Pediatric Obstetrics Kate Debiec MD Yakima Grand Rounds
Pediatric Obstetrics Kate Debiec, MD Yakima Grand Rounds May 21, 2010
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Definition Teenage Pregnancy: Pregnancy in a woman 13– 19 years old
Deviant Mothers “Mothers who fail to meet normative expectations of the role of mothering inevitably are positioned as the deviant ‘other’ and considered unfit to parent. ” Helen Wilson and Annette Huntington Helen Wilson, Annette Huntington. Deviant (M)others: the construction of teenage motherhood in contemporary discourse. Jnl Soc Pol, 35(1): 59– 76.
The Emergence of the Teenage Mother _ Before the 1960 s, the deviant mother was poor or unmarried, without emphasis on age _ “Teenage pregnancy” emerged as a social problem in the 1960 s and 1970 s Wong, James. Information and Responsibility: The case of social kinds. Canadian Journal of Communication. Vol 25, 2, 2000
Teenage Pregnancy Becomes Visible In the 1960 s and 1970 s, teen pregnancy rates were lower than in the 1950 s _ Baby boom lead to more teens in 1960 s and 1970 s _ Declining birthrate among older, married women _ Teenagers began keeping their babies Wong, James. Information and Responsibility: The case of social kinds. Canadian Journal of Communication. Vol 25, 2, 2000
Teenage Pregnancy Becomes an “Epidemic” December 1985 October 1994 _Increased visibility lead to an “epidemic” _Once teen pregnancy was a social problem, expert knowledge was needed to solve Wong, James. Information and Responsibility: The case of social kinds. Canadian Journal of Communication. Vol 25, 2, 2000 Jan 2008
Definition of Teen Pregnancy Summary _Maternal age 13 -19 _A relatively recent concept _An epidemic?
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy Diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Teen Pregnancy in the US _ Teen pregnancies result in 42. 5 births per 1, 000 women aged 15– 19 _ 2/3 of all teen pregnancies occur among 18– 19 year olds The Guttmacher Institute http: //www. guttmacher. org/pubs/fb_ATSRH. html#n 25
US Teen Pregnancy Rate by State The National Campaign to Prevent Teen and Unplanned Pregnancy Girls 15– 19, 2000 (rate per 1, 000) http: //www. thenationalcampaign. org/state-data/state-comparisions. asp? id=3&s. ID=18
The US Has One of the Highest Birth Rates Among Developed Nations Teenage birth rate/1000 women ages 15– 19 (2002) About 13 million children are born to women under age 20 worldwide, more than 90% in developing countries. Indicator: Births per 1000 women (15– 19 years)— 2002 UNFPA, State of World Population 2003 53 Niger Congo Mexico US UK Canada Switz- South North erland Korea
Is teen pregnancy an epidemic? _Teenage Pregnancy: Why the Epidemic? September 1979 _Babies Having Babies: The Epidemic of Teen Pregnancy June 1981 _Treating the Nation’s Epidemic of Teen Pregnancy June 1984 _Teen Pregnancy: A Preventable Epidemic November 2008
Births/1, 000 Teen Girls Aged 15 -19 Teen Birth Rates Have Declined Since Peak in 1957 2007 1940 1950 1960 1970 1980 1990 2000 2010 Ventura, S. J. , Mathews, T. J. , & Hamilton, B. E. (2001). Births to Teenagers in the United States, 1940 -2000. National Vital Statistics Reports, 49(10). ; Hamilton, B. E. , Sutton, P. D. , & Ventura, S. J. (2003). Revised Birth and Fertility Rates for the 1990 s and New Rates for Hispanic Populations, 2000 and 2001: United States. National Vital Statistics Reports 51(12). ; Hamilton, B. E. , Martin, J. A. , & Ventura, S. J. (2007). Births: Preliminary Data for 2006. National Vital Statistics Report, 56(7).
Why have teen birth rates decreased since the 1990 s? _ Overall abortion rates _ in use ofcontraceptives _ Sociopolitical changes? The Guttmacher Institute; Santelli, JS and Melnikas AJ. Teen fertility in transition: recent and historic trends in the US. Ann Rev. Public Health 2010. 31: 371 -383.
