Pregnant teens: Numbers are down but risks are up

May 19, 2000
Web posted at: 11:18 AM EDT (1518 GMT)

In this story: The good and the bad news Delayed prenatal care Premature birth and low birth weight On their way home RELATEDS

(WebMD) -- The summer before freshman year of high school is usually carefree and easy -- a time of fun before focusing on homework and meeting new friends. Probably the last thing on a teenage girl's mind is going through labor. That certainly held true for Cassandra, then almost 15. "I didn't even realize I was pregnant," she says. "I skipped my periods all the time."

Her mother suspected this time was different and gave Cassandra a pregnancy test, telling her to go upstairs and take it while she and her father waited below. "I was thinking there was no way I was pregnant," she says. But, sure enough, two lines appeared on her test stick. Cassandra, in fact, had been pregnant for three months.

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Tales like Cassandra's are actually becoming less common: Teens have been having fewer babies, with the number of pregnancies among those aged 15 to 17 declining by 15 percent since 1991, according to a February 2000 report by the Centers for Disease Control and Prevention. Reasons for this drop in pregnancies included increases in condom use, more widespread use of injectable and implant contraceptives and the leveling off of teen sexual activity, says the CDC.

That's the good news. The bad news is that nearly one in five of the teenagers who do become pregnant receive inadequate prenatal care, according to a 1999 CDC report. As a result, babies born to young mothers are more likely to be premature, to have a low birth weight and childhood health problems and to be hospitalized than children born to older mothers, all of which put them at lifelong health disadvantages.

Why don't teenagers get the prenatal care they need? Arthur Ollendorff, M.D., assistant professor of obstetrics and gynecology at the University of Cincinnati, says teenagers often just don't think about it, and many wait until the fifth month or later before seeing their doctor.

"Among teens, there seems to be a perception that prenatal care doesn't really do anything," says Ollendorff, who works with these young moms. He tells them, "You aren't going for prenatal care just for the heck of it. There actually is a purpose."

Overwhelming fear was the reason 17-year-old high school senior Sara didn't go to the doctor. "I knew I was pregnant right away, but I was in denial. My boyfriend and I didn't even start talking about it until three months into the pregnancy because we were both scared to death," she says.

By the sixth month of pregnancy, critical tests such as the triple blood screen, which can detect genetic defects like Down's syndrome and spina bifida, are two months or more overdue. In addition, maternal health problems that could have been easily caught and treated in the first trimester -- such as anemia, gestational diabetes and high blood pressure -- have had time to cause greater damage to both mother and child. Gestational age and due date are also much harder to accurately pinpoint at this advanced stage.

When Sarah's baby was born weighing less than 6 pounds, "I got a long lecture at the hospital for hiding it so long, that's for sure," she says.

As Sarah experienced, low birth weight -- as well as premature birth -- can be exacerbated by lack of prenatal care. Premature infants are babies born before 37 weeks of pregnancy rather than the full-term 40 weeks, while low birth weight occurs when the baby is born on time, but is dangerously underweight -- 5.5 pounds or less -- according to the "Merck Manual of Medical Information."

At 27 weeks -- just under seven months into her pregnancy -- Cassandra noticed she was bleeding. Her contractions started on the way to the hospital, and she realized she hadn't felt the baby kick in awhile. "Just when I thought the baby was dead, he gave one hard kick, like it was a sign."

When she arrived at the hospital, the doctors tried to stop her labor but were unsuccessful. After the fetal monitor showed the baby's heart was slowing, an emergency cesarean delivery was ordered. "I knew it was way too early," Cassandra says. "I was so afraid, I couldn't imagine how a baby that early could ever survive."

Cassandra had real reason for concern. Despite advances in technology that allow the delivery of ever younger and smaller babies, serious long-term health issues can result from these early births. Valerie E. Whiteman, M.D., director of obstetric services and assistant professor of obstetrics and gynecology at Temple University Hospital in Philadelphia, notes that these consequences can include cognitive delays, brain damage, blindness or deafness.

If the premature or low birth weight baby survives, "it is only the first hurdle, not the last, for both the parents and the baby," Whiteman says. "Taking care of a high-needs infant is incredibly stressful -- emotionally and financially -- especially if the caretaker is not yet mature herself. This is not a baby that will be easy to raise."

That's what Cassandra's currently dealing with. After 79 days in the neonatal intensive care unit, she finally was able to take her baby home. Despite his initial poor outlook, her baby managed to beat the odds, and doctors predict he will likely catch up to other youngsters his age soon. "We do physical therapy every day to help him get stronger," she says. "Whatever happens, we're going to get through this together."

© 2000 Healtheon/WebMD. All rights reserved.

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