INTRODUCTION — The topic of adolescent pregnancy arises in pediatric practice during discussions of sexual activity/contraception and during diagnostic evaluations for problems such as menstrual irregularities, gastrointestinal complaints, or pelvic mass. Adolescents may seek information regarding pregnancy directly from their health care provider. Laws regarding confidential pregnancy testing and counseling vary from state to state. (See "Confidentiality in adolescent health care" and "Consent in adolescent health care", section on 'Consent for specific services'.)
The diagnosis and early clinical management of adolescent pregnancy relevant to the pediatric health care provider will be discussed here. The prevention of pregnancy, contraceptive issues, and an overview of the diagnosis and clinical manifestations of early pregnancy are discussed separately. Prenatal and postpartum care, pregnancy complications, and labor and delivery issues also are reviewed separately. (See "Contraception: Issues specific to adolescents" and "Clinical manifestations and diagnosis of early pregnancy".)
EPIDEMIOLOGY — The teenage birth rate in the United States (across racial and ethnic groups) declined continuously between 1991 and 2005 [1]. Although it increased transiently between 2005 and 2007, it decreased to historic lows between 2007 and 2019 [1], largely related to increased contraceptive use and increased use of highly effective methods of contraception [2]. (See "Contraception: Issues specific to adolescents", section on 'Choosing a method'.)
The majority of teen pregnancies occur in 18- and 19-year-olds as this age group has the highest number of sexually active teenagers. In 2019, the birth rates among teenagers aged 10 to 14 years and 15 to 19 years were 0.2 and 16.7 per 1000, respectively [1]. The overall birth rate for teenagers 15 to 19 years of age fell by 4 percent between 2018 and 2019. However, racial/ethnic disparities related to social determinants of health (eg, health care access) continue. The birth rate in Hispanic teens and non-Hispanic Black teens was approximately twice that in non-Hispanic White teens; the birth rate in American Indian/Alaska Native teens was approximately 2.5 times that in non-Hispanic White teens [1]. Adolescents with mental health symptoms or major mental illness (eg, major depression, bipolar disorder, psychotic disorders) appear to be at increased risk of pregnancy [3,4].
Approximately 10 percent of all women aged 15 to 19, and 19 percent of those who have sexual intercourse, become pregnant. Many pregnancies among teenagers are unintended [5-7]. Among 15- to 19-year-old females with unintended pregnancies resulting in live births between 2004 and 2008, 50 percent were not using any method of contraception before the pregnancy (24 percent because their partner did not want to use contraception), 31 percent believed they could not get pregnant at the time, 13 percent had trouble getting contraception, and 22 percent did not mind if they got pregnant [8]. Surveillance data indicate that approximately 17 percent of births to teenagers 15 to 19 years of age in the United States in 2015 were repeat births [9]. Risk factors for repeat teenage pregnancy include depression, history of abortion, living with a partner or increased partner support, lower socioeconomic conditions (eg, poverty, unemployment), and fewer publicly funded family clinics [10,11]. Protective factors include higher levels of education and use of contraception, particularly long-acting reversible contraceptives [12].
Approximately one in five infants born to adolescents is fathered by men five or more years older than the mother. In a large observational study, 36 percent of adolescents with first pregnancy before age 15 years and 17 percent of adolescents with first pregnancy between 15 and 19 years reported that their sexual partner was ≥6 years older than they were at the time of their first sexual encounter [6].
DIAGNOSIS OF PREGNANCY — The diagnosis and clinical manifestations of early pregnancy are discussed in detail separately. Aspects of the history that pertain specifically to adolescents are discussed below. (See "Clinical manifestations and diagnosis of early pregnancy".)
History — Pediatric health care providers should have a low threshold for suspecting pregnancy in adolescents [13]. A pregnant adolescent may complain of missing her periods or of irregular periods. Some adolescents mistake implantation bleeding in early pregnancy for normal menstrual bleeding and, thus, do not seek pregnancy testing, whereas others are more likely than adults to report early first-trimester vaginal bleeding [14].