Births/1, 000 Teen Girls Aged 15 -19 Teen Birth Rates Increased in 2006 and 2007 1957 2007 1940 1950 1960 1970 1980 1990 2000 2010 Ventura, S. J. , Mathews, T. J. , & Hamilton, B. E. (2001). Births to Teenagers in the United States, 1940 -2000. National Vital Statistics Reports, 49(10). ; Hamilton, B. E. , Sutton, P. D. , & Ventura, S. J. (2003). Revised Birth and Fertility Rates for the 1990 s and New Rates for Hispanic Populations, 2000 and 2001: United States. National Vital Statistics Reports 51(12). ; Hamilton, B. E. , Martin, J. A. , & Ventura, S. J. (2007). Births: Preliminary Data for 2006. National Vital Statistics Report, 56(7).
Why has there been a rise in the pregnancy and birth rate since 2006? Dept. of Disputation Red Sex, Blue Sex Why do so many evangelical teenagers become pregnant? by Margaret Talbot
Prevalence and Trends Summary _ US has highest teen pregnancy rate for a developed country _ Overall, birth rates have declined since the 1950 s _ Teenage birth rates rose in 2006 and 2007 for the first time since the early 1990 s
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens & Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Hypothesis Teenage pregnancy is different than adult pregnancy.
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
The Highest Rates of Unplanned Pregnancy Are Among Women Age 20– 24 Unplanned Pregnancy Rate Per 1000 Women 20– 24 Teens 15– 19 25– 29 All Women 1981 1987 1994 2002 http: //www. thenationalcampaign. org/national-data/pdf/Unplanned-pregnancy-rates-by-age. pdf
The Majority of Teen Pregnancies are Unintended Proportion of Unplanned Pregnancies by Age Group % 2001 % % http: //www. thenationalcampaign. org/national-data/pdf/Unplanned-pregnancy-rates-by-age. pdf
Most Pregnant Teens Are Unmarried Source: National Center for Health Statistics, "Births to Teenagers in the United States, 1940 -2000, " National Vital Statistics Report, 2001, Vol. 49, No. 10.
Teen Pregnancy is a Marker for Socioeconomic Disadvantage _ Worldwide, socioeconomic disadvantage is associated with — Early age at first intercourse — Less reliance on or poor use of contraceptives — Lower motivation to avoid having a child — Lower likelihood of having an abortion once pregnant _ In the US, risk of teen pregnancy is highest for teens who are — Poor — Less educated — Black or Hispanic — Related to someone who has had a teen pregnancy Singh et al. Socioeconomic disadvantage and adolescent women’s sexual and reproductive behavior: The case of five developed countries. Family Planning Perspectives, 2001; 33(6): 251– 258 and 289. East p. L, Felice ME. Pregnancy risk among the younger sisters of pregnant and childbearing adolescents. J Dev Behav Pediatr. 1992. 13(2): 128 -36. Whitehead E. Understanding the association between teenage pregnancy and inter-generational factors: A comparative and analytical study. Midwifery 2009. 25: 145 -154. Sipsma, H. Like Father, Like Son: The Intergenerational Cycle of Adolescent Fatherhood. Am J Public Health. 2010. 100 (3): 517 -524.
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
High Schoolers Have Sex _ Currently 46. 8% of all high school students report they have had sexual intercourse _ Had intercourse at least once (2005 data): 9 th graders 10 th graders 11 th graders 12 th graders 34% 42% 51% 63% http: //www. thenationalcampaign. org/national-data/pdf/ Teen. Sex. Activity. One. Pager. June 06. pdf
There is a Concerning Amount of Coerced or Exploitive Sex Amongst Teenagers _ 8% of births to 15– 19 year olds involved unmarried minors and older males, compared with 3 percent in 1988 _ The younger the age of the mother, the more likely that the relationship involved an older man: Teen Partner ≥ 5 Mother Years Older 15 yo 40% 16 yo 27% 17 yo 24% Lindberg L D, Sonenstein F, Ku L, & Martinez G. (1997). Age Differences Between Minors Who Give Birth and Their Adult Partners. Family Planning Perspectives 29(2), 61– 66.
Fathers’ Average # Years Older The Younger the Mother, the More Likely that the Relationship Involved an Older Man 11– 12 13– 14 Maternal Age (years) 15– 19 Males, M. (1993). School-age Pregnancy: Why Hasn't Prevention Worked? Journal of School Health 63(10), 429– 432.
Teens Are More Likely Not to Use Contraception or to Use Condoms for Contraception Than Adults % of At-Risk Women Currently Using Various Birth Control Methods 2002 National Survey for Family Growth Condoms None 15– 44 15– 19 Pill Withdrawal Depo-Provera IUD 20– 24 25– 29 30– 34 35– 39 40– 44 Reproductive Age Group National Surveys of Family Growth. James Trussell and LL Wynn (January 2008). "Reducing unintended pregnancy in the United States". Contraception, http: //www. arhp. org/publications-and-resources/contraception-journal/january-2008.
