Babies of young teens at high risk of complications

April 20, 2015

NASPAG 29th conference featured research on the increased risk of complications in teen pregnancy, the desire on over-the-counter contraception, and a tool to help identify patients with menorrhagia.

Risks of preterm delivery, low and very low birthweight, and death are higher in babies born to young teens than to older teens and young adults. The findings, from a population-based study presented at the NASPAG 29th Annual Clinical Research Meeting, may help clinicians counsel and care for the youngest mothers throughout pregnancy and delivery.

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Researchers from the University of Washington analyzed data on singleton births at 24 to 43 weeks to nulliparas in Washington State from 1987 to 2009 for the retrospective report. They compared method of delivery and secondary outcomes in adolescents aged 11 to 14, teens aged 18 to 19, and young adults aged 20 to 24. Secondary outcomes reviewed were postpartum hemorrhage, shoulder dystocia, third- and fourth-degree perineal lacerations, chorioamnionitis, maternal length of stay, gestational age at delivery, birthweight, respiratory distress syndrome, neonatal length of stay, and neonatal and infant death.  Multivariate logistic regression was used to look at the association between age and delivery outcomes.

For adolescents aged 11 to 14, risk of cesarean and operative vaginal delivery was lower but maternal length of stay was increased compared with women aged 20 to 24 (OR, 0.67; 95% CI, 0.58-0.78; OR, 0.77; 95% CI, 0.72-0.84; and OR 1.52; 95% CI, 1.33-1.74, respectively). Young adolescents also had increased rates of preterm delivery (OR, 2.11; 95% CI 1.79-2.48), low and very-low-birthweight (OR, 2.08; 95% CI, 1.73-2.50 and OR, 3.25; 95% CI 2.22-4.77, respectively), and infant death (OR 3.09; 95% CI, 2.36-6.44). 

NEXT: Teens and OTC contraceptives

 

Facebook Survey: Teens want OTC contraception

Results of a survey presented at the NASPAG 29th Annual Clinical Research Meeting suggest that adolescents favor making oral contraceptives (OCs) available over the counter (OTC) without age restriction. Doing so, the authors said, might increase use of OCs by adolescents-particularly those who are already having sex.

Facebook ads were used by researchers from the Jane Fonda Center for Adolescent Reproductive Health at Emory University to recruit adolescents aged 14 to 17 during September 2014. The goal was to explore adolescents’ attitudes toward OTC OCs. To the authors’ knowledge, this is the first study to look at how a move to OTC status for OCs might impact teens.

The Facebook ads received 3720 clicks, which resulted in completion of the survey by 348 adolescents. Approximately a third of the respondents (32%) were aged 17, 31% were 16, 24% were 15, and 13% were aged 14. Seventy-nine percent of the participants identified as white. Overall, the respondents came from 44 states with an equal geographic distribution; 53% lived in suburban areas, 41% had private insurance and 33% had public health insurance.

Nearly half (44%) of the teens were sexually active, 60% of whom said they had unprotected sex and 12% of whom reported having been pregnant. Half of the respondents had used contraception.

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Of the respondents, 73% were in favor of OTC access to OCs for teens and 61% said they were likely to use OCs if they were available OTC. Adolescents who had used contraception and who were sexually active were statistically significantly more likely to support OTC access to OCs (P<.001 for both relationships). The same was true for being likely to use OCs, were they available OTC (P<.001 for the relationships with use of contraception and being sexually active). Respondents supportive of unrestricted OTC access to OCs were more likely to be white, but that association was not statistically significant (P=.003). Age, geographic region, rural/urban location, health insurance status, and pregnancy history did not influence support for or likelihood of use of OTC OCs.

NEXT: A tool to diagnose menorrhagia

 

New tool may identify teens with heavy menstrual bleeding

A patient-reported questionnaire developed by researchers in Cincinnati may help clinicians identify teens with menorrhagia, according to results of project profiled at the NASPAG 29th Annual Clinical Research Meeting.  In the future, the authors said, they may use the survey-called the Menorrhagia Assessment Tool (MAT)-to evaluate response to treatment.

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Administered to all new patients aged 9 or older who present to the Pediatric and Adolescent Gynecology clinic at Cincinnati Children’s Hospital Medical Center, MAT includes questions on bleeding severity, spontaneous bleeding symptoms, and personal and family history of anemia. Bleeding severity questions are scored, with each question receiving a 0, 1, or 2. Patients diagnosed with menorrhagia based on MAT results are entered into a menorrhagia registry and receive work-up for heavy menstrual bleeding.

For the study presented at the NASPAG conference, researchers compared the total MAT score and the score on each of the five questions on the survey from 576 patients in the menorrhagia registry with data from 954 clinic patients with other primary diagnoses from January 1 through December 31, 2013.  Menorrhagia scores for the two groups were statistically significantly different (5.04 + 3.97 vs 3.66 + 2.84; P<.0001) as were scores for individual measures of bleeding severity (P<.0001).

The results, the authors said, reinforce results from a prior revaluation of MAT that found it to be a psychometrically sound and reliable, noninvasive way of evaluating menstrual bleeding symptoms in patients with menorrhagia.