Healthy management of very early adolescent pregnancy.

191BackgroundArguments exist regarding the association between very early adolescent pregnancies and adverse outcomes.1 Whether the association is causal or associated with the poorer social situation of adolescent mothers remains at issue.2 Many studies from the developed and developing world have reported that teenage pregnancies are at increased risk for preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA).3'17 Other studies have not confirmed the LBW and PTB association18'21 or the SGA association.16'20 Some studies also demonstrate increased risk for maternal death, early neonatal death, and anemia.3'4'6'7'12 This concern is heightened, particularly due to the information that approximately 12% of adolescent pregnancies are in females Other studies note that the very early adolescent pregnancies have decreased morbidities. Specifically these pregnancies demonstrate decreased rates of cesarean sections,6'9'15'18'21 gestational diabetes mellitus,6'16 rates of lacerations,16 and risk for third trimester bleeding.6 Satin et al. 1994 demonstrated a decreased rate of use of Pitocin and an increased vaginal delivery rate.9 Leppalahti et al. 2013 found that very early adolescent pregnancies had an increased vaginal delivery rate.17 These findings are thought to be related to a younger age with less obesity, hypertension, macrosomia, and tobacco or substance abuse.Due to this conflicting data we asked the following questions:1. Are very early adolescent pregnancies (2. Are very early adolescent pregnancies (3. Are there interventions that might ameliorate adverse outcomes in the very early adolescent pregnancies?Material and MethodsMedline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies for very early adolescent pregnancy articles from inception of Medline until January, 2016.ObjectivesTo systematically review risk for adverse outcomes among very early adolescent pregnancies:1. Are very early adolescent pregnancies at increased risk for adverse pregnancy outcomes compared to older gravida pregnancies?2. Are very early adolescent pregnancies at decreased risk for operative delivery (cesarean section) and other pregnancy associated morbidities?3. Are there interventions that might ameliorate adverse outcomes in the very early adolescent pregnancies?Criteria for Considering Studies for This ReviewObservational studies that assessed the association between any adverse pregnancy outcome and very early adolescent pregnancies compared to an older gravida cohort. The older gravidas included all women >15 years of age and included multiple cohorts with varying age groups. All outcomes of LBVv^ PTB, SGA, diabetes, preeclampsia, eclampsia, cesarean section, vaginal delivery, neonatal mortality, maternal mortality, postpartum morbidities, anemia, third trimester bleeding, induction rates, labor abnormalities, and lacerations were included. A study was included if it provided adequate information on outcomes with very early adolescent pregnancies and its effects on the outcomes of interest. Only information available from the publications was included and no authors were contacted. Studies published were included only if there was a comparative cohort. Studies published solely as an abstract were not included.Types of StudiesObservational cohort studies 'with matched, unmatched, or historical controls; longitudinal studies; and case-control studies were included. Reports of data from national or local vital statistics not published as peer-reviewed articles were not included.Types of ParticipantsParticipants included women who had any delivery, including stillbirths, to ascertain any complications with delivery with the very early adolescent pregnancies and the comparison groups of older gravida pregnancies. …