A few years back, a certified nurse-midwife contacted me to consult about a patient with a complex pregnancy. The patient had been through a series of traumas and was receiving her first prenatal care close to 20 weeks into the pregnancy.
The patient was in the extremely vulnerable 10-14 age range.
She didn’t know why her belly was getting bigger. She didn’t understand what had been done to her. And she couldn’t imagine how difficult life was about to become.
The patient was an extreme case but not entirely unique. Though the U.S. teen birth rate declined 7% among girls 15-19 since 2020, the birth rate among girls 10-14 remained unchanged at 0.2% (fewer than 1 in 1,000). Elementary and middle school-aged girls who become pregnant often are victims of assault, depending on the age of the male involved. When these situations happen, patients and their families need far more than standard pregnancy care.
Studies have shown that teens ages 16-19 who become pregnant face an increased risk of preterm birth but typically have similar pregnancy outcomes compared to adult patients. But much less research exists in patients 15 and younger – a gap that further endangers these already vulnerable patients.
To define a path forward, UT Southwestern conducted a retrospective study of 11 years’ worth of patient data that revealed young patients who give birth face much steeper complications, both with pregnancy and preexisting conditions. In some instances, those complications can also lead to lifelong health and wellness risks.
Alarming trends in our research
In our study, which I co-led with David B. Nelson, M.D., Division Chief of Maternal-Fetal Medicine at UT Southwestern, with funding in part by the Parkland Community Health Plan, we analyzed Dallas-area patient data from January 2010 to May 2021 in an obstetric quality database.
We narrowed the parameters to include only single-baby pregnancies born to patients with no evidence of chronic high blood pressure or diabetes before pregnancy. Sorting the data by patient age, we looked at 868 patients age 15 and younger and 10,894 patients age 16-19. We also identified as a control group a set of patients ages 20-34 who had never given birth to a live infant.
The data on young pregnant patients revealed several alarming trends about access to care, continuity of care, racial disparities, and a sizeable gap in ongoing patient and family support.
Limited prenatal care. Whereas older patients typically initiate prenatal care at 16 weeks of pregnancy or sooner, young patients often have their first visit around 19 weeks and attend visits less frequently. This could be due to several reasons. Elementary and middle school students cannot drive themselves or consent to their own reproductive care. They may be scared to tell their parents, worried about upsetting an abuser, or afraid of deportation.
Many young patients don’t have a solid understanding of how their bodies work, and they may not notice a few missed periods – it is normal to have erratic cycles during the first few years of menstruation. In some cases, they visit the emergency department for what they think are gastrointestinal symptoms and learn they are pregnant.
Pregnancy complications: Young patients were more likely than older teens to develop high blood pressure in pregnancy (preeclampsia) and five times more likely to have eclampsia (a condition associated with high blood pressure that causes seizures in pregnancy[MO1] ). Their babies were more likely to:
- Be born before 37 weeks
- Have a low birthweight
- Need extra care in the neonatal intensive care unit (NICU)
“I will never forget watching my young patient hold back tears while cradling the doll we gave her to represent her coming baby. We developed the adolescent pregnancy specialist team as a result of caring for this patient, and we think about her daily, as we encounter new patient challenges, and while I tuck my own girls into bed at night.”
Most young patients who became pregnant in our data set were Hispanic and non-Hispanic Black. A growing body of research has shown that non-White pregnant patients typically have worse maternal outcomes regardless of education level, family income, or other socioeconomic factors.
Obesity: Young pregnant patients were more likely to have obesity – some had body mass indexes (BMIs) of 40, which is categorized as morbidly obese for adults. Obesity is linked to life-shortening, chronic health problems such as sleep apnea, depression, and several types of cancer, as well as pregnancy complications.
We found that young pregnant patients with obesity are at double the risk of severe preeclampsia and three times as likely to need a cesarean (C-section) delivery, a major surgery that involves cutting through skin, muscle, and the uterus to deliver the baby. We try to limit C-section deliveries to only when they are necessary for the mother’s or baby’s safety.
Our research showed that young patients face far greater pregnancy-related health risks than older teens and adults, combined with known lifelong concerns associated with teen pregnancy, such as:
- Higher unemployment rates
- Lower rates of education completion
- Increased risk of intimate partner violence
- Cyclical socioeconomic challenges for their babies
Young girls who become pregnant need empathic maternal and emotional care, with right-sized information in terms they can understand. But most health care materials are geared toward adults – a significant gap that must be filled by providers who are specially trained in working with children who have been through traumatic experiences.
‘A universe of support’
As a result of our research and pressing needs in the Metroplex, UT Southwestern and Parkland Health have created a universe of support for young pregnant girls and their families. Our two-pronged goal is to prevent tragedies from occurring and, when they do, initiate fast-acting specialist teams to help the girls and their families – right now and for years to come.
Our team covers the spectrum of patient needs, from preparation for delivery through connections to health care and community services.
Key to this team are our CNMs. Young pregnant patients love the midwives – they develop caregiving relationships with families that never ceases to amaze me. The CNMs provide prenatal care and can be there to support the patient through labor, delivery, and postpartum care. CNMs can provide referrals for mental health services, pediatric gynecologic care, and other health needs that arise.
Maternal-fetal medicine doctors
MFM doctors like me are involved with young patients’ care from Day One. We specialize in complex, high-risk pregnancies, so we work closely with the CNMs from prenatal care through postpartum to prevent or manage complications. When needed, we partner with in-person translators in the family’s preferred language to help support the patient and their family.
Child Life specialists
These specialists collaborate with the care team to break down potentially scary or overwhelming medical information for young patients. Child Life helps them understand what will happen during labor and delivery and how their life will change after they take the baby home.
Each family is assigned a social worker who provides priceless connections to community resources, such as family counseling, safe-at-home support, and baby supplies such as a crib, a car seat, and clothing. Patients can get a plan for finishing school in person or online, as well as suggestions for support groups.
Our team also includes lawyers, who help providers follow the laws around reproductive care, and police officers, who can activate their networks to ensure the patient and her family are safe, if needed.
Working against the odds
Over the last 20 years, the number of teen pregnancies have been on the decline, but as long as there are young patients facing this traumatic situation, we will be there to help guide them toward the best outcomes. Our team makes it easier for patients to get to pregnancy and postpartum care visits, tackling problems such as transportation, childcare, and school schedules.
Establishing a caring, supportive health team is our best chance to engage them in lifelong personal health care. The right interventions can help young patients break the cycle of negative outcomes.