Questions 1. A 14-year-old girl comes to the labour ward in early labour at 2 am.

She is 38 weeks
pregnant with a single viable fetus. She had regular uneventful antenatal care. Her serial growth
scans are all normal. She had stopped smoking during this pregnancy and her sexually
transmitted disease screening is negative. What would you recommend in her delivery? A. Avoid
epidural anaesthesia at all costs. B. Advise tocolysis to try to stop labour until 39 weeks. C.
Continuous electronic fetal monitoring. D. Recommend emergency Caesarean section. E. Routine
care of labour. 2. In the antenatal clinic, the midwife tells you about your next patient. She is one
of a group of five schoolgirls who decided to get pregnant. They are all under-achieving in
school. They do not attend all their clinic appointments. What should you do in this situation? A.
Advise them to terminate the pregnancy. B. Do not give any further appointments if they do not
attend. C. Do nothing extra. D. Send a letter to the school manager to criticize this event. E. Try
to encourage them to attend the clinics and arrange a school visit to give information to other
girls. 3. A 15-year-old girl comes to the antenatal clinic. She is 11 weeks pregnant. She comes
from a broken family. She claims it was an unintended pregnancy; she does not want to
terminate the pregnancy but is not sure what to do with the child when it is born. What options
will you offer her? A. Insist she should have a termination of pregnancy. B. She can offer the child
for adoption. C. She can leave the child to her divorced mother. D. She can leave the child to the
social healthcare services. E. She can leave the child to any of her relatives. 4. You work as an ST
5 in an inner city hospital. You are asked to discuss the high incidence of teenage pregnancy with
the local school administration to see how it may be possible to prevent and reduce teenage
pregnancy.

Khalil, A. M. (2017). Teenage pregnancy. In Mastering Single Best Answer Questions for the Part
2 MRCOG Examination: An Evidence-Based Approach.
https://doi.org/10.1017/9781316756447.013

Adolescent pregnancy, although on the decline, represents a significant public health concern.
Often adolescents present late to prenatal care, either from lack of knowledge, fear of
consequences, limited access, stigma, or all of the above. Although multifaceted, there are many
risks both to mother and child that are increased in adolescent pregnancy. Many are unintended
and are at risk for repeat adolescent pregnancy, especially within the first 2 years. Risks include
but are not limited to: low birth weight, preterm delivery, stillbirth, and preeclampsia, as well as
feelings of social isolation, delayed or neglected educational goals, and maternal depression.

Leftwich, H. K., & Alves, M. V. O. (2017). Adolescent Pregnancy. Pediatric Clinics of North
America. https://doi.org/10.1016/j.pcl.2016.11.007
Although trauma in pregnancy is rare, it is one of the most common causes of morbidity and
mortality to pregnant women and fetus. Pathophysiology of trauma is generally time sensitive,
and this is still true in pregnant patients, with the additional challenge of rare presentation and
balancing the management of two patients concurrently. Successful resuscitation requires
understanding the physiologic changes to the woman throughout the course of pregnancy.
Ultimately, trauma management is best approached by prioritizing maternal resuscitation.

Sakamoto, J., Michels, C., Eisfelder, B., & Joshi, N. (2019). Trauma in Pregnancy. Emergency
Medicine Clinics of North America. https://doi.org/10.1016/j.emc.2019.01.009

B efore the advent of antibiotic agents, pregnancy was a recog-nized risk factor for severe
complications of pneumococcal pneumonia, in-cluding death. 1 The influenza pandemic of 2009
provided a more recent re-minder that certain infections may disproportionately affect pregnant
women. Are pregnant women at increased risk for acquiring infections? Are pregnant women
with infection at increased risk for severe disease? During pregnancy, several mechanical and
pathophysiological changes occur (e.g., a decrease in respiratory volumes and urinary stasis due
to an enlarging uterus), and immune adaptations are required to accommodate the fetus. In this
article, we review and synthesize new knowledge about the severity of and susceptibility to
infections in pregnant women. We focus on the infections for which there is evidence of
increased severity or susceptibility during pregnancy that is not fully explained by mechanical or
anatomical changes, and we discuss these infections in light of new findings on immunologic
changes during pregnancy. Pr egna nc y a nd Sev er it y of Infec tion

