Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing, Volume II Working Papers only (1987) / Chapter Skim
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5. The Health and Medical Consequences of Adolescent Sexuality and Pregnancy: A Review of the Literature
5. The Health and Medical Consequences of Adolescent Sexuality and Pregnancy: A Review of the Literature
Pages 93-122
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From page 93... ...
As rates of sexual experience rose among adolescents throughout the decade, attention turned to parallel increases in use of induced abortion to terminate pregnancy and in rates of sexually transmitted diseases. This chapter discusses the effects of these increases on the health of the adolescent, her future reproduction and the health of her offspring, as well as the health consequences of adolescent pregnancy.
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From page 94... ...
Fou rthly, the f actors that place the adolescent at increased risk of unfavorable birth outcomes should be specified in future research. Fifthly, maternal age differences in the rate of fetal growth need further clarif ication.
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From page 95... ...
A second explanation is the rise in sexual activity among teenagers, coupled with an earlier initiation of sexual activity and the use of contraceptives that are ineffective in preventing lower genital tract infections (Bell, 1983; Mascola et al.,
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From page 96... ...
. Within the teenage and young adult population, the prevaler~ce of lower genital tract infections with Neisseria gonorrhocae has been estimated recently in clinical studies of presumably sexually active women {Bowie et al., 1981; Chacko and Lo~chik, 1984; Saltz et al., 1983; Anglin et al., 1981; Fraser et al., 1983: Shafer et al., 1984; wiesmeier et al., 19831.
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From page 97... ...
is the most severe complication of lower genital tract infections in women (Cates, 1984}, resulting f rom an ascending spread of infection of the lower genital tract (Westro~n, 19801. Although it has been held for a number of years that Neisseria gonorrhoese is a common cause of PID, recent evidence sugges~cs that it has ~ multifactorial microbis1 etiology (Thompson and Washington, 1983 Hestrom, 19801.
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From page 98... ...
bighe~t in 197S78. Among nonwhite women aged 15-24 years, rates of hospitalization remained stable between 1975 and 1981.
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From page 99... ...
The percentage with tubal occlusion infertility was twice as great for women aged 25-34 as for women aged 15-24, but age differences were found only for women with one infection. Infertility varied directly with the number of infections, reaching a peak of 54 percent among women with three or Snore infections.
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From page 100... ...
Unlike gonorrhea, however, infections caused by Chla~dia tracho~natis are not reportable conditions. Thus, most estimates of the prevalence of chlamydial infections are derived from clinical studies or reports of nonspecific lower genital tract infections in women (Here and min.
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From page 101... ...
trachomatis and maternal occupation and maternal education among pregnant women; the ir sample included older women as well as adolescents, although the reported relationship remained signif leant when adjustments were made for age differences in education and occupation. Sexual behavior, as measured by a young age at f irst inte rcourse (Shafer et al., 1984 ~ and multiple recent sexual partners (Chacko and Lovehik, 1984; Wiesmeier et al., 1984)
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From page 102... ...
Prevalence and Trends in Herpes Simplex Virus Infections of the Lower Genital Tract -~ ~ widely held content ion that herpes s implex ~ irus (}ISV) inf em tior~< If the lower genital tract increased dur ing the 1970s is sups porter by an analysis of data from the NDTI (Becker et al., 198S)
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From page 103... ...
Nevertheless, Sullivan-Bolysi et al. (1983 ~ also reported a rise in the percentage of visits for genital herpes infections between 1976 and 1981 among patients attending STD clinics in Ring County, Washington.
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From page 104... ...
(1983) reported a rise in the rate of neonatal herpes infections in Rings County, Washington between 1965 and 1982, mirroring the rise in consultations for genital herpes.
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From page 105... ...
This review will f irst discuss the literature cow par ing compl ications following induced abort ion between adolescent and older women. It will be followed by a review of the literature on the impact of induced abortion on subsequent fertility and pregnancy outcomes.
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From page 106... ...
Nevertheless, because they experience an induced abortion at a young age, they are at greater risk of a repeated abortion Than older women by virtue of their 9 Seances length of time remaining for exposure to an unwanted pregnancy. Number of previous abort ions has been associated with subsequent pregnancy outcomes (Maine, 1979)
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From page 107... ...
The extent to which the greater delay in obtaining abort ion among teenagers increases their overall risk of morbidity, regardless of their lower rates of morbidity following second trimester induced abortions, cannot be evaluated f ram their analysis. Harman (1981)
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From page 108... ...
