Adolescent Maternity Research Articles

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care.

Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.

Community Advanced First Aid Training for Day-to-Day Emergency and Disaster Response in Nepal

Introduction:Nepal is a country with geographical difficulties in tackling day-to-day emergency healthcare and disaster preparedness. The aim is to develop community preparedness by training for day-to-day emergency and disaster response in Nepal to generate preventive and first aid awareness of consequences and complications of simple to severe emergency conditions during day-to-day emergencies and disasters.Method:It is an analysis of five years of advanced first-aid training at the Nepal Disaster and Emergency Medicine Center from July 2015 to March 2020. In April 2015, the earthquake affected 15 districts of Nepal.Results:During July 2015 to March 2020, NADEM has been training 3,995 Community First Aiders for Male Leaders and Active Community people: 1,315 special mothers’ group–Adolescent Maternity & Child Health First Aiders; 794 Ambulance Drivers–Advanced First Aid Trained of remote districts of Mountain and hilly region’s ambulance’s Drivers and Assistants ; 637 ToT First Aiders for Community School Teachers (Training of Trainers); Total AFAT Trained by NADEM = 6,741 (Province 1 to 5); Total Population AFAT Trained = 52,610 (Province 1 to 5); Total Population Benefit by AFAT = 902,100 and its ongoing. NADEM Study Reports of Nepali community with ‘Incident Rate of First Aid Required’ is 9% per day with First Aid Services for 87.4% minor causes, 5.4% major causes, 0.5% gynecological causes, 1.7% AMCH causes, 4.5% trauma causes, 0.5% Prehospital Cardiac Arrest. With NADEM advanced first-aid training, now we are preventing 70% of deaths in remote parts of those districts before reaching the health care centers.Conclusion:It is a great challenge to train community laypersons to be Community First Aiders who can tackle day-to-day emergencies and disasters in their community with knowledge, skills practice, and attitude to prepare and prevent the increased tendencies of disability, deformity, morbidity, and mortality in Nepal.

Intergenerational Replication of Teenage Pregnancy and Educational Attainment in Mexico.

Mexico ranks among the OECD countries with the highest prevalence of teenage pregnancies, exhibiting a fertility rate of 70.6 births for every 1000 adolescents. Mexican adolescents with a history of pregnancy are twice as likely to lag behind in their studies as those who have not been pregnant. Research on adolescent maternity and its explanatory mechanisms is required as a basis for implementing policies and programs that effectively curb teenage pregnancy-related behaviors, prevent educational gaps, and reduce the intergenerational transmission of poverty. Based on quasi-experimental methodology and a non-recursive structural equation model with instrumental variables, this paper analyzed the intergenerational transmission of teenage pregnancy from mothers to daughters, as well as the relationship between teenage pregnancy and educational attainment. Using data from the 2009 National Survey of Demographic Dynamics in Mexico, our estimated model indicated a unidirectional relationship from teenage pregnancy to educational attainment. An association was observed between teenage pregnancy and an increased probability of a moderate or severe educational gap (≥ 1year) by 21% ± 5 and a severe educational gap (≥ 2years) by 33% ± 8. Adolescents whose mothers reported teenage pregnancy at < 15years of age were approximately 84% more likely to experience teenage pregnancy themselves than other adolescents. Relevant explanatory mechanisms included low socioeconomic status and a low level of education in the household. Mexico needs to formulate, implement, and expand comprehensive and early prevention strategies as well as teenage pregnancy care throughout its most vulnerable regions. Efforts should be made at the individual, family, and community levels; incorporate alliances with teenage networks; actively engage parents, teachers, and health care providers; and reinforce educational initiatives on sexual and reproductive health for adolescents. It would be convenient for the Government to implement public policies that emphasize the results obtained. There is no better instrument than to show the evidence of the gradual deterioration of human capital in Mexico associated with adolescent pregnancy.