Calvert, C., & Ronsmans, C. (2014). Pregnancy and infection. New England Journal of Medicine.
https://doi.org/10.1056/NEJMc1408436

A proportion of women enter pregnancy with active psychiatric symptoms or disorders, with or
without concomitant psychotropic medication. Studies report that exposure to untreated
depression and stress during pregnancy may have negative consequences for birth outcome and
child development. Studies also report that antenatal exposure to antidepressant medications
may have adverse consequences for birth outcome and child development. Antidepressant
medication use during pregnancy leads to a small increased risk of miscarriage, a possible small
increased risk of congenital cardiac malformations, a small increased risk of preterm birth, a
small increased risk of persistent pulmonary hypertension of the newborn (PPHN), and transient
neonatal symptoms in up to one-third of neonates. In addition, there is a possible increased risk
of delayed motor development in children. Several recent systematic reviews and meta-analyses
of the existent literature emphasize that there are minimal definitive conclusions to guide
treatment recommendations. This review describes best practices for the management of
depression in pregnancy, and it provides suggestions for future research.

Pearlstein, T. (2015). Depression during Pregnancy. Best Practice and Research: Clinical Obstetrics
and Gynaecology. https://doi.org/10.1016/j.bpobgyn.2015.04.004

Objective. The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes
of teenage pregnancy in a tertiary care teaching hospital. Methods. A retrospective case control
study was performed over a period of 5 years. Data were retrieved from hospital records. All
teenage mothers (aged 13-19 completed years at delivery) delivering in the University Hospital
were taken as cases. Next 3 consecutive deliveries in the age group of 20-30 year were selected
as controls for each case. For statistical analysis the cases were further subdivided into 2 groups,
≤17 years (Group A) and 18-19 years (Group B). Groups were compared for obstetric
complications and neonatal outcome. Statistical analysis was done by software package SPSS 10.
Results. The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of
the teenagers were primigravida (83.2% vs. 41.4%, p<0.01). Complications like pregnancy
induced hypertension (PIH) (11.4% vs 2.2%, p<0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%,
p<0.01) eclampsia (4.9% vs 0.6%, p<0.01) and premature onset of labor (26.1% vs 14.6%,
p<0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had
increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p<0.01), premature delivery
(51.8% vs 17.5%, p<0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%,
p<0.01), jaundice (5.7% vs 1.2%, p<0.01) and respiratory distress syndrome (1.9% vs 0.3%,
p<0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p<0.05) and
neonatal mortality (3.8% vs 0.5%, p<0.05). Conclusion. Teenage pregnancy was associated with a
significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and
premature delivery. Increased neonatal morbidity and mortality were also seen in babies
delivered to teenage mothers. Younger teenager group (≤17 years) was most vulnerable to
adverse obstetric and neonatal outcomes. © 2007 Dr. K C Chaudhuri Foundation.

Kumar, A., Singh, T., Basu, S., Pandey, S., & Bhargava, V. (2007). Outcome of teenage pregnancy.
Indian Journal of Pediatrics. https://doi.org/10.1007/s12098-007-0171-2

The UK has the highest rate of teenage pregnancies in Western Europe and within the UK higher
rates are found amongst women with certain social risk factors, such as those who live in areas
of higher deprivation. Teenage pregnancy can be a positive event for some young women.
However, there are a number of adverse social outcomes associated with teenage motherhood
in the UK, including being more likely to live in poverty, being unemployed or having lower
salaries and educational achievements than their peers. Furthermore, children of teenage
mothers are more likely to become teenage parents themselves. Strategies to tackle social issues
associated with teenage pregnancy need to involve concurrent interventions, including
education, skill building, clinical and social support for teenage mothers and contraception
services for young people and pregnant teenagers.
Cook, S. M. C., & Cameron, S. T. (2017). Social issues of teenage pregnancy. Obstetrics,
Gynaecology and Reproductive Medicine. https://doi.org/10.1016/j.ogrm.2017.08.005

