and a reduction in Cesarean sections from the pre-ACA to post-ACA period.</p><p><strong>Discussion: </strong>Overall, our findings indicate that the implementation of the ACA contributed to decreased teen birth rates in Pennsylvania and reduced racial disparities in the incidence of teen births. This decline and improved prenatal care usage point to how the implementation of comprehensive sexual education and improved access to care through the ACA promote maternal health and prevent births for young women.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences and Experiences of Parents/Guardians of Adolescents and Young Adults with Epilepsy and Intellectual Disability Regarding Decision-Making Surrounding Contraception.","authors":"Geetha Vasudevan, Robyn Filipink, Jenna Gaesser, Traci M Kazmerski, Yoshimi Sogawa, Laura Kirkpatrick","doi":"10.1016/j.jpag.2025.05.004","DOIUrl":"10.1016/j.jpag.2025.05.004","url":null,"abstract":"<p><strong>Objective: </strong>To explore the preferences of parents/guardians of adolescents and young adults (AYAs) of childbearing potential with co-occurring epilepsy and intellectual disability (ID) regarding decision-making on contraception METHODS: We conducted semi-structured interviews with parents/guardians of female AYAs (12-28 years old) with co-occurring epilepsy and ID recruited from a tertiary-care children's hospital. We confirmed the diagnoses of epilepsy and ID with the patient's neurologist and parent/guardian. All degrees of ID (eg, mild/moderate/severe) were eligible. We audio-recorded and transcribed interviews. Two coders performed qualitative thematic analysis.</p><p><strong>Results: </strong>Twenty-five parents/guardians completed the interviews. Themes included the following: (1) Parents'/caregivers' desire for birth control for their child was more centered around menstruation-related concerns rather than pregnancy prevention; (2) many parents were afraid of potential adverse effects of contraception for their children, including perceptions that risks might outweigh benefits; (3) a common important factor in contraceptive decision-making was ease of administration, and, generally, the pill form was preferred; (4) longer-acting methods, if chosen, were largely selected due to trusting recommendations from health care providers yet were often feared due to perceptions of lower ease of reversibility if problems arise, as well as greater challenges in delivery or placement.</p><p><strong>Conclusion: </strong>Findings may inform interventions to improve contraceptive care for AYAs with epilepsy and ID, including development of discussion guides and decision aids for parents/caregivers.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Outcomes in Adolescent Pregnancies: A Retrospective Analysis of 3.6 Million Deliveries from 2000 to 2019 in Florida.","authors":"Anna M Scipioni, Holly VanDeman, Jean Paul Tanner, Jason L Salemi, Jose R Duncan","doi":"10.1016/j.jpag.2025.05.001","DOIUrl":"10.1016/j.jpag.2025.05.001","url":null,"abstract":"<p><strong>Study objective: </strong>We aimed to compare the risk of adverse obstetrical outcomes in adolescent deliveries to adult deliveries in Florida, and to compare the risks between younger and older teenage deliveries.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study using a linked maternal-infant database of livebirths in Florida from 2000 to 2019. Demographic and clinical characteristics, and obstetric and neonatal outcomes of interest were compared by groups with 5-year intervals, using ages 25-29 as reference. Marginal standardization was used to estimate risk ratios (RR) and 95% confidence intervals (CI) representing the association between maternal age and outcomes of interest. A P value < .05 was considered statistically significant.</p><p><strong>Results: </strong>Of the 3,614,274 deliveries, adolescent pregnancy (10-19-year-olds) comprised 8.1% of deliveries. Teenage deliveries had higher rates of fetal growth restriction and low birth weight, and were less likely to have a cesarean birth, premature rupture of membranes, and adequate prenatal care. Preterm birth, respiratory distress syndrome, neonatal/infant death, and maternal sepsis were also significantly higher in teens, with highest rates among the youngest teen deliveries. Younger teens also had selectively increased risk of hypertensive disorders (HTNP).</p><p><strong>Conclusion: </strong>Adolescent mothers are at increased risk for several obstetric and neonatal outcomes, with the youngest mothers are at highest risk of certain outcomes. These results suggest that tailoring prenatal and intrapartum care in teenage pregnancies may be warranted, however larger studies are needed to corroborate our findings.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Developmentally-Informed Model of Adolescent Decision-Making Around Pregnancy: A Qualitative Study.","authors":"Lauren A Bell, Elizabeth I Harrison, Traci M Kazmerski, Margaret R Russell, Tahniat Syed, Nicholas Szoko, Crystal P Tyler, Laura A Kirkpatrick","doi":"10.1016/j.jpag.2025.05.002","DOIUrl":"10.1016/j.jpag.2025.05.002","url":null,"abstract":"<p><strong>Study objective: </strong>This study sought to formulate a model of the process through which adolescents and young adults (AYAs) progress when making decisions around pregnancy.</p><p><strong>Methods: </strong>We recruited United States-based participants aged 18-35 years in 2020-2021 who experienced pregnancy under age 20 across 3 pregnancy outcomes (parenting, adoption, abortion). Through semi-structured phone interviews, we explored participants' emotions around pregnancy, pregnancy disclosures, and pregnancy-related decision-making. We used qualitative analysis to identify common themes in the steps of the process experienced by participants in their decision-making and associated influences and develop a model of that process.</p><p><strong>Results: </strong>We interviewed 50 participants aged 13-19 years at the time of 1 or more pregnancies, totaling 56 pregnancies (16 parenting, 19 abortions, 18 adoptions, and 3 miscarriages). The developed Pregnancy Decision-making and Outcome Trajectories (PDOT) model incorporates varied trajectories of intention establishment/achievement. PDOT has 4 stages: 1) initial reactions, 2) intention analysis, 3) planning, and 4) action/inaction. PDOT highlights AYA potential to experience persistent uncertainty around pregnancy but also potential to express certainty and move toward thoughtful research, support-seeking, and cost/benefit analysis. PDOT also highlights the impact of barriers and facilitators that limit AYAs from or help AYAs with achieving their desired pregnancy outcome.</p><p><strong>Conclusion: </strong>Pregnant AYAs experience difficulty making and following through with decisions around pregnancy outcomes. People interfacing with pregnant AYAs can utilize this framework to give AYAs appropriate, intentional support to boost AYA agency in making decisions around pregnancy and acting on those decisions.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}