Continuum of care for maternal, newborn and child health: Evidence from a national survey in Mexico

ObjectiveTo compare coverage of maternal, newborn and child health (MNCH) continuum of care between women who had experienced adolescent maternity (AM) and those who had not. MethodsUsing a Mexican probabilistic survey representative at the national level (ENSANUT 2018–19), we developed a cross-sectional analysis of 1,768 women aged 12 to 49 years who had a child within five years before the interview. We used modified Poisson models to estimate prevalence ratios (PRs) and independent and conditional coverage levels based on the probability estimates yielded by these models at different stages of maternal-newborn care process. ResultsPRs for the MNCH continuum of care were approximately 40% lower for women who had experienced AM compared to those who had not (95%CI:0.35, 1.14). The coverage for the MNCH continuum of care was only 7.4% [95%CI: 3.5, 11.2] and 11.7% [95%CI: 9.3, 14.1] in women who had/not experienced AM, respectively. ConclusionsThe provision of a continuum of care for mothers and their children can be achieved through a combination of well-defined policies and strategies that improve health care practices and services throughout the life cycle. It is necessary to expand the coverage and quality of care, which will provide the opportunity to shift the focus from vertical programs to integrated continuous care. Policy makers must implement interventions that are consistent with specific problems of population and health-care providers. Our analysis highlights the deficiencies in the care process, making this study a useful reference for countries with similar characteristics.

1.13 Adverse and Benevolent Childhood Experiences Association With Self-Reported Psychiatric Symptoms in the Colorado Adolescent Maternity Program

1.13 Adverse and Benevolent Childhood Experiences Association With Self-Reported Psychiatric Symptoms in the Colorado Adolescent Maternity Program

215Impact of Brazilian Family Health Strategy on Reproductive Health: Analysis at Individual and Population Levels

Abstract Background Family Health Strategy (FHS) is the largest community-based health program in Brazil. There is limited evidence about its effectiveness, especially about adolescents. We aimed to access its effects on adolescents’ reproductive health. Methods We estimate its effects on contraception at individual level using data from a national health survey carried out in 2013 and applying propensity score matching combined with complex survey weights. We employed a differences-in-differences approach for evaluate its effects on adolescent maternity rate at municipal level between 1996 and 2016. Results FHS has positive effects on the probability of using contraceptives. The highest effect was over the concomitant use of pills and male condom (increase of 12 percentage points). For households with female adolescents, it was even higher (26 percentage points). We found a monotonous decrease on adolescent maternity rate following exposure time to FHS, especially in the poorest regions. Conclusions Even not being focused on reproductive health, FHS has positive effects on it. We interpret the negative impact on adolescent maternity rates to be linked to an increased use of contraceptive methods. Key messages Programs such as FHS can be extremely important in promoting knowledge about family planning, especially for adolescents living in social vulnerability. We believe our findings to be important inputs for the discussion in countries where early childbearing is more prevalent, and inequalities are particularly striking..

Levels and trends of adolescent marriage and maternity in West and Central Africa, 1986-2017.

