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Better Counseling Might Reduce Repeat Pregnancies in Teens


 

SAN ANTONIO — The number of unintended subsequent teenage pregnancies might decrease with enhanced postpartum contraceptive counseling, particularly about side effects of different birth control options, according to a study of 40 young women.

Dr. Suzanne Elizabeth Jose and Dr. Julie Jacobstein explored the effectiveness of postpartum counseling at their institution, Sinai Hospital in Baltimore, through a telephone survey of 40 women (aged 21 years and younger) who were delivered between April and September 2007.

“We see a lot of 15-year-old, 16-year-old girls coming in with their second or third babies,” Dr. Jose said in an interview. “Before they leave the hospital, we counsel them about birth control options.” They are allowed to choose a contraceptive option. The most common choices were the birth control pill (13 patients) and injectable contraception (10 patients).

“But they come back. So we asked ourselves: What are we doing wrong?” Dr. Jose said at her poster during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The survey was conducted 7 months to 1 year post partum. The investigators called the patients to determine if they were using contraception, including the type they selected during postpartum counseling. “All of them got some form of counseling, but half had discontinued [contraception],” said Dr. Jose.

“Some had no reason—they just stopped.” Others cited the adverse effects of contraception. “We have to improve our counseling about side effects,” Dr. Jose said. Group contraception counseling for these adolescent women is a possible future strategy.

Talking to adolescents is not the same as talking to 30-year-olds. “You have to be able to talk to them in language they understand,” Dr. Jose said. Determination of the most effective, age-appropriate dialogue is planned for a future study.

The routine 6-week follow-up visit following vaginal deliveries might be a good time to reinforce contraceptive counseling, she added. Of the 40 adolescent mothers, 11 (28%) reported a subsequent pregnancy—all unintended, Dr. Jose said. There were no miscarriages or ectopic pregnancies.

Although it did not occur in this study, some adolescents choose to get pregnant again, she said. Physicians can ask about such plans during contraceptive counseling and consider the duration of different options. For example, an intrauterine device that lasts 5 years may not be a good option for a teenager.

Next, Dr. Jose and her associates plan to study the effectiveness of postpartum contraceptive counseling in a prospective study.

Dr. Jose said she had no relevant financial disclosures.

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