Teenage pregnancy is a cause and consequence of inequality, limiting the life chances of
young parents and their children. It is an issue of global concern, with many countries
developing programmes of prevention. This review focuses on the experience of the England
strategy, launched in 1999 to address the historically high rates. It is one of the few
examples of a successful long term, multi-agency programme, led by national government
and locally delivered which, between 1998 and 2015, reduced the under-18 conception rate
by 55%. It sets out the case for helping young people delay early pregnancy, the
international evidence for prevention, and how evidence is translated into a ‘whole system’
approach. Questions are included to encourage both investigation into local programmes on
teenage pregnancy prevention, and reflection on individual practice. The review concludes
with summarising the next steps for England and the lessons that can be shared more
widely.

Hadley, A. (2018). Teenage pregnancy: strategies for prevention. Obstetrics, Gynaecology

and Reproductive Medicine. https://doi.org/10.1016/j.ogrm.2018.02.003

Background: Risk factors for teenage pregnancy are linked to many factors, including a
family history of teenage pregnancy. This research examines whether a mother's teenage
childbearing or an older sister's teenage pregnancy more strongly predicts teenage
pregnancy. Methods: This study used linkable administrative databases housed at the
Manitoba Centre for Health Policy (MCHP). The original cohort consisted of 17,115 women
born in Manitoba between April 1, 1979 and March 31, 1994, who stayed in the province
until at least their 20th birthday, had at least one older sister, and had no missing values on
key variables. Propensity score matching (1:2) was used to create balanced cohorts for two
conditional logistic regression models; one examining the impact of an older sister's teenage
pregnancy and the other analyzing the effect of the mother's teenage childbearing. Results:
The adjusted odds of becoming pregnant between ages 14 and 19 for teens with at least one
older sister having a teenage pregnancy were 3.38 (99 % CI 2.77-4.13) times higher than for
women whose older sister(s) did not have a teenage pregnancy. Teenage daughters of
mothers who had their first child before age 20 had 1.57 (99 % CI 1.30-1.89) times higher
odds of pregnancy than those whose mothers had their first child after age 19. Educational
achievement was adjusted for in a sub-population examining the odds of pregnancy
between ages 16 and 19. After this adjustment, the odds of teenage pregnancy for teens
with at least one older sister who had a teenage pregnancy were reduced to 2.48 (99 % CI
2.01-3.06) and the odds of pregnancy for teen daughters of teenage mothers were reduced
to 1.39 (99 % CI 1.15-1.68). Conclusion: Although both were significant, the relationship
between an older sister's teenage pregnancy and a younger sister's teenage pregnancy is
much stronger than that between a mother's teenage childbearing and a younger daughter's
teenage pregnancy. This study contributes to understanding of the broader topic "who is
influential about what" within the family.

Wall-Wieler, E., Roos, L. L., & Nickel, N. C. (2016). Teenage pregnancy: The impact of
maternal adolescent childbearing and older sister’s teenage pregnancy on a younger sister.
BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-016-0911-2