Education Impacts Sexual Behavior and Contraception Primary prevention: Initiation of sexual education before a teen becomes sexually active Secondary prevention: Preventing sexual activity in sexually active teens Miller R. Preventing Adolescent pregnancy and associated risks. Canadian Family Physician. 1995: 41: 1523 -1531.
Sex Education in the US Is a Source of Contention Trends in Education Have Shifted By 2002: _ 1/3 of teens had not received any formal instruction about contraception _ Only 62% of sexually experienced female teens had received instruction about contraception before they first had sex, compared with 72% in 1995 _ 21% of females and 24% of males received abstinence education without receiving instruction about birth control, compared with 8– 9% in 1995 _ 1/4 of sexually experienced teens had not received instruction about abstinence before first sex Lindberg LD, Changes in formal sex 1995– 2002, education: 1995– 2002, Perspectives on Sexual and Reproductive Health, Lindberg LD, Changes in formal sex education: Perspectives on Sexual and Reproductive Health, 2006, 38(4): 182– 189.
Abstinence-Only Education Has NOT Been Shown to Change Sexual Activity _ No evidence that abstinence-only education delays teen sexual activity _ Abstinence-only strategies may deter contraceptive use among sexually active teens Kirby D, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001; Bearman PS and Bruckner H, Promising the future: virginity pledges and first intercourse, American Journal of Sociology, 2001, 106(4): 859– 912; Bruckner H and Bearman PS, After the promise: the STI consequences of adolescent virginity pledges, Journal of Adolescent Health, 2005, 36(4): 271– 278.
Sex Education Should Combine Abstinence and Contraceptive Education + _ Comprehensive sex ed programs — Help delay the onset of sexual activity — Number of sexual partners — Contraceptive use
Sexual Behavior and Contraception Summary _ Women become sexually active in their teens _ Sex is rare among young teens, and more common in the later teenage years _ There is a concerning amount of coerced or exploitive sex amongst teenagers _ Teens are more likely not to use contraception, or to use condoms for contraception, than adults _ There has been a shift away from providing formal sex education _ Abstinence-only education has not been shown to change sexual activity
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Early pregnancy diagnosis in adolescents may be more challenging _ “Hidden agenda” _ Barriers to pregnancy test _ In a 1997 study of ER visits in which 171 adolescent pregnancies were diagnosed and 100 were missed – < 10% mentioned the possibility of pregnancy at initial triage – ~ 10% denied sexual activity Causey, Al, et al. Pregnant adolescents in the emergency department: Diagnosed and not diagnosed. Am J Emerg Med 1997; 15: 125. Aruda, et al. Early pregnancy in adolescents: Diagnosis, assessment, options counseling and referral. J Ped Health Care 24 (1): 4.
Factors that improve likelihood of diagnosing a teen pregnancy _Complaints related to GI or GU system _Documentation of a menstrual or sexual history _Private conversation with teen Causey, Al, et al. Pregnant adolescents in the emergency department: Diagnosed and not diagnosed. Am J Emerg Med 1997; 15: 125. Aruda, et al. Early pregnancy in adolescents: Diagnosis, assessment, options counseling and referral. J Ped Health Care 24 (1): 4.
Management after pregnancy has been confirmed _Assess feelings surrounding pregnancy _Determine support system _Assist with disclosure _Evaluate for gestational age _Discuss options Aruda, et al. Early pregnancy in adolescents: Diagnosis, assessment, options counseling and referral. J Ped Health Care 24 (1): 4.