BackgroundThe world has made considerable progress in the reduction of adolescent maternity and early marriage. However, this progress has been uneven, with many countries finding themselves far from achieving the Sustainable Development Goals in this dimension. We assessed levels and trends over time in adolescent marriage and maternity prevalence within the West and Central African region as well as their correlation with select macro-level indicators for income and social institutions.MethodsWe estimated country-specific prevalence rates using survey data (pooled cross-sectional) conducted between 1986 and 2017. The pooled sample provides information on 262 721 adolescent girls between the ages of 15 and 19. We assessed the relative country-level trends by comparing prevalence rates from the first and latest available survey in each country. We further analyzed regional trends by country income group (low- and middle-income) and examined the association of prevalence rates with measurements of gender discrimination and social institutions at the country-level. Estimations were conducted using survey weights and country-specific weights for population shares in the pooled sample.ResultsPrevalence of adolescent maternity declined from 30.1 percent (95% confidence interval (CI) = 29.6%-32.2%) in the 1990s, to 28.7 percent (95% CI = 27.9%-29.6%) in the 2000s and 26.2 percent (95% CI = 25.4%-27.1%) in the 2010s. Adolescent marriage rates decreased from 37.3 percent (95% CI = 35.5%-39.1%) in the 1990s to 27.5 percent (95% CI = 26.5%-28.6%) in the 2000s, and to 24.9 percent (95% CI = 24.1%-25.7%) in the 2010s. Between 1986 and 2017, adolescent marriage decreased in all countries except for the Central African Republic (with a rise from 39% to 55%) and Niger (56% to 61%). The prevalence of adolescent maternity decreased in all but three countries: Congo, Dem. Rep. (25% to 37%), Niger (36% to 40%), and the Central African Republic (36% to 49%). When grouped by income level, the prevalence was 8 percentage points higher in low-income countries than in middle-income countries in both outcomes. We did not establish any statisticly significant association between adolescent marriage and maternity with country-level measures of discrimination against women. However, we found evidence of an association between specific legal measures of protection against early marriage and lower prevalence rates for both early marriage and maternity.ConclusionsDespite considerable progress in the reduction of adolescent maternity and marriage over the last 30 years, current levels of both indicators remain overall high in the WCA region, with high heterogeneity across individual countries. Countries with higher income level and higher standard in legal protection of young girls perform consistently better on both indicators. The prevalence rates of adolescent marriage and maternity reversed over the course of three decades, so that nowadays adolescent maternity rates exceed adolescent marriage rates in most countries. Further research is needed to understand the weak or non-existent association between adolescent marriage and maternity with gender discrimination and social institutions.

Socio-economic predictors of adolescent marriage and maternity in West and Central Africa between 1986 and 2017.

BackgroundEarly marriage and maternity prevalence rates among adolescent girls remain alarmingly high in West and Central Africa (WCA). This study aims to explore the associations between socio-economic factors and the prevalence of early marriage and maternity, thus contributing to the identification of girls at risk of early pregnancy or marriage.MethodsWe pooled data from national representative surveys (1986 – 2017) for 23 countries in WCA to examine associations between wealth, educational attainment, religious affiliation, and place of residence with adolescent marriage and maternity. We decomposed the wealth and education gradients for individual countries, while controlling for common characteristics of the local environment via the use of primary sampling unit fixed-effects. The pooled sample provides information on 262 721 girls (age 15-19 years). Survey weights and population share weights were used in the estimations.ResultsThe prevalence of adolescent maternity and marriage exhibited a wealth and education gradient. Prevalence of marriage in the poorest wealth quintile was 41.1% (95% confidence interval (CI) = 38.8%-43.5%) and 10.5% (95% CI = 9.5%-11.6%) in the richest. For maternity it was 38.3% (95% CI = 36.4%-40.3%) in the poorest quintile and 12.7% (95% CI = 11.5%-13.9%) in the richest. Marriage/maternity is three/two times more likely to occur among girls with incomplete primary or no formal education than in those with at least primary. Maternity and marriage among adolescents exhibit a geographical pattern and differences between religious groups. Adolescent marriage prevalence was 34.4% (95% CI = 32.9%-35.8%) in rural areas compared to 13.3% (95% CI = 12.3%-14.2%) in urban areas. Adolescent maternity prevalence was 32.8% (95% CI = 31.7%-33.9%) in rural compared to 16.3% (95% CI = 15.3%-17.3%) in urban areas. Finally, the prevalence of adolescent marriage was substantially higher among Muslims compared to all other religious groups.ConclusionsOur results highlight the disparities in the prevalence of adolescent marriage and maternity and confirm the existence of wealth and education gradients. These findings can help to improve targeting of vulnerable adolescents and to identify areas for policy implementation.