Objectives: To determine the impact on teenage pregnancy of interventions that address the
social disadvantage associated with early parenthood and to assess the appropriateness of
such interventions for young people in the United Kingdom. Design: Systematic review,
including a statistical metaanalysis of controlled trials on interventions for early parenthood
and a thematic synthesis of qualitative studies that investigated the views on early
parenthood of young people living in the UK. Data sources: 12 electronic bibliographic
databases, five key journals, reference lists of relevant studies, study authors, and experts in
the field. Review methods: Two independent reviewers assessed the methodological quality
of studies and abstracted data. Results: Ten controlled trials and five qualitative studies
were included. Controlled trials evaluated either early childhood interventions or youth
development programmes. The overall pooled effect size showed that teenage pregnancy
rates were 39% lower among individuals receiving an intervention than in those receiving
standard practice or no intervention (relative risk 0.61; 95% confidence interval 0.48 to
0.77). Three main themes associated with early parenthood emerged from the qualitative
studies: dislike of school; poor material circumstances and unhappy childhood; and low
expectations for the future. Comparison of these factors related to teenage pregnancy with
the content of the programmes used in the controlled trials indicated that both early
childhood interventions and youth development programmes are appropriate strategies for
reducing unintended teenage pregnancies. The programmes aim to promote engagement
with school through learning support, ameliorate unhappy childhood through guidance and
social support, and raise aspirations through career development and work experience.
However, none of these approaches directly tackles all the societal, community, and family
level factors that influence young people's routes to early parenthood. Conclusions: A small
but reliable evidence base supports the effectiveness and appropriateness of early
childhood interventions and youth development programmes for reducing unintended
teenage pregnancy. Combining the findings from both controlled trials and qualitative
studies provides a strong evidence base for informing effective public policy.

Harden, A., Brunton, G., Fletcher, A., & Oakley, A. (2009). Teenage pregnancy and social
disadvantage: Systematic review integrating controlled trials and qualitative studies. BMJ
(Online). https://doi.org/10.1136/bmj.b4254

Teenage pregnancy is a global problem and is considered a high-risk group, in spite of

conflicting evidence. Our objective was to compare obstetric outcomes of pregnancy in
teenagers and older women. This was a retrospective study of case records of pregnancies
from August 2000 to July 2001. Girls aged ≤19 years were compared with pregnancy
outcomes in older women (19-35 years) in the same hospital. The study took place in the
Government General Hospital, Sangli, India, a teaching hospital in rural India, with an annual
delivery rate of over 3,500. A total of 386 teenage pregnancies were compared with
pregnancies in 3,326 older women. Socioeconomic data, age, number of pregnancies,
antenatal care and complications, mode of delivery, and neonatal outcomes were
considered. The incidence of teenage pregnancy in the study was 10%. A significant
proportion of teenage pregnant mothers were in their first pregnancies. The teenage
mothers were nearly three times more at risk of developing anaemia (OR = 2.83, 95% CI =
2.2-3.7, p < 0.0001) and delivering pre-term (OR = 2.97, 95% CI = 2.4-3.7, p < 0.0001).
Teenage mothers were twice as likely to develop hypertensive problems in pregnancy (OR =
2.2, 95% CI = 1.5-3.2, p < 0.0001) and were more likely to deliver vaginally with no
significant increase in the risk of assisted vaginal delivery or caesarean section. Young
mothers were nearly twice at risk of delivering low birth weight babies (OR = 1.8, 95% CI =
1.5-2.2, p < 0.0001) and 50% less likely to have normal birth weight babies (OR = 0.5, 95%
CI = 1.2-2.9, p < 0.0001). The outcome of this study showed that teenage pregnancies are
still a common occurrence in rural India in spite of various legislations and government
programmes and teenage pregnancy is a risk factor for poor obstetric outcome in rural
India. Cultural practices, poor socioeconomic conditions, low literacy rate and lack of
awareness of the risks are some of the main contributory factors. Early booking, good care
during pregnancy and delivery and proper utilisation of contraceptive services can prevent
the incidence and complications in this high-risk group. © 2008 Informa Healthcare USA,
Inc.

Mahavarkar, S. H., Madhu, C. K., & Mule, V. D. (2008). A comparative study of teenage
pregnancy. Journal of Obstetrics and Gynaecology.
https://doi.org/10.1080/01443610802281831