Pediatric health care providers need to be aware that an adolescent may or may not have considered the possibility of pregnancy or may present with vague complaints with suspected pregnancy as her "hidden agenda." One study compared the presenting complaints and historical information of pregnant adolescents (≤16 years) whose diagnosis of pregnancy was made or not made in the emergency department of a tertiary-care hospital [15]. The following findings were noted:
●Adolescents whose pregnancy was diagnosed more frequently had complaints related to the abdomen or genitourinary system than those whose pregnancy was not diagnosed (91 versus 22 percent).
●Less than 10 percent of the patients who had pregnancy diagnosed mentioned the possibility of pregnancy at initial triage, and 10.5 percent denied having had sexual activity.
●68 percent of patients whose pregnancies were not diagnosed (ie, who were pregnant at the time of the visit, but in whom the diagnosis was missed) had no documentation of their menstrual or sexual history.
Thus, pediatric health care providers should elicit a detailed menstrual and sexual history routinely from their female adolescent patients, regardless of the nature of their complaints. Historical features, such as amenorrhea, morning sickness, urinary frequency, increased appetite, weight gain or bloating, and tender or tingling breasts, are suggestive of pregnancy but are not reliable indicators for excluding pregnancy when absent [16]. Specific questions include [17]:
●When was your last menstrual period, and was it similar to other menstrual periods?
●Do you engage in sexual activity?
●Do you use any birth control method, including withdrawal (pulling out)?
●Do you have any symptoms of pregnancy, such as morning sickness, urinary frequency, increased appetite, or weight gain?
●Is there any chance you may be pregnant?
Signs and symptoms of pregnancy are discussed in greater detail separately. (See "Clinical manifestations and diagnosis of early pregnancy", section on 'Clinical manifestations of early pregnancy'.)
Physical examination — Pertinent physical examination findings of the adolescent in whom pregnancy is suspected are discussed separately. (See "Clinical manifestations and diagnosis of early pregnancy", section on 'Findings on physical examination'.)
Laboratory evaluation — The laboratory evaluation of the adolescent in whom pregnancy is suspected is discussed separately. (See "Clinical manifestations and diagnosis of early pregnancy", section on 'Detection of human chorionic gonadotropin'.)
Pretest counseling — In addition to questions related to pregnancy symptoms, it is important to ask the teenager what she would do if her pregnancy test were positive before the test is performed, so that appropriate support can be in place when the results are provided, particularly if the adolescent responds that she would kill or otherwise endanger herself if she were pregnant. Teenagers may have a variety of emotional responses to a newly diagnosed pregnancy, the most extreme of which may be suicidality, particularly if there is a history of previous suicide attempt. (See 'Posttest counseling' below.)
The conversation about how the teen would respond to the reality of pregnancy or motherhood before the test is performed also may force the teen to consider the potential consequences of her actions. Such a conversation may be a useful adjunctive strategy for pregnancy prevention in girls who are not pregnant.
Posttest counseling — Clinicians providing posttest counseling must bear in mind the laws regarding the adolescent's right to confidentiality in their state. In some states, the provider "shall not" disclose the information to a parent or guardian; in others, they "may" do so. (See "Confidentiality in adolescent health care", section on 'Parental notification'.)
●Positive pregnancy test – The first step after confirming a pregnancy with a pregnancy test is informing the adolescent of the test result and eliciting her thoughts and feelings about the test result. The second step is determining whether and how she wants to inform her parent(s) or caregiver(s) and the father of the baby. We usually encourage the pregnant adolescent to inform her parent(s)/caregiver(s) and the father of the baby, but some adolescents have valid reasons not to do so (eg, if doing so with threaten her safety).
The clinician should anticipate a variety of responses from the adolescent who is confirmed to be pregnant: ambivalence, apathy, fear, tearfulness, or even shock [13]. Providing emotional support to the adolescent is important at this time, and these feelings should be acknowledged as normal. Factual information regarding the duration of pregnancy and estimated due date should be provided despite her emotional response.
•Some adolescents perceive positive consequences of pregnancy or childbearing and want to be pregnant [18-20]. In a nationally representative survey of 975 adolescent females, 15 percent reported a positive pregnancy attitude (response to the question: "If you got pregnant now, how would you feel? Would you be very upset, a little upset, a little pleased, or very pleased?") [20]. Another study surveyed 200 pregnant 13- to 18-year-olds to see why they failed to use contraception before conception [21]. Nearly one-fifth of the girls responded that they wanted to get pregnant, and another one-fifth that they didn't mind being pregnant. In a separate case-control study, adolescents who wanted a baby were more likely to be married and out of school before becoming pregnant than teens who reported their pregnancy "just happened" [22].
