Maternal psychological stress/depression and low birth weight. Is there a relationship?
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Animals↗
Biomedical subjects
C Stevens-Simon
Publications and source records attributed to C Stevens-Simon.
Repeat adolescent pregnancy and low birth weight: methods issues.
Longitudinal studies of the relationship between birth order and birth weight suggest that mean birth weight increases with parity among women of all ages. In contrast, national birth statistics and other cross-sectional studies of these relationships suggests a decrease in mean birth weight and an increased incidence of low-weight births with parity among adolescent mothers. We examine the potential reasons for these strikingly different conclusions. Our aim is to determine whether multiparity itself is a low-birth-weight risk factor among adolescent mothers or whether it is a marker for other adolescent maternal conditions that increase the risk of a low birth weight, independent of parity.
Adolescent↗
Subfecundity: a prenatal risk factor for adults but not for adolescents.
Young maternal age is associated with an increased incidence of low birth weight and prematurity; controlling for sociodemographic factors reduces the significance of this relationship. We hypothesized that this is partly because in a sociodemographically homogeneous population the adverse effects of maternal subfecundity on fetal growth confound the relationship between maternal age and infant outcome. To test this hypothesis, we studied the reproductive histories of 90 adolescent (less than 20 years old) and 35 adult lower socioeconomic, black prenatal patients. We found a strong, positive relationship between maternal age at conception and duration of unprotected intercourse prior to conception (r = 0.40; p less than 0.0001). Adults reporting 2 or more years of unprotected intercourse prior to conception were at highest risk for low birth weight (p = 0.02). Our findings demonstrate that it is important that adult controls for adolescent pregnancy studies have voluntarily postponed conception.
Adolescent↗
Effects of race on the validity of clinical estimates of gestational age.
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Black People↗
Teenage pregnancy. Caring for adolescent mothers with their infants in pediatric settings.
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Adolescent↗
Adolescent maternal weight gain and low birth weight: a multifactorial model.
Maternal weight gain is one of the most important independent predictors of infant birth weight and interacts with other maternal characteristics, including age, so that infant birth weight reaches a plateau at a higher level of maternal weight gain for young adolescents than for adults. It has been suggested that encouraging young adolescents to gain larger amounts of weight during pregnancy may be one way to decrease their risk of low-birth-weight deliveries. This recommendation may be premature because the mechanisms underlying the interaction between maternal age and weight gain are incompletely understood and may include such diverse factors as incomplete maternal growth, reproductive immaturity, diminished maternal body size, nutritional deficiencies, socioeconomic and behavioral factors, and maternal emotional stress. This review summarizes the literature on adolescent maternal weight gain and infant birth weight and discusses the importance of considering a multifactorial model in reformulating the weight-gain recommendations for pregnant adolescents.
Adolescent↗
A comparison of chronologic age and gynecologic age as indices of biologic maturity.
The clinical usefulness of gynecologic age (GA) (the difference between chronologic age [CA] and menarcheal age [MA]) is controversial. We compared CA and GA with bone age (BA) (the standard reference criterion for biologic maturity), in 107 Caucasian girls who ranged in age from 8.3 to 18.5 years. Chronologic age and GA each correlated significantly with BA. Regression analysis revealed no significant difference between the BAs of early-maturing girls and late-maturing girls of the same CA. However, the BAs of late-maturing girls were significantly greater than those of early-maturing girls of the same GA. Chronologic age may be preferable to GA in studies of adolescents that require an assessment of biologic maturity because CA is a more accurate measure of BA than is GA.
Adolescent↗
How accurately do pregnant adolescents estimate their weight prior to pregnancy?
An accurate determination of maternal prepregnancy weight (PPW) is critical because it is used to calculate weight gain during pregnancy and is one of the best correlates of infant birthweight. The PPW recorded in the prenatal record is usually obtained as part of the patient's history. This study compares PPWs reported by a group of 76 adolescent women (stated weight) with actual weights taken and recorded in medical and school health records by health professionals prior to conception. Simple correlations and a linear regression were used for data analysis. A highly significant correlation (0.98) was found between the stated and actual PPW. Overweight girls tended to underestimate their PPW. These findings suggest that the PPW estimates by adolescents with an identifiable source of medical care are accurate enough to be used to estimate weight gain during pregnancy.
