Pregnancy in Adolescence

IntroductionThere are over 14 million adolescents in the world giving birth each year, including 5.7 million in Asia, 4.5 million in Sub-Saharan Africa, 2.1 million in the Middle East and North Africa and 1.3 million in the developed countries (1). In North America, 5% of females ages 15-19 give birth each year, in contrast to 2% in Europe, 4% in Asia, 8% in Latin America and 12% in Africa (2). Approximately 750,000 adolescent pregnancies occur annually in the United States (US) to those 15 to 19 years of age; of those pregnancies delivery of a live baby occurs in 51%, while 35% end in abortion (400,000) and 14% in a miscarriage (3). Approximately 82% of adolescent pregnancies are unintended. In 2008, there were 434,758 live births to adolescent females under age 20 out of a total birth number of 4,247,696 in the US (4).Table 1 reviews teen birth rates (ages 15-19 years of age) in the US over the last part of the 20th century, indicating a drop in pregnancies since 1960, except for several years in the late 1980s and early 1990's (5). This reduction in adolescent pregnancies is noted in all teen age groups (less with those 10 to 14 years of age) and racial/ethnic groups (especially black teenagers); this drop is especially observed in the 15 to 17 year old teen (6). Considerable ethnic disparity, as reflected in Figures 1 and 2, are noted in adolescents in the US, with more pregnancies and births noted in Black and Hispanic youth than in Caucasian youth (3,7). Abortion rates among adolescents increased in the 1970s, stabilized in the 1980s, and has dropped since the late 1980's. This drop in adolescent pregnancies and abortions is due to increased availability of contraceptives as well as less youth becoming sexually active (8). However, over 40% of American teen females become pregnant at least once per year before they turn 20 and adolescent females account for 13% of all births in America and 26% of the abortions (2,9). Approximately 8% of 15-19 year old American female adolescents become pregnant each year. Most teenage pregnancies are to those 18 or 19 years of age, though there were over 12,000 pregnancies in those under age 15 in 1992 versus less than 7,000 in 1960. Teenage pregnancy under age 15 is relatively rare in the world with under 3% of women in developing countries give birth by age 15 years.The 2002 birth rate of 40 per 1000 females aged 15 to 19 years (49.6 in 1999) in the U S is the highest among developed nations; the rate is 5 per 1000 in Japan, 6 per 1000 in the Netherlands, 20 per 1000 in Canada and 31 per 1000 in the United Kingdom (10,7). The abortion rate per 1000 females (15 to 19 years of age) is 36 in the U S and is higher than the pregnancy rate in many countries (such as the Netherlands, France, Sweden) (11). Sexual activity rates among adolescents are not higher in the United States versus Western Europe. However, access to comprehensive sexuality education and availability of contraceptives is higher in Europe. Approximately half of adolescent pregnancies occur within the first 6 months after beginning sexual intercourse and American adolescents typically wait one year or more after starting sexual intercourse before seeking advice about effective contraception.Risks of adolescent pregnancyIn general, the obstetric risks for pregnant adolescents are similar to that of adults, if comprehensive prenatal care services are provided early and throughout the pregnancy (9,12).Table 2 presents a comprehensive checklist for providers to follow when caring for pregnant adolescents throughout the nine months of pregnancy.If prenatal care is not available at all, started late in the pregnancy or is not comprehensive, or the adolescent fails to seek out such care (out of shame, for example), her risks increase, leading to a two to four times increase in maternal mortality in youth versus adults.Table 3 reviews global maternal mortality statistics (1, 2, 10). …