Objective: To summarise the published research on teenage pregnancy in Malaysia, discuss

the impact of the findings on clinical practice, and identify gaps in teenage pregnancy
research in Malaysia. Methods: There were 31 articles related to teen pregnancy found after
searching a database dedicated to indexing all original clinical research data published in
Malaysia from year 2000 to 2014. Twenty-seven articles (including reports from the
National Obstetrics Registry) were selected and reviewed on the basis of clinical relevance
and future research implications. This literature review has been divided into eight sections:
epidemiology, age at first marriage, adolescent fertility rate, unmarried childbearing, risk
factors, maternal risks and neonatal outcome, future plan after delivery, and contraceptive
use. Results: More than 19,000 births to teenage mothers were recorded each year between
2009 and 2011. Adolescent fertility rates were recorded at 6 births per 1000 women ages
15–19 years in 2013. Many of these births were from unwed pregnancies, which accounted
for 1.99% of total deliveries. A majority of young mothers were willing to take care of their
baby, although some of them planned to put their baby up for adoption. Risk factors for
teenage pregnancy were found to be similar to those published in studies worldwide.
Conclusion: More research is needed to better understand the issue of teen pregnancy. For
the best results, collaborative studies among nationwide hospitals and institutions should
be the way forward.

Suan, M. A. M., Ismail, A. H., & Ghazali, H. (2015). A review of teenage pregnancy research in
Malaysia. Medical Journal of Malaysia.

Background: South Asia has a large proportion of young people in the world and teenage
pregnancy has emerged as one of the major public health problem among them. The
objective of this study is to systematically review to identify the risk factors associated with
teenage pregnancy in South Asian countries. Methods: We systematically searched
MEDLINE, EMBASE and CINAHL database (1996 to April 2007) and web-based information.
Inclusion criteria were the English-language papers available in the UK and describing
teenage pregnancy in South Asia. Results: Out of the seven countries in South Asia, most of
the studies were related to Nepal, Bangladesh, India and Sri Lanka. Socio-economic factors,
low educational attainment, cultural and family structure were all consistently identified as
risk factors for teenage pregnancy. Majority of teenage girls are reported with basic
knowledge on sexual health however, very few of them have used the knowledge into
practice. Both social and medical consequences of teenage pregnancies are reported
consistently along the most of the studies. Utilization of health services, which is a
protective factor, remains low and consistent. However, teenagers agreed to delay the
indexed pregnancy if they would know its consequences. Conclusions: In South Asia, many
risk factors are a part of socio-economic and cultural influences. This systematic review is
limited by the amount and the quality of papers published on factors associated with
teenage pregnancy. In particular, future research in South Asian countries is needed with
standardised measures and methodologies to gain an insight into observed variations in
pregnancy rates.

Raj, A. D., Rabi, B., Amudha, P., van Teijlingen Edwin, R., & Glyn, C. (2010). Factors associated
with teenage pregnancy in South Asia: A systematic review. Health Science Journal.

Background: The proportion of teenage girls who are mothers or who are currently
pregnant in sub-Saharan African countries is staggering. There are many studies regarding
teenage pregnancy, unsafe abortions, and family planning among teenagers, but very little is
known about what happens after pregnancy, ie, the experience of teenage motherhood.
Several studies in Ghana have identified the determinants of early sexual activity,
contraception, and unsafe abortion, with teenage motherhood only mentioned in passing.
Few studies have explored the experiences of adolescent mothers in detail with regard to
their pregnancy and childbirth. This qualitative study explores the experiences of
adolescent mothers during pregnancy, childbirth, and care of their newborns. Methods: This
qualitative study was based on data from focus group discussions and indepth interviews
with teenage mothers in a suburb in Accra. Participants were recruited from health facilities
as well as by snowball sampling. Results: Some of the participants became pregnant as a
result of transactional sex in order to meet their basic needs, while others became pregnant
as a result of sexual violence and exploitation. A few others wanted to become pregnant to
command respect from people in society. In nearly all cases, parents and guardians of the
adolescent mothers were upset in the initial stages when they heard the news of the
pregnancy. One key fnding, quite different from in other societies, was how often teenage
pregnancies are eventually accepted, by both the young women and their families. Also
observed was a rarity of willingness to resort to induced abortion. Conclusion: Special
programs should be initiated by the government and the various responsible departments
to address ignorance on sexual matters, and the challenges and risks associated with
pregnancy and parenting by adolescents. Parenting techniques should be taught in sex
education programs. © 2013 Gyesaw and Ankomah.