Adolescent↗
What is the relationship between postpartum withdrawal from school and repeat pregnancy among adolescent mothers?
An association between the failure of teenage mothers to return to school postpartum and rapid repeat pregnancy (recidivism) has been described. We report the postpartum education pursuits and contraceptive practices of 29 teenage mothers. Our data, together with the literature, suggest that with close postpartum follow-up, young mothers who are not motivated to return to school following delivery can effectively postpone pregnancy.
Adolescent↗
Composition of gestational weight gain in adolescent pregnancy.
The objective of this study was to test three hypotheses concerning age-related differences in the composition of the weight gained by pregnant adolescents. We studied the change in maternal body composition during gestation in relation to maternal age and infant birth weight in relation to change in maternal body composition in 108 consecutive, low-income, pregnant, black adolescents. Regardless of age, approximately 26% of adolescents' body weight and 38% of the weight adolescents gain during gestation is fat. A hierarchical regression analysis revealed that the rate of gestational weight gain is significant predictor of infant birth weight among younger (R2 change = 0.15, P = 0.004), but not older (R2 change = 0.01, not significant), adolescents. Among younger adolescents, the rate of fat weight gain is the best predictor of infant birth weight. Maternal age interacts with fat weight gain (but not total or lean weight gain) to predict infant birth weight (R2 change = 0.046, P = 0.022). During gestation maternal age does not have a clinically important effect on the composition of the body or weight gained by pregnant adolescents. However, maternal age interacts with the composition of the gestational weight gain to predict infant birth weight; the fat component of the weight gain is a significant predictor of infant birth weight in younger, but not older, adolescents.
Adipose Tissue↗
Short cervix: a cause of preterm delivery in young adolescents?
OBJECTIVE: To test the hypothesis that at midgestation younger adolescents (<16 years of age at conception) have shorter cervices than older adolescents (16-19 years of age at conception). METHODS: At midgestation (22.9 +/- 2.4 weeks) we measured cervical length by transvaginal ultrasound in a group of 46 13-19-year-old participants in an intensive, adolescent-oriented, antenatal program. Subjects were also comprehensively screened and treated for other recognized physiologic, microbiologic, obstetric, behavioral, and psychosocial factors associated with preterm delivery. Univariate, bivariate, and logistic regression analyses were used. RESULTS: The 18 younger adolescents had significantly shorter cervices than the 28 older adolescents (30 +/- 11 mm vs. 39 +/- 8 mm; P = 0.002). The younger adolescents' cervices were also more likely to be < or =25 mm long (33% and 4%, respectively; P = 0.02) and to exhibit funneling (39% vs. 4%; P = 0.01). Teenagers with cervices < or =25 mm long were younger, thinner, more apt to report vaginal bleeding and substance abuse, and to be treated for preterm labor (71% vs. 21%; P = 0.005). Logistic regression analyses revealed that age <16 years at conception (odds ratio = 13.7; 95% CI: 1.3-151.4) and substance abuse (odds ratio = 8.5; 95% CI: 1.2-62.8) were associated with cervical length < or =25 mm. Cervical length < or =25 mm was the only significant predictor of preterm delivery (odds ratio = 26.2; 95% CI: 2.1-333.6; P = 0.01) in this population of adolescents who were routinely treated for other recognized causes of preterm delivery. CONCLUSIONS: Cervical length < or =25 mm and cervical funneling may be complications of conception prior to 16 years of age. Randomized trials are needed to determine if younger adolescents benefit preferentially from ultrasound screening for short cervix at midgestation.
Adolescent↗
A comparison of the psychological resources of adolescents at low and high risk of mistreating their children.