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

BackgroundExcess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity.MethodsThe current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography.DiscussionThis pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring.Trial registrationClinicalTrials.gov NCT03086161, retrospectively registered

Práticas colaborativas para intervenção em grupo com adolescentes e profissionais de saúde sobre sexualidade

O relato experiência de intervenção colaborativa como possibilidade para construção de discursos alternativos sobre adolescentes e sexualidades constitui o objetivo do presente artigo. Trata-se de pesquisa-ação colaborativa envolvendo: passos de construção da intervenção; organização e desenvolvimento do grupo; entrevistas de avaliação. O processo de produção de sentidos foi registrado por notas de campo, áudio do grupo e entrevistas, sensibilizado pelas Práticas Colaborativas. Envolveu oito adolescentes, nove profissionais e pesquisadoras, em ambos planejamento e desenvolvimento. O grupo propriamente dito compreendeu sete encontros e seguiu as temáticas eleitas conjuntamente: gênero e sexualidade; puberdade; métodos contraceptivos; sexualidade na adolescência; parentalidade/maternidade na adolescência; álcool e outras drogas; escolhas e repercussões. Narramos relação como pesquisadoras participantes e destacamos a participação de três adolescentes no grupo. Evidenciamos o agir colaborativo e a singularidade das pessoas, evitando rotulações, portanto a potência das práticas colaborativas para atitudes democráticas na construção e manejo do grupo, favorecendo conversas sobre sexualidade na adolescência.

Percepciones de adolescentes sobre los derechos sexuales y reproductivos que favorecen la prevención del embarazo en esta etapa

Objetivo: describir la percepción de un grupo de adolescentes acerca de los derechos sexuales y reproductivos que favorecen la prevención de la maternidad y la paternidad en esta etapa. Método: estudio cualitativo fenomenológico. La información se recogió con 20 adolescentes escolarizados a través de grupos focales. Análisis mediante codificación abierta, conformación de categorías y su descripción. Resultados: limitaciones en el conocimiento sobre concepto de derechos sexuales y reproductivos porque los asocian exclusivamente con relaciones sexuales; las preguntas que guiaron el desarrollo de los grupos focales facilitaron discusión y expresión de su percepción sobre el tema de estudio. Conclusiones: los participantes perciben el derecho a fortalecer la autoestima como fundamental para prevenir maternidad y paternidad en la adolescencia porque: proporciona seguridad en sí mismo; favorece tomar decisiones de tener o no relaciones sexuales y anticonceptivos; disminuye probabilidad de dejarse presionar para tener relaciones sexuales, y facilita informar si está siendo presionado al respecto. Enfatizan importancia de promover autoestima en mujeres porque son quienes reciben mayor presión o presentan mayor riesgo de violación sexual. Recibir información sobre sexualidad y reproducción proporciona conocimientos que facilitan toma de decisiones para prevenir maternidad y paternidad; la información que reciben no es suficiente porque existen muchos tabúes de progenitores, quienes restringen este derecho por temor a estimular inicio de relaciones sexuales tempranas. Priorizan derecho a recibir servicios de salud para anticonceptivos porque previenen embarazos en adolescentes. Obstáculos para ejercer este derecho: desconocer tema/lugar para adquirirlos; limitaciones económicas; miedo de ser descubierto y ser juzgados.

Trauma-informed care in a patient-centered medical home for adolescent mothers and their children.

Adolescent mothers experience higher rates of trauma and abuse, as well as increased risks for mental health disorders, compared to adolescent girls who are not mothers, making them a particularly vulnerable population and contributing to them feeling less supported by or allied with their medical provider. Women with a history of childhood abuse face increased rates of obstetric complications; their infants are at increased risk for low birthweight, developmental and intellectual delays, and behavioral problems. Trauma-informed care has become widespread in mental health settings; however, this model has not been as commonly applied to other settings, such as patient-centered medical homes (PCMHs). The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children's Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration's six key principles of a trauma-informed approach. Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02). Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Adolescent parenthood associated with adverse socio-economic outcomes at age 30 years in women and men of the Pelotas, Brazil: 1982 Birth Cohort Study.

