High Risk Adolescent Pregnancy

There are quite a few things that put an expectant mother at risk for a difficult pregnancy or birth. In this article we’re going to look at the pregnant adolescent and why they are considered high-risk. 

The first thing we’ll look at is the mother’s weight. If the pregnant mom weighs less than 100 pounds, she is likely to not have enough stores for optimal fetal development, putting the infant at risk for low birthweight. Secondly, teens under age 16 may have not yet had their final growth spurt, and her pelvic bones may not have adequate room for a normal delivery…this is called a “contracted pelvis” which leads to cephalopelvic disproportion (CPD), which is a condition in which the baby is too large to fit through the birth canal.  During this time of growth in the mom, she needs a lot of calories for their own growth. If we add a fetus into the mix and neither one of them may get their caloric needs met.

When working with pregnant adolescents, it’s important to look at the factors that go beyond physiology. We need to look at the teen’s developmental stage, socioeconomic status, high-risk behaviors and psychosocial factors. 

Looking at the teen’s developmental tasks can help you develop a plan of care that is appropriate for that individual. For example, among a teen’s developmental tasks are to gain autonomy and independence, develop their identity, and have a sense of achievement. They also need to have good role models for what healthy intimate relationships look like and develop comfort with their own sexuality. 

A key factor that contributes to teen pregnancy is this invincibility that teens believe they have. It’s a “this won’t happen to me” mentality combined with a limited ability to see long-term consequences. When I worked in advertising, our messages to teens didn’t have to do with the long-term effects of teen pregnancy, they focused instead on the here and now. The point with this is that a pregnant teen may not initially realize how drastically their life is about to change, so you need to have a lot of sympathy and understanding for their point of view. They will also need a lot of teaching, so you can use the teen’s desire to gain independence to your advantage if you position your teaching as an opportunity for them to develop autonomy. 

Physiologically, the pregnant adolescent faces a lot of potential problems. One of the biggest factors is prenatal care, which a lot of teens don’t receive. This is either because of a lack of health insurance, lack of transportation or access to care, or even the knowledge that they need it. Additionally, nicotine use puts the infant at risk for premature birth, low birthweight, lung damage, birth defects and even sudden infant death syndrome while putting both mom and baby at risk for abnormal bleeding during pregnancy.  A 2018 study showed that teen mothers are 2.5 x more likely to smoke daily than their peers and that pregnant teens have higher rates of prenatal smoking. 

In order for baby to develop optimally, the mother needs to gain the appropriate amount of weight. For a mom who begins her pregnancy at a normal weight, this is approximately 25-35 pounds. The issue here is that a lot of teen girls don’t want to gain weight and may actually diet during pregnancy to avoid getting too big. This can be highly detrimental to the growing fetus, leading to anemia and premature birth. Conversely, teen moms who gain too much weight are at higher risk for preeclampsia as well as cephalopelvic disproportion because the infant grows too large to fit through that narrow pelvis. A 2017 study showed that more than 60% of adolescent pregnancies involved inappropriate gestational weight gain, either too much or not enough, with most teens falling into the underweight category.

Anemia is another issue that teen mothers face, namely due to not getting adequate nutrition during pregnancy.  Iron deficiency anemia increases the risk of preterm birth, having a baby with a low birthweight and even postpartum depression. One study cited by the Mayo Clinic suggests an increased risk of sudden infant death in that time period immediately prior to and after the birth. 

One more physiologic concern with pregnant teens is the prevalence of STIs among this patient population. A 2015 study found that 23% of pregnant teens have some sort of sexually transmitted infection, with chlamydia being the most common. STIs can cause preterm birth, low birthweight and premature rupture of membranes, all of which can have potentially poor outcomes.

Lastly, we have to look at the teen mom with a global view. Not only does she have physiologic risk factors, she faces psychologic and sociologic risks as well. These range from having to “grow up too fast” and neglect completing those tasks of adolescence we talked about earlier. There’s a huge threat to their self esteem during this time, as image and fitting in with peers is very important for individuals at this development stage. In addition, many pregnant teens are socially isolated, lack a healthy and nurturing family life and, therefore, view parenthood as the way to avoid feeling lonely. 

Sociologically, the teen mother has a high risk for being economically disadvantaged, may have to leave high school, and is at high risk of having a second baby before age 19. In fact the CDC states that nearly one in five births to adolescent mothers in the age range of 15 to 19 is a repeat birth. Think about what this does to the teen’s education, employment and economic opportunities. This population is also at risk for early marriage and domestic violence. This all puts the child at risk for an unstable home environment, abuse and even neglect. It’s a very complicated situation to be in, so these young mothers are going to need a lot of teaching, a lot of support and a nonjudgmental environment in which to receive care.

Get this on audio on the Straight A Nursing Podcast, episode 122.

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References

CDC. (2013, April 2). CDC vitalsigns—Preventing repeat teen births. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/teenpregnancy/index.html

Mayo Clinic. (n.d.). Prevent iron deficiency anemia during pregnancy. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455

Rodriguez Gonzalez, Z. M., Leavitt, K., Martin, J., Benabe, E., Romaguera, J., & Negrón, I. (2015). The prevalence of sexually transmitted infections on teen pregnancies and their association to adverse pregnancy outcomes. Boletin De La Asociacion Medica De Puerto Rico, 107(3), 89–94. https://pubmed.ncbi.nlm.nih.gov/26742204/

Vivatkusol, Y., Thavaramara, T., & Phaloprakarn, C. (2017). Inappropriate gestational weight gain among teenage pregnancies: Prevalence and pregnancy outcomes. International Journal of Women’s Health, 9, 347–352. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439718/

Davidson, M. R., London, M. L., Ladewig, P. W., & Olds, S. B. (2008). Olds’ maternal-newborn nursing & women’s health across the lifespan (8th ed.). Upper Saddle River, N.J.: Pearson Prentice Hall.

Deglin, Judith Hopfer, and April Hazard Vallerand. Davis’s Drug Guide for Nurses, with Resource Kit CD-ROM (Davis’s Drug Guide for Nurses). Philadelphia: F A Davis Co, 2009. Print.

Hanson-Smith, B.  (2010, February 19). High Risk Pregnancy. Maternal-Newborn Nursing. Lecture conducted from CSU Sacramento, Sacramento.