•Other adolescents may feel stigmatized by pregnancy. In one report, 39 percent of 925 adolescents (<18 years) who were interviewed on the postpartum ward reported feeling stigmatized by their pregnancy [23]. Feeling stigmatized was independently associated with multiple factors, including White race/ethnicity, not being legally/common-law married or engaged to the baby's father, feelings of social isolation, aspirations to complete college, experiencing verbal abuse or being fearful of being hurt by other teenagers, and experiencing family criticism. Cultural attitudes regarding out-of-wedlock pregnancies must be considered when assessing response to a positive test in an adolescent from an immigrant family [13,24].
•Suicidal ideation occurs in 5 to 14 percent of women during pregnancy and the postpartum period, and teenagers are at greater risk than older women to complete suicide [25]. Self-poisoning during the early first trimester of pregnancy in adolescent and adult women has been reported [26]. A prior history of a suicidal attempt may place an adolescent diagnosed with a pregnancy at risk for a repeat suicidal attempt [27]. (See "Suicidal behavior in children and adolescents: Epidemiology and risk factors".)
After exploring the adolescent's feelings about the pregnancy, it is important to determine how she wants to go about informing her parent(s) or caregiver(s) and the father of the baby. The adolescent may not be comfortable informing her caregivers at the visit when pregnancy is confirmed, although the health care provider may feel caregiver involvement is the next best step to take. Special attention should be given to teenagers belonging to cultures that stigmatize unmarried mothers. Scheduling another office visit or a phone call in 24 to 48 hours for a follow-up in this situation is advisable. During this period, older adolescents may seek support from extended family and friends. In the author's clinical experience, most adolescents inform their caregivers within this time period and on their own terms. The provider may offer to help the adolescent disclose the information to her parents/guardians, either by simply being present for support or by helping the adolescent initiate the discussion [13]. Additional information on providing confidential services to adolescents is described separately. (See "Confidentiality in adolescent health care".)
●Negative pregnancy test – A negative pregnancy test provides an opportunity to discuss effective contraception [13]. Emergency contraception may be warranted if the adolescent had unprotected sex in the past five days and does not desire pregnancy. (See "Contraception: Issues specific to adolescents", section on 'Choosing a method' and "Emergency contraception", section on 'Candidates'.)
CLINICAL MANAGEMENT OF EARLY PREGNANCY
Pregnancy counseling — The adolescent may have considered her options already; the options should be discussed in a factual, respectful, nonjudgmental, and open manner, using neutral language: "What thoughts do you have of what you might want to do?" [13,24]. Estimating gestational age and expected date of delivery may be important information when making referral decisions. Gestational age can be estimated by a pregnancy calculator. (See "Prenatal assessment of gestational age, date of delivery, and fetal weight", section on 'Best estimate of delivery date'.)
She should be referred as soon as possible to a clinician or clinic where comprehensive pregnancy counseling involving shared or collaborative decision-making is provided, unless the health care provider has expertise in pregnancy counseling [24,28]. The adolescent should be offered all options (eg, abortion, adoption or kinship care, parenthood), especially when she has ambivalent feelings. Information regarding resources for pregnancy counseling is available through referrals from colleagues, women's clinics, and the internet. The location and limits of abortion clinics can be accessed through the National Abortion Federation. If a pregnancy is considered too advanced for a termination (based on state law), it is important that the provider convey this as a possibility. (See "Counseling in abortion care".)
Adolescents who decide to continue the pregnancy, or are uncertain whether they will continue the pregnancy, should initiate folic acid-containing prenatal vitamins and be counseled about the adverse effects of alcohol, drugs, and smoking on the developing fetus [29]. The health care provider should contact the adolescent approximately one week after the scheduled referral for follow-up information, to demonstrate concern for the adolescent, and to ensure appropriate care [13].
Most adolescents (<20 years) in the United States carry their pregnancies to term [30]. The prevalence of abortion is higher among urban than rural-dwelling teens [31]. Common reasons adolescents give for choosing to have an abortion include being concerned about how the baby would change their lives, feeling they are not mature enough to be a parent, and financial issues.