To investigate the potential long-term effects of adolescent parenthood on completed education and income. Population-based birth cohort study. All live births in 1982, whose mothers lived in the urban area of Pelotas, southern Brazil. A total of 3701 participants: 1914 women and 1787 men at age 30 years. Questionnaires were completed by the mothers in the early phases of this study, and by the cohort members in adolescence and adulthood. Linear regression models and G-computation were used in the analyses. Educational attainment and income at age 30 years. In women, adolescent parenthood was associated with lower attained education compared with women without adolescent maternity: by -2.8 years [95% confidence interval (CI) -3.2 to -2.3] if their first birth was at age 16-19, and by -4.4 years (-5.5 to -3.3) at age 11-15. These effects were greater among women who had three or more children. Women with adolescent parenthood also had 49 or 33% lower income at age 30 if their first child was born when aged 16-19 or 11-15, respectively. In men, the adverse effect of adolescent parenthood on education appeared to be mediated by a higher number of children and there was no effect of adolescent paternity on income at age 30 years. These findings suggest lasting socio-economic disadvantages of adolescent parenthood, with larger effects being apparent in women than in men. Adolescent parenthood has an adverse effect on educational attainment later in life, and on household income among women.

Marriage, Gender and Transnational Migrations in Fertility Transitions of Romanian Roma Women

This paper explores how a group of immigrant Roma women are shaping their reproductive lives in the transnational context generated by the migratory flows of post-1989 Romania. The analysis is based on the ethnographic reconstruction of the reproductive lives of 124 women from seven Roma family networks residing in Spain and connected with relatives all over Europe. Although these groups are increasingly heterogeneous, some common patterns seem clear. Primarily, we observe that these women are transforming the tempo and quantum of their reproductive careers in a culturally specific fertility transition that is not based on the postponement of childbearing and marriage. Early, pronatalist and patrilocal marriage followed by adolescent maternity are powerful normative orientations in the groups studied. Spacing the second or the third child and stopping having children in their early 30s seem to be the most common strategies by which they are responding to the increasing costs and setbacks of high fertility. Their transnational experiences in Western Europe are contributing to this process in ideological, structural and instrumental terms. The demographic contrasts of many Roma groups with their non-Roma neighbours are a source of prejudice and ‘ethno-demographic anxiety’ that fuel populist, nationalist and illiberal sentiments and movements.

Low Vitamin D is Associated With Infections and Proinflammatory Cytokines During Pregnancy.

Vitamin D is known to regulate innate and adaptive immune processes at the cellular level, but the role of vitamin D status on associated inflammatory processes across pregnancy is unclear. Our primary objective was to evaluate the relationships between serum biomarkers of inflammation (interleukin [IL]-6, IL-10, tumor necrosis factor [TNF]-α), acute-phase proteins (C-reactive protein and hepcidin) and vitamin D status, 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D), measured across pregnancy and in the neonate at birth. A second objective was to identify associations between vitamin D status and clinically diagnosed infections. In this study, 158 racially and ethnically diverse pregnant adolescents were recruited from the Rochester Adolescent Maternity Program (RAMP) in Rochester, NY. Serum 1,25(OH)2D was significantly lower in adolescents and neonates with IL-6 concentrations above the 75th percentile at delivery ( P = .04) and at birth ( P = .004), respectively. After adjusting for other potential covariates of inflammation, maternal serum 1,25(OH)2D was significantly positively associated with TNF-α during pregnancy ( P = .02), but at delivery 1,25(OH)2D and TNF-α were inversely associated with one another ( P = .02). Teens with 25(OH)D concentrations <30 ng/mL were more likely to test positive for candida ( P = .002) and bacterial vaginosis ( P = .02) during pregnancy. African Americans exhibited significantly lower TNF-α concentrations at both mid-gestation ( P = .009) and delivery ( P = .001) compared to the Caucasian adolescents. These results suggest that lower maternal vitamin D status may increase risk of infection across gestation.

