Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing, Volume II: Working Papers and Statistical Appendices (1987) / Chapter Skim
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5 The Health and Medical Consequences of Adolescent Sexuality and Pregnancy: A Review of Literature
5 The Health and Medical Consequences of Adolescent Sexuality and Pregnancy: A Review of Literature
Pages 93-122
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From page 93... ...
First, further research is needed to determine whether the elevated risk of STDs among adolescents is due to an increased biological susceptibility to these infections or to a preponderance of other risk factors among young sexually active women. In particular, the role of patterns of sexual behavior among adolescents, such as unplanned sexual encounters, in increasing their risk needs elaboration.
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From page 94... ...
Fourthly, the factors 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 clarification.
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From page 95... ...
This would influence the number of cases. 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 prevalence of lower genital tract infections with Neisseria gonorrhoeae has been estimated recently in clinical studies of presumably sexually active women (Bowie et al., 1981; Chacko and Lovchik, 1984; Saltz et al., 1983; Anglin et al., 1981; Fraser et al., 1983; Shafer et al., 1984; Wiesmeier et al., 1983~. These studies provide estimates of recovery rates of Neisseria gonorrhoeae from 0 to 12 percent among women whose endocervix was cultured during a pelvic examination.
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From page 97... ...
Sequelae of Gonococcal Infections Pelvic inflammatory disease (PID) is the most severe complication of lower genital tract infections in women (Cates, 1984)
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From page 98... ...
Among nonwhite women aged 15-24 years, rates of hospitalization remained stable between 1975 and 1981. Nonwhite women had higher rates of hospitalization during the entire period, but because of the rise in rates for young white women, the ratio of nonwhite to white rates declined from 1975 to 1981 (Washington et al., 1984~.
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From page 99... ...
found that infertility because of tubal occlusion occurred in 15.2 percent of women treated earlier for laproscopically verified salpingitis who later exposed themselves to the risk of pregnancy. 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.
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From page 100... ...
Westrom estimated that women in the post-PID state accounted for about one-quarter of the rise in ectopic pregnancies in Lund, Sweden between 1960 and 1979 in women aged 20-29 years. Prevalence and Trends in Chlamydial Infections Chlamydial infections of the lower genital tract have surpassed gonococcal infections as the most prevalent STD among U.S.
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From page 101... ...
trachomatis and number of lifetime or recent sexual partners. There appears to be an increased risk of chlamydial infections among adolescents using oral contraceptives (Shafer et al., 1984; Fraser et al., 1983~.
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From page 102... ...
These estimates may be low for pregnant adolescents, given their high rates of chlamydial infections. There is considerable epidemiological evidence linking the number of sexual partners and a young age at first intercourse to an increased risk of cervical cancer (Hare and Thin, 1983; Rotkin, 1967; Schachter et al., 1982~.
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From page 103... ...
(1983) also reported a rise in the percentage of visits for genital herpes infections between 1976 and 1981 among patients attending STD clinics in King County, Washington.
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From page 104... ...
The two strains of HSV, HSV-1 and HSV-2, have been commonly thought to infect different sites in the body, HSV-1 with a predilection for sites above the waist and HSV-2 for the genital tract (Baker and Amstey, 1983; Josey et al., 1972; Lancet, 19811. Recent studies have questioned this distinction; suggesting that about one-third of genital herpes infections are HSV-1 infections (Kalinyak et al., 1977; Lancet, 19811.
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From page 105... ...
In sheer numbers alone, complications associated with induced abortion could have a major impact on the health of the adolescent and her subsequent offspring. This review will first discuss the literature comparing complications following induced abortion between adolescent and older women.
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From page 106... ...
Number of previous abortions has been associated with subsequent pregnancy outcomes (Maine, 1979) , although the evidence regarding increased risk of subsequent pregnancy problems is not confirmatory (Hogue et al., 19821.
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From page 107... ...
, was the greater risk of cervical trauma among teenagers. Cervical trauma following induced abortion may increase the risk of unfavorable outcomes in subsequent pregnancies because of the presumed association between cervical trauma and the occurrence of incompetent cervix (Tyler, 1983; Hogue et al., 1982~.
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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 prior spontaneous abortion tHogue et al., 1982~; the risk of subsequent 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 abortions the risk 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... ...
(1982~. They found no significant association between a subsequent ectopic pregnancy and one induced abortion, but the odds of an ec topic pregnancy was 2.6 for women with two or more prior induced abortions.
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From page 111... ...
There 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 first year of life, are compared for adolescents and older mothers.
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From page 112... ...
An increased incidence of PIH among adolescents appears, in part, to be explained by a preponderance of women who are black, experiencing their first pregnancy and who receive inadequate prenatal care among adolescents, when compared with older women. Yet, understanding of the etiology of PIH among adolescents as well as older women remains limited.
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From page 113... ...
Jorgensen (1972) , on the other hand, found a marked drop in the percentage of adolescents with preeclampsia at Pennsylvania Hospital after introduction 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 PIH, anemia, is not uniformly defined in the adolescent pregnancy literature, although most investigators measure it by low hemoglobin or hematocrit levels. In many studies, these levels are not taken at a uniform time during pregnancy and for convenience are frequently measured at the time of registration for prenatal care.
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From page 115... ...
, reported that adolescents attending an adolescent clinic at the University of Pennsylvania were less likely to have anemia, as measured by a hemoglobin under 10.5 at delivery, than adolescents receiving care at the hospital before the clinic's inception. The possibility of self-selection of the adolescents into the special program cannot be ruled out as an explanation for the results of this latter study.
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From page 116... ...
and lower mean birth weights of infants born to adolescents than those born to an older control sample. Maternal age differences in LBW rates and in mean birth weights may in part be explained by racial differences by age; black infants in general weigh less than white infants and pregnant adolescents are more likely to be black than older mothers.
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From page 117... ...
(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 118... ...
found no relationship between maternal age and mean length of gestation using data from the National Collaborative Perinatal Project, 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 119... ...
Prevention of LBW infants among adolescents and at all maternal ages is a major public health priority. Perinatal, Neonatal and Infant Mortality Among the Offspring of Adolescent Mothers Maternal age differences in perinatal, neonatal and infant mortality have been investigated in a number of the studies including crosssectional studies of births occurring in a geographic area.
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From page 120... ...
Thus, the results of Shah and Abbey showed that maternal age was an important predictor of infant death only in the postneonatal period. It appears that much of the risk of elevated neonatal mortality rates among infants born to adolescent mothers is due to the increased proportion of LBW infants born to these mothers.
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From page 121... ...
CONCLUSI 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... ...
Most recent research indicates that the elevated risk of poor pregnancy outcomes among adolescents is most likely explained by a preponderance of risk factors among young mothers. Although race, primiparity and poor prenatal care have been suggested as possible risk factors, research is still needed to specify the factors that are most likely to explain their increased risk of poor outcomes.
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