Adolescents who decide to continue their pregnancies to term should be referred for specialized prenatal care as soon as possible [13]. Adolescents younger than 15 years of age are less likely to receive prenatal care, and late entry into prenatal care has been positively correlated with preterm or low-birth-weight delivery and complications from preeclampsia [32-34]. Early testing for sexually transmitted diseases, initiation of folic acid-containing prenatal vitamins and good nutrition, avoidance of alcohol and other substances, and assessment of underlying familial and medical conditions are important for a healthy pregnancy [13,29]. The health care provider also can assist with smoking cessation by educating an adolescent smoker on the negative effects of nicotine on the developing fetus and by encouraging her to stop smoking. (See "Prenatal care: Initial assessment" and "Cigarette and tobacco products in pregnancy: Impact on pregnancy and the neonate" and "Alcohol intake and pregnancy", section on 'Perinatal outcomes'.)
Assistance from a social worker may be necessary to facilitate referral for comprehensive pregnancy counseling and enrollment into prenatal care and financial assistance programs because adolescents identify lack of finances, transportation, and waiting time for appointments as barriers to public prenatal care [34,35]. Social workers also can help to arrange tutoring or enrollment in special educational programs to allow the adolescent to remain in school or complete her academic requirements for graduation at home.
In the United States, adolescents choosing to terminate the pregnancy should be aware that some states require parental notification for a legal abortion [36]. The gestational limit for a termination also varies by state. State-specific information about parental notification and gestational limits is available through the Guttmacher Institute.
If an adolescent chooses abortion, parental notification of a termination in a minor is required only of health care personnel directly involved with providing legal abortions. This statute should not be interpreted as parental notification by the health care provider. A judicial bypass system also exists whereby a minor may ask a judge to consent to the procedure in lieu of a parent/guardian [37]. The judge must consent if they have determined the adolescent to be a mature minor or if termination of pregnancy is in the minor's best interest. In the United States, there is no legal requirement to notify the father of the baby prior to a termination. (See "Consent in adolescent health care", section on 'Abortion' and "Confidentiality in adolescent health care", section on 'Parental notification'.)
It might be helpful to prepare the adolescent for the potential presence of abortion protesters outside the clinic that performs pregnancy terminations and to let her know that such clinics frequently provide a volunteer escort service during an active protest.
Morning sickness — The evaluation and management of pregnancy-related nausea and vomiting are discussed separately. (See "Nausea and vomiting of pregnancy: Clinical findings and evaluation" and "Nausea and vomiting of pregnancy: Treatment and outcome".)
Nutrition — Pregnant adolescents should take one folic acid-containing prenatal vitamin every day [29]. Adequate nutrition during pregnancy is necessary to optimize maternal, fetal, and infant health. Pregnant adolescents are at particular risk for nutritional deficiencies [38]. Adolescents have increased nutritional needs related to normal pubertal changes (eg, increased height and changes in body composition). At baseline, they may have poor diet quality, with insufficient intake of micronutrients (eg, iron, folate, zinc, calcium) and excess intake of total fat, saturated fat, and sugar [39]. Pregnancy compounds these risks. (See "Normal puberty" and "Adolescent eating habits".)
A complete discussion of nutrition during adolescent pregnancy is beyond the scope of this review. Areas of particular importance include [38]:
●Adequate energy intake – Recommendations for weight gain during pregnancy are the same for adolescents and adults. (See "Gestational weight gain".)
●Iron – Iron is necessary for both fetal/placental development and to expand the maternal red cell mass. (See "Iron requirements and iron deficiency in adolescents" and "Nutrition in pregnancy: Dietary requirements and supplements", section on 'Iron'.)
●Folic acid intake – Folic acid (folate) requirements are increased during pregnancy. Adequate folate intake is important for prevention of some congenital anomalies and in red blood cell production. The preconceptional period is the optimal time for ensuring adequate folic acid consumption. (See "Folic acid supplementation in pregnancy" and "Nutrition in pregnancy: Dietary requirements and supplements", section on 'Folate/folic acid'.)
●Calcium intake – Calcium intake during adolescence is an important determinant of bone mineralization and bone density. Adequate calcium intake in pregnant and nonpregnant adolescents (14 to 18 years) is 1300 mg per day. (See "Bone health and calcium requirements in adolescents", section on 'Calcium intake'.)
Referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may helpful for pregnant teenagers who meet eligibility requirements.
OUTCOME
Pregnancy outcome — Approximately 25 percent of pregnancies in adolescents (<20 years) in the United States are terminated electively, 15 percent result in miscarriages, and 61 percent result in a birth [30]. The pregnancy termination rate among adolescents is lower than observed in 1990 (34 percent) and represents approximately one-fifth of all abortions performed in the United States. Data from 2018 indicate adolescents 18 to 19 years old accounted 70 percent of abortions in adolescents (<20 years) and adolescents <15 years old accounted for approximately 3 percent [40].
There are few data regarding the rate of adoptions from teen pregnancies. The rate of adoptions from pregnancies is not reported in the same manner as other reproductive health variables. The "adoption at the time of birth" rate has not been a standard pregnancy outcome measure in national/state surveys. Estimating adoption rates is also difficult because infants may be relinquished at different times (eg, at birth or after being assigned to foster care). Data from the National Survey of Family Growth, which asked women about the status of each child ever born, indicate that the rate of premarital births with a plan for adoption declined from 9 percent in the 1970s to 3 percent in the 1980s and approximately 1 percent in the early 1990s [41,42].
Adolescents appear to be at increased risk for adverse pregnancy outcomes, such as preeclampsia, preterm birth, fetal growth restriction, and infant deaths [43-51]. Whether these outcomes are the result of biologic immaturity or sociodemographic factors related to adolescent pregnancy (eg, less well educated, unmarried, lower economic status) remains unclear. However, in a multicountry study that included 124,446 mothers ≤24 years, the risk of adverse outcome remained increased in adolescent (≤19 years) compared with young adult mothers (ie, 20 to 24 years) after controlling for country, marital status, educational attainment, and parity [48]. Similar results were noted in an earlier study in a homogeneous population (134,088 White primiparous women ≤24 years from a single state in the United States) [43].
Adverse outcomes in teenage pregnancies have been confirmed in some [44,47-49,52], but not all, studies [53,54]. Black adolescents do not have an inherent biologically increased risk for preterm birth compared with older Black women [53].
The primary cesarean birth rate for teenagers was approximately 18 percent in 2019 [1]. Teenage mothers require instrumental deliveries (ie, forceps or vacuum extraction) approximately twice as often as women aged 20 to 24 years [46,55]. The reason for the higher rates of instrumental delivery is not clear. Proposed explanations include the physical immaturity of the younger mother and fright or lack of cooperation during the second stage of labor [55,56].
Subsequent pregnancies — Other reports have evaluated the outcomes of subsequent pregnancies after a first teenage pregnancy. In a population-based series limited to teenage pregnancies, adverse perinatal outcomes were more common among second, but not first, births to nonsmoking teenage mothers [57]. In another study, the increased rate of preterm birth diminished in subsequent pregnancies after the teenage period [58].
Postpartum depression — Adolescent mothers are at risk for post-partum depression. In a systematic review, reported rates of postpartum depression in adolescents ranged from 7 to 37 percent, in part secondary to the methods of assessment (eg, structured interview versus self-report) [59]. The prevalence of depressive symptoms was increased during the first three months after delivery. Postpartum depression is discussed separately. (See "Postpartum unipolar major depression: Epidemiology, clinical features, assessment, and diagnosis".)
Long-term effects — Data regarding long-term effects of adolescent pregnancy on physical development are too limited to draw any conclusions [60]. A population-based cohort study from Sweden reported teenage mothers were at increased risk of premature death later in life compared with older mothers [61]. The increased risk was attributable to both social and biologic factors and included lung and cervical cancer, ischemic heart disease, suicide, inflicted violence, and alcohol abuse.