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy Diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
About 1/3 of Teen Pregnancies End in Abortion, ~ 2/3 End in a Live Birth Teen Pregnancy Outcomes, 2001– 2003 14% Miscarriage 29% Abortion 57% Live Birth http: //www. guttmacher. org/pubs/fb_ATSRH. html
A Teenage Pregnancy Is More Likely to End in Abortion Than an Adult Pregnancy _ Teen abortion rates have in the last two decades: Abortion Rate/1, 000 Teens 15– 19 1989 2004 42 20 _ 29% of pregnancies among 15– 19 year olds ended in abortion in 2002 vs. 21% among all women http: //www. thenationalcampaign. org/resources/pdf/Teen. Births_Exam. Increase. pdf
A Higher Percent of Pregnancies End in Abortion for Younger Teens 2000 Data 47% 27% Maternal Age Group (years) http: //www. childtrendsdatabank. org/indicators/14 Teen. Pregnancy. cfm 29%
Abortion Summary _ About 1/3 of teen pregnancies end in abortion, ~ 2/3 end in a live birth _ Teen abortion rates have in the last two decades _ A teenage pregnancy is more likely to end in abortion than an adult pregnancy _ Younger teens are more likely to have an abortion than older teens
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Overall, 3. 6% of Women Receive Late or No Prenatal Care http: //www. childtrendsdatabank. org/indicators/25 Prenatal. Care. cfm
Teens Are by Far the Most Likely to Receive Late or No Prenatal Care http: //www. childtrendsdatabank. org/indicators/25 Prenatal. Care. cfm
Teenage Mothers Are More Likely to Have Inadequate Prenatal Care vs. Adult Mothers Prenatal Care (Modified Kessner Index) 100% 16% Inadequate 38% 9% 32% 7% 26% 9% 5% 19% 29% Intermediate 76% 59% 67% 62% Adequate 47% Adequate Maternal Age (years) Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker m. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007 Apr; 36(2): 368 -73. Epub 2007 Jan 8.
Teens are Much More Likely to Receive Late or No Prenatal Care _ In Washington State in 1995, girls 17 and younger giving birth received late or no prenatal care almost 3 times more often than women 20 years and older Martin JA et al. , Births: final data for 2002, National Vital Statistics Reports, 2003, Vol. 52, No. 10.
What can we do to improve adequate prenatal care utilization? _Diagnose pregnancy earlier _Encourage prenatal care attendance _Connect with public resources: vouchers? _ Flynn, et al (2008): 83 low income pregnant teens vs. 216 controls Intervention: monthly RN and SW visits Outcomes: All case teens received PNC vs ~ 4% control teens with no PNC Intervention teens attended more visits (12 vs. 8) Flynn, L, et al. Enhancing resource utilization among pregnant adolescents. Public Health Nursing. 2008. 25(2): 140 -148.
Pregnant teens have a particular need for risk reduction _Tobacco, alcohol and illicit drugs are associated with poor pregnancy outcomes _Domestic violence and depression also pose risk _Screening and counseling during pregnancy decrease risky behaviors Herzig, et al. Seizing the 9 -month moment: addressing behavioral risks in prenatal patients. Pateint Education and Counseling. 2006. 61: 228 -235.
Adolescents have unique nutritional needs _ Pregnant teens eat like teenagers (Derbyshire, 2007) Too much: fat, sugar, refined foods Too little: Iron, Zinc, Calcium, Magnesium, Folate, Vitamin D, Vitamin E _ Pregnant teens have lower mean vitamin D levels compared with pregnant adults and have significantly higher nonuse of Vitamin D containing supplements (Ginde, et al. 2010) _ Anemia is common among pregnant teens (Iannotti, et al. 2005) Iannoti, et al. Iron defiiciency anemia and depleted body iron reserves are prevalent among pregnant African American adolescents. J Nutr. 2005. 135: 2572 -2577. Derbyshire, E. Nutrition in pregnant teenagers: how nurses can help. British Journal of Nursing 2007. 16(3): 144 -145. Ginde, et al. Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States. Am J Obstet Gynecol 2010. 2002: e 1 -8.
Prenatal Care Summary _ Nationally and in the state of Washington, teenage mothers are more likely to have inadequate prenatal care compared with adult mothers
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Pregnancy Outcomes Is there an increased risk of poor outcomes for teenage pregnancies?
Younger Teens Are More Likely to Experience Poor Birth Outcomes Compared with Nulliparous Women Aged 20 -29 1. 9 3. 1 1. 3 2. 5 2. 1 3. 2 1. 4 2. 3 1. 9 3. 1 1. 3 2. 2 1. 8 3. 1 1. 3 2. 5 1. 1 2. 8 1. 3 2. 5 Odds Ratios Gilbert WM, Jandial D, Field NT, Bigelow P, Danielsen B. Birth outcomes in teenage pregnancy. Journal of Maternal, Fetal and Neonatal Medicine; Nov 2004; 16, 5.
Young Teens Are at Greater Risk of Preeclampsia, Preterm Delivery, and LBW than Older Teens Pregnancy Outcomes of Adolescents vs. Control Subject at GMH, 1985– 2000 IUGR Preeclampsia 6. 14 Eclampsia Preterm Delivery LBW VLBW Cesarean Maternal Age 11– 15 year olds 16– 19 year olds Oper Vag Delivery Eure CR, Lindsay MK, Graves WL. Risk of adverse pregnancy outcomes in young adolescent parturients in an inner-city hospital. Am J Obstet Gynecol 2002 May; 186(5): 918– 20.