There is considerable debate regarding what constitutes an appropriate comparison group for women with a prior induced abortion, particularly with regard to gravidity and parity. Both cannot be controlled in a comparison group unless the group experienced a pr for spontaneous abortion (Hogue et al., 1982 }; the r isk of subset quent unfavorable pregnancy outcomes is increased for women experiencing a prior spontaneous abortion.
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From page 109... ...
Among women with two or more prior induced abort ions the r isk was increased by threefold. There was no increased risk of second trimester spontaneous abortions among multiparous women with a history of induced abortion.
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From page 110... ...
There is no evidence in prospective studies of a relationship between a history of induced abortion and subsequent offspring with congenital anomalies (Finn et al., 1983; Madore et al., 1983~. In a case~control study, Bracken and Holford { 1979 ~ reported an increased risk of congenital malformations following induced abortion, but only among infants born to black women under 30 years of age.
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From page 111... ...
Ther e are a few investigations reported here that explored explanations for the increased incidence of complications and unfavorable outcomes among adolescent mothers only. The following complications of pregnancy: pregnancy induced hypertension; anemia: cesarean deliveries; and contracted pelvis, and unfavorable pregnancy outcomes: low birth weight; prematurity: perinatal mortality; neonatal mortality; infant mortality; neonatal morbidity; and morbidity during the f irst year of life, are c ompared for adolescents and older mothers.
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From page 112... ...
An increased incidence of PTH among adolescents appears, in part, to be explained by a preponderance of women who are black, experiencing their f irst pregnancy and who receive inadequate prenatal care among adolescents, when compared with older women. Yet, understanding of the et iology of PIH among adolescen~cs as well as older women rema ins limited.
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From page 113... ...
Jorgensen ~ 1972) , on ache ocher hand, found a marked drop in the percentage of adolescents with preeclampsia at Pennsylvania Hospital after introduct ion of an adolescent clinic; the clinic was developed on the premise that intensive prenatal care and health education would lower the risk of adolescent pregnancy.
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From page 114... ...
Like PIR, anemia, is not uniformly defined in the adolescent pregnancy literature, although most investigators measure it by low hen oglobin or hematocrit levels. In many studies, these levels are not taken at uniform time during pregnancy and for convenience are frequently measured at the tone of registration for prenatal care.
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From page 115... ...
, these studies were no~c designed to specif ically investigate differences in anemia between adolescent and older mothers and, accordingly, do nor address normal physiologic changes in pregnancy. Cesarean Sections and Cephalopelvic Disproportion Cesarean delivery rates have been studied as a possible complication of adolescent childbearing, largely because of their indication as a method of delivery for women with cephalopel~ric disproportion or contracted pelvis.
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From page 116... ...
More rem cent studies suggest that not only race but other r isk factors such as low socioeconomic status, lower prepregnancy weights and later initiation of prenatal care may also explain maternal age differences in birth weight. Many of the early studies of adolescent pregnancy interchanged the terms prematurity and LBW.
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From page 117... ...
Carn and Petzold ~1983~ found no relationship between maternal age and mean length of gestation using data f ram the National Collaborative Perinatal Pro ject, but the percentage of pregnancies ending before 38 weeks varied inversely with age, as did the percentage of LBW infants. While these results supported previous studies of age variations in birth weight and measures of maturity of infants at birth, they provided little explanation for these variations.
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From page 118... ...
(1983) found no significant difference in mean birth weights between infants born to adolescent mothers and infants born to older mothers, when adjustment was made for age differences in a number of confounding variables.
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From page 119... ...
( 1975) also found no significant maternal age differences in neonatal mortality rates.
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From page 120... ...
T t appears that much of the r isk of elevated neonatal mortality rates among infants born to adolescent mothers is due to the increased proportion of LBW infants born to these mothers. Neonatal and ~ irst-Year Morbid ity Among Offspring of Adolescent Mothers The relationship of maternal age with morbidity in the newborn or the infant during the f irst year of life has been much less extensively studied than birth weight or mortality.
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From page 121... ...
CONCI`USI ONS This review of the literature indicates that rates of sexually transmitted diseases rose from adolescents during the 1970s, and for some infections, such as genital herpes or chlamydial infections, they could continue to climb. The risk of gonorrhea, syphilis, and
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From page 122... ...
However, an elevated risk of postneonatal deaths among the offspring of adolescent mothers appears to be independent of age differences in birth weight. The research on early childhoed morbidity is too limited to determine whether this increased risk extends to morbidity as well.
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