Social impact — Adolescent parenthood is challenging [24]. Family and social support is crucial to mitigating the adverse socioeconomic outcomes associated with adolescent parenthood [13]. These include [39,46,62-68]:
Mother:
●Less likely to receive a high-school diploma; although 7 in 10 adolescent mothers complete high school, they are less likely than women who delay childbearing to go on to college
●More likely to live in poverty and receive public assistance for long periods
●At risk for intimate-partner violence
Father:
●Finish fewer years of schooling than older fathers
●Earn less income
●Less likely to have a job
Child:
●More likely to have health and cognitive disorders
●More likely to have poor academic performance and repeat a grade or drop out of high school
●More likely to be neglected or abused
●Females are more likely to have an adolescent pregnancy, and males have a higher rate of incarceration
PREVENTION — Systematic reviews of pregnancy prevention programs suggest that successful programs include a combination of interventions that provide comprehensive sexuality education, focus on delay of sexual activity in young teens, and promote consistent and correct use of effective contraceptives [69-71]. Individual counseling, provision of contraceptives or prescriptions for contraceptives, and free or low cost services also contribute to program effectiveness. A list of evidence-based teen pregnancy prevention programs in the United States is available through the Office of Adolescent Health Teen Pregnancy Prevention Program. (See "Adolescent sexuality" and "Contraception: Issues specific to adolescents".)
Although they are popular, "infant simulator" programs, which combine educational sessions and "care" for a doll that is programmed to replicate infant behaviors, are not effective in reducing teen pregnancy. In a school-based cluster randomized trial, 13- to 15-year-old girls received the infant simulator intervention (n = 1267) or standard health education curriculum [72]. By 20 years of age, girls in the intervention schools had higher rates of birth and abortion than those who received the standard curriculum (8 versus 4 percent for birth; 9 versus 6 percent for abortion; adjusted relative risk for either outcome 1.4, 95% CI 1.1-1.7). These findings support those from smaller observational studies and literature reviews [73,74].
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Adolescent sexual health and pregnancy".)
INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient education" and the keyword[s] of interest.)
●Basics topics (see "Patient education: Teen sexuality (The Basics)")
●Beyond the Basics topics (see "Patient education: Adolescent sexuality (Beyond the Basics)")
SUMMARY
●Approximately 10 percent of all women aged 15 to 19 years, and 19 percent of those who have sexual intercourse, become pregnant. Approximately one-quarter of adolescent mothers have a second child within two years of their first. (See 'Epidemiology' above.)
●Pediatric health care providers should have a low threshold for suspecting pregnancy in adolescents. A pregnant adolescent may complain of missing her periods or of irregular periods. Pediatric health care providers also must be aware that a pregnant adolescent may present with vague complaints and may or may not have considered the possibility of pregnancy. (See 'History' above.)
●The diagnosis and clinical manifestations of early pregnancy are discussed separately. (See "Clinical manifestations and diagnosis of early pregnancy".)
●It is important to ask the teenager what she would do if her pregnancy test were positive before the test is performed, so that appropriate support can be in place when the results are provided, particularly if the adolescent responds that she would kill or otherwise endanger herself if she were pregnant. (See 'Pretest counseling' above.)
●When the results of a positive pregnancy test are disclosed to the adolescent, her thoughts and feelings about the test result should be elicited and emotional support provided. In addition, factual information regarding the duration of pregnancy and estimated due date should be provided. It is also important to determine how the adolescent wants to go about informing her parent(s) or caregiver(s) and the father of the baby. (See 'Posttest counseling' above.)
●Options regarding the pregnancy should be discussed in a nonjudgmental manner and the adolescent referred as soon as possible to a clinician or clinic where comprehensive pregnancy counseling is provided, unless the health care provider has expertise in pregnancy counseling. Adolescents who decide to continue the pregnancy, or are uncertain whether they will continue the pregnancy, should initiate prenatal vitamins and be counseled about the adverse effects of alcohol on the developing fetus. The health care provider should contact the adolescent approximately one week after the scheduled referral for follow-up information, to demonstrate concern for the adolescent, and to ensure appropriate care. (See 'Pregnancy counseling' above.)
●Adolescents appear to be at increased risk for adverse pregnancy outcomes, such as low-birth-weight babies and infant deaths. Whether these outcomes are the result of biologic immaturity or sociodemographic factors related to adolescent pregnancy remains unclear. (See 'Pregnancy outcome' above.)
●Adolescent pregnancy is associated with several adverse socioeconomic outcomes for the mother, father, and child. (See 'Social impact' above.)
●Pregnancy prevention is multifaceted and should include comprehensive sexuality education, focus on delay of sexual activity in young teens, and promote consistent and correct use of effective contraceptives. (See 'Prevention' above and "Contraception: Issues specific to adolescents".)