Pregnancy Outcomes _Is there intrinsic risk to maternal youth? or _Are adverse pregnancy outcomes associated with poor socioeconomic status, poor prenatal care, poor weight gain?
Risk of Preterm Delivery and LBW for Teens, Even When Controlled for Known Confounders Compared with 2, 006, 650 Mothers Aged 20– 24 GA at Delivery Maternal Age 10– 15 yo (n=175, 019) 16– 17 yo (n=646, 594) 18– 19 yo (n=1, 058, 101) Birth Weight • Adjusted for state of birth, race, marital status, tobacco/alcohol use, prenatal care status Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker m. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007 Apr; 36(2): 368 -73. Epub 2007 Jan 8.
isk Lower Apgars/Neonatal Mortality for Teens, R Even When Controlled for Known Confounders Compared with 2, 006, 650 Mothers Aged 20– 24 <4 Apgar Score <7 Maternal Age 10– 15 yo (n=175, 019) 16– 17 yo (n=646, 594) 18– 19 yo (n=1, 058, 101) Adjusted for state of birth, race, marital status, tobacco/alcohol use, prenatal care status A Neonatal Deaths (<28 days) B* *Further adjusted for GA & BW Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker m. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007 Apr; 36(2): 368 -73. Epub 2007 Jan 8.
Teens May or May Not Have Risk of Hypertensive Disease _ Preeclampsia is not in early or late teen pregnancies (Gilbert, 2004) _ 11– 15 yo are more likely than non- adolescents to have preeclampsia (RR 1. 33) or eclampsia (RR 3. 24) (Eure, 2002) _ 16– 19 yo are more likely than non- adolescents to have eclampsia (RR 1. 99, 95%) (Eure, 2002)
Poor Outcomes of Teen Pregnancy Include Social and Educational Risk Factors _ For the pregnant teen: — School drop out rates and gaps in education — Employment opportunities and reliance on state or federal aid _ For the child of teen pregnancy: — Hospital admission due to accidental injuries — Risk of teen pregnancy — Poor housing and nutrition Deirdre Fullerton, Rumona Dickson, Alison J Eastwood, Trevor A Sheldon. Preventing unintended teenage pregnancies and reducing their adverse effects. Quality in Health Care 1997; 6: 102 -108
Improving Outcomes Summary _ First, prevent pregnancy _ Good antenatal care is associated with improved pregnancy outcomes for teenagers _ Prenatal care that includes social and behavioral services could improve both the health of the mother and the outcome of her pregnancy _ Centering pregnancy model? Deirdre Fullerton, Rumona Dickson, Alison J Eastwood, Trevor A Sheldon. Preventing unintended teenage pregnancies and reducing their adverse effects. Quality in Health Care 1997; 6: 102 -108. Scholl TO, Hediger ML, Belsky DH. Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis. JAdolesc Health 1994; 15: 444 -56.
Pediatric Obstetrics Part 1: Introduction _ Definition of Teen Pregnancy _ Prevalence and Trends Part 2: Differences Between Teens and Adults _ Demographics _ Sexual behavior and contraception _ Pregnancy diagnosis _ Abortion _ Prenatal care _ Pregnancy outcomes _ Postpartum concerns
Goals of Postpartum Care _Provide social and psychological support for the new parent _Help complete educational goals _Prevent a 2 nd pregnancy: Provide contraception Monitor for depression Barnet, et al. Double Jeopardy: Depressive symptoms and rapid subsequent pregnancy in adolscent mothers. Arch Pediatr Adolesc Med 2008. 162 (3): 246 -252. Deirdre Fullerton, Rumona Dickson, Alison J Eastwood, Trevor A Sheldon. Preventing unintended teenage pregnancies and reducing their adverse effects. Quality in Health Care 1997; 6: 102 -108. Schreiber, CA, et al. A randomized controlled trial of the effect of advanced supply of emergency contraception in postpartum teens: a feasibility study. Contraception 2010. 81: 435 -440
Home Visitation Has an Impact Postpartum Compared with routine care, home visitation Return to school and graduation rates Adolescent Parenting Inventory scores Trend toward consistent use of contraceptive Trend toward identification of a PCP No change in repeat pregnancy rates or depression Barnet B. Effects on parenting, maternal life course and primary care linkage. Annals of Family Medicine. 2007 May-Jun; 5(3): 224 -32.
Thank you! Questions?
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