OBJECTIVE: Our objective was to compare the psychological resources of pregnant teenagers who are at low and high risk for mistreating their children. METHOD: We studied 71 participants in a comprehensive, adolescent-oriented maternity program. During the prenatal period, the Family Stress Checklist was used to quantify child abuse potential, with scores > or =25 defining high risk. Information about the social context of the pregnancy and maternal psychological resources was obtained with self-administered questionnaires. A composite psychological resource variable was computed by summing the z scores for intelligence, mental health, and mastery, with scores < or =0 defining the low-resource group. RESULTS: Of the 71 teenagers, 26 (36.6%) were classified as high risk for child abuse and neglect. Compared with low-risk teens, high-risk teens had more behavioral problems, lower psychological resource scores (mean +/- SD of z score: -0.98 +/- 2.02 compared with 0.39 +/- 1.79; P =.004), and were more likely to have low psychological resources (69.2% compared with 44.4%; P =.04). CONCLUSIONS: Pregnant teenagers who are at risk for child abuse and neglect exhibit fewer psychological resources than their low-risk peers do, and may therefore benefit preferentially from intensive, in-home intervention.
Adaptation, Psychological↗
Racial variation in vaginal pH among healthy sexually active adolescents.
BACKGROUND AND OBJECTIVES: To determine if there are racial differences in vaginal pH that could account for the increased prevalence of trichomoniasis among sexually active black women. STUDY DESIGN: We measured the pH of vaginal secretions in a group of 273 sexually active, adolescent females without evidence of lower genital tract infection or cervical inflammation. RESULTS: Univariate analyses revealed that seven factors (black race, current alcohol use, nonsmoking status, gravidity, parity, and younger chronologic and gynecologic age) were significantly associated with a more alkaline vaginal pH. After a step-wise multiple regression analysis only three factors (black race, current alcohol use and parity) remained significantly related to vaginal pH, with the strongest association for black race (mean + standard deviation [SD] for vaginal pH among black adolescents 5.3 + 0.7 compared to 4.7 + 0.6 for other adolescents; P < .0001). CONCLUSION: The pathophysiologic mechanisms that underlie the racial differences we identified in vaginal pH remain to be elucidated. Nevertheless, we speculate that race-related variations in the pH of normal vaginal secretions may decrease the resistance of black adolescents, one of the highest-risk obstetric population in this country, to common vaginal infections, such as trichomoniasis and bacterial vaginosis.
Adolescent↗
Preventing repeat adolescent pregnancies with early adoption of the contraceptive implant.
CONTEXT: Even in intensive, adolescent-oriented programs, in which access to highly effective contraceptives is guaranteed, repeat adolescent pregnancies commonly occur. METHODS: To assess whether adoption of the contraceptive implant would lower the rate of repeat pregnancy, contraceptive use and pregnancy outcomes were tracked among 309 adolescent mothers--171 "early" implant users who began use within six months of delivery and 138 who either adopted another method or had used no method. Participants were interviewed at delivery and at six-month intervals through the second year postpartum. Multivariate logistic regression analyses were conducted to ascertain the likelihood of a repeat pregnancy within the first and second year postpartum. RESULTS: During the first year postpartum, although 7% of the early implant users had their implants removed, pregnancy rates were significantly (p < .0001) lower among early implant users (less than 1%) than among the other adolescent mothers in the sample (20%). By the end of the second year postpartum, 37% of early implant users had discontinued use. Nevertheless, their two-year pregnancy rate (12%) remained significantly lower (p < .0001) than that of the other adolescent mothers (46%). The multivariate analysis showed that early implant use was the only independent predictor of a repeat pregnancy within the first year postpartum, while early use, parity and number of risk factors for repeat pregnancy were independently associated with the likelihood of another pregnancy in the second year postpartum. CONCLUSIONS: Although early implant insertion significantly decreased the rate of rapid, repeat adolescent pregnancies, the rates of removal and of pregnancy by the end of the second year postpartum were high. Thus, health care providers need to address the motivational components of adolescent pregnancy even among those who accept ostensibly long-term methods.
Adolescent↗