49: Marijuana use and adverse perinatal outcomes in young mothers

Self-report underestimates drug use, which may affect the validity of existing studies reporting on pregnancy outcomes with marijuana (MJ) exposure. We aimed to evaluate the association between MJ use and adverse pregnancy outcomes in a population with universal biologic sampling. Retrospective cohort study of all mothers in an adolescent maternity program (13-22 years old) with singleton, non-anomalous pregnancies who delivered at a single tertiary center (Sept 2011-May 2017). Adolescents are screened universally with urine toxicology (utox) at the first prenatal visit. Exposure was defined as MJ detected on utox or by self-report on a uniformly administered questionnaire. The primary composite outcome included spontaneous preterm birth, hypertensive disorders of pregnancy, stillbirth, or small for gestational age. A sample size of 1200 was calculated to have 80% power to detect a difference in the rate of the composite outcome of 8% assuming a MJ use prevalence of 18%. Demographic and clinical characteristics were compared using t-tests or χ2. A multivariable model estimated the effect of MJ use on the primary outcome adjusting for race/ethnicity. Other covariates considered for inclusion were age, tobacco use, other illicit substances, history of psychiatric disorder, and a maternal stress score. Of 1206 included births, overall 17% (n=204) were exposed to MJ. Self-report identified 6% and utox 16%. Utox results were available for 91% of births. For others, utox was ordered but not completed. Demographics differed between exposed and unexposed (Table 1). The primary composite outcome occurred more frequently in adolescents who used MJ (46 vs 34%, p<0.001) (Table 2). In multivariable modeling adjusting for race/ethnicity, MJ use was associated with the composite adverse outcome (OR 1.53, 95% CI 1.12-2.09). After excluding 114 adolescents without utox results, odds of the composite adverse outcome increased slightly (OR 1.73, 95% CI 1.25-2.39). In a population with nearly universal biologic sampling, marijuana use was associated with a composite adverse pregnancy outcome including spontaneous preterm birth, hypertensive disorders of pregnancy, stillbirth, or small for gestational age. Uncertainty regarding the impact of MJ on pregnancy outcomes in the literature may result from incomplete ascertainment of exposure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vitamin D mediates the relationship between placental cathelicidin and group B streptococcus colonization during pregnancy

Vitamin D is thought to modulate innate immune responses, and recent studies have highlighted the autocrine and paracrine functions of vitamin D in the placenta. Our objective was to determine the relationship between maternal vitamin D status and placental antimicrobial peptide (AMP) expression in a group of racially and ethnically diverse pregnant adolescents. In this study, 158 pregnant adolescents were recruited from the Rochester Adolescent Maternity Program (RAMP) in Rochester, NY. Maternal serum concentrations of the vitamin D biomarkers, 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D), were measured at mid-gestation (∼26 weeks) and at delivery. At the placental level, vitamin D regulatory proteins (cubilin, megalin, 1α-hydroxylase (CYP27B1), 24-hydroxylase (CYP24A1), vitamin D receptor (VDR)) and AMPs (cathelicidin and hepcidin) were analyzed using quantitative PCR and western blot techniques. Placental CYP27B1 mRNA expression was significantly positively associated with both placental cathelicidin mRNA expression (P<0.0001) and placental hepcidin mRNA expression (P=0.002). In teens with positive recto-vaginal group B streptococcus (GBS) colonization, placental mRNA expression of cathelicidin (P=0.007), cubilin (P=0.03), and CYP27B1 (P=0.04) were significantly lower compared to those who tested negative for this infection. A mediation analysis showed that the indirect relationship between GBS colonization and placental cathelicidin mRNA expression was mediated by the placental mRNA expression of the vitamin D proteins cubilin and CYP27B1 (P=0.02). Additional research is needed to identify the role and relative contributions of placental and systemic vitamin D metabolites in relation to potentially pathogenic microorganisms which may be present during pregnancy.

Prevalence and Risk Factors for Infections in a Pregnant Adolescent Population

Study ObjectiveOur objective was to identify risk factors associated with maternal infections and placental inflammation in pregnant adolescents attending an urban adolescent maternity clinic. DesignThis cross-sectional, descriptive study used survey and medical chart data collected at entry and prospectively across gestation. The prevalence of maternal infections and placental inflammation was determined and potential risk factors were identified. SettingRochester Adolescent Maternal Program (RAMP) in Rochester, NY. ParticipantsRacially and ethnically diverse pregnant adolescents (n = 158 ≤ 18 y at entry) were recruited. Interventions and Main Outcome MeasuresMain outcome measures were diagnosis of an infection or inflammatory condition in relation to demographic, anthropometric, dietary, socioeconomic, and health data. ResultsThe three most prevalent infections diagnosed in this study population were recto-vaginal colonization of group B Streptococcus (GBS) (38%), bacterial vaginosis (BV) (40%) and candida (42%). African-American teens (AOR = 4.6; 95% CI: 1.74-13.02) and those with higher pre-pregnancy BMI (ppBMI; AOR = 1.2; 95% CI: 1.04-1.31) were more likely to test positive for BV across gestation. Older maternal age decreased the likelihood of positive tests for trichomoniasis (OR = 0.51; 95% CI: 0.26-0.92) and gonorrhea (OR = 0.38; 95% CI: 0.16-0.82). Higher mean dietary vitamin D intake (mcg/d) was associated with a lower likelihood of testing positive for recto-vaginal GBS (OR = 0.87; 95% CI: 0.77-0.98). ConclusionAddressing modifiable risk factors associated with dietary intake and pre-pregnancy weight may help reduce health disparities among pregnant minority adolescents. Additionally, targeted sexual health education may greatly benefit younger female adolescents.

A Brief Survey of Dietary Beliefs and Behaviors of Pregnant Adolescents

Study ObjectiveTo provide a brief assessment of dietary beliefs and behaviors in an understudied high-risk population of pregnant adolescents. Design, Setting, and ParticipantsDiverse pregnant adolescents (n = 66) recruited from the Rochester Adolescent Maternity Program at the University of Rochester Medical Center in Rochester, New York completed a nutrition knowledge and beliefs survey once during pregnancy. Interventions and Main Outcome MeasuresResponses were recorded by a health project coordinator who had good rapport with the teens. Study staff evaluated responses for emergent themes and thematically coded survey data. All responses were assessed relative to demographic variables using χ2 and analysis of variance tests. ResultsMost (83%; 55/66) pregnant teens self-identified as African American with 21% (14/66) identifying as Hispanic. Most (92%; 61/66) adolescents had medical insurance and 28% (19/66) reported participating in the Supplemental Nutrition Program for Women, Infants, and Children. The importance of proper nutrition was acknowledged but 14% (9/66) reported that diet did not matter or they were unsure of the importance of nutrition for the fetus. Money, access to food, and personal relationships were reported as constraining factors for a healthy diet. Response themes did not differ according to demographic characteristics. ConclusionOverall, pregnant teens recognize the importance of dietary intake during pregnancy but this knowledge does not always translate into behaviors. Understanding the health knowledge and behaviors of pregnant adolescents might provide a foundation for future lifestyle and clinical interventions.

Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home.

Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011-January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART's inception, 20% of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5% of identified patients. Following the creation of HEART, 41% of patients were identified as needing mental health services. Nearly half of the identified patients (47%) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers. Limitations of the program are discussed as well directions for future research.