Konadu Gyesaw, N. Y., & Ankomah, A. (2013). Experiences of pregnancy and motherhood
among teenage mothers in a suburb of Accra, Ghana: A qualitative study. International
Journal of Women’s Health. https://doi.org/10.2147/IJWH.S51528

Background: South African teenage pregnancy rates remain high by international

comparison and, in the rural town of Taung, the rate of 13% is twice the national average of
6.5%. Teenage pregnancy is a risk factor for disruption of education, future unemployment,
sexually transmitted infections, HIV, preterm birth and poor mental health. The aim of this
study was to understand the attitudes and perceptions of teenagers in Taung regarding
teenage pregnancy and to explore their understanding of sexuality and contraception. This
study intended to contribute to a deeper understanding by exploring teenagers' own
perceptions on the matter, to identify factors that, in their view, may influence the risk of
pregnancy and suggest possible interventions. No previous studies from the Taung area
have been identified. Methods: The qualitative study entailed 13 in-depth interviews with
pregnant teenagers and three focus groups: one with 10 women aged 19 to 25 years who
had a baby as a teenager, one with 14 teenage girls aged 16 to 19 years who had never been
pregnant, and one with 11 males aged 18 to 23 years. Qualitative data was analysed through
the framework method. Results: Factors influencing teenage pregnancy were found to be
broad and complex: 1) Socioeconomic factors included poverty, the controversial influence
of the child support grant, transgenerational sex and financial support from an older
partner to secure income for the teenage girl or her family. 2) Substance abuse, particularly
alcohol, in either the teenager or her parents was found to have a critical influence. A lack of
alternative entertainment and social infrastructure made shebeens (local bars) a normal
part of teenage social life. 3) Peer pressure from boyfriends and the broader social network.
4) Other factors included the right to motherhood before becoming HIV positive, poor
sexual negotiation skills, the need to prove one's fertility, sexual coercion and low self-
esteem. Understanding of contraceptives and reproductive health was poor, condoms were
the contraceptive method most known by teenagers and their understanding of the
menstrual cycle was inaccurate. Most teenagers perceived falling pregnant as a negative
event with consequences such as unemployment, loss of a boyfriend, blame from friends
and family members, feeling guilty, difficulty at school, complications during pregnancy or
delivery, risk of HIV, secondary infertility if an abortion is done and not being prepared for
motherhood. A number of teenagers, however, perceived some benefits and saw that it could
be a positive event depending on the circumstances. Conclusions: The study identified a
number of factors that may influence the teenage pregnancy rate. These factors may
influence teenagers' behavioural intentions through altering their perceptions of the
personal and social consequences of falling pregnant and their self-efficacy in relation to
sexual behaviour. Environmental factors may also facilitate or prevent teenagers from
fulfilling their intentions. Teenagers may also vary in their ability to carry out these
intentions. Strategies to reduce teenage pregnancy should focus on building social capital
for teenagers in communities, further exploring the influence of the child support grant,
targeting transgenerational sexual norms, applying the law on underage drinking, making
information on contraception more accessible and offering programmes that empower girls
in the area of sexuality. Multifaceted and intersectoral approaches are required and it is
likely that strategies to reduce teenage pregnancy will also impact on HIV and other sexually
transmitted infections. © SAAFP.

Kanku, T. (2010). Attitudes, perceptions and understanding amongst teenagers regarding

teenage pregnancy, sexuality and contraception in Taung. South African Family Practice.
https://doi.org/10.1080/20786204.2010.10874048

Doi:10.5901/jesr.2013.v4n3p53 Abstract Recently, the incidence of teenage pregnancy has

been very high in Ghana. The study therefore was designed to explore the effects of teenage
pregnancy on the educational attainment of the girl-child at Chorkor. A total sample size of
fifty-five (55) respondents was used for the study. Questionnaire, in-depth interview, focus
group discussions and observation were used to collect data for the study. With respect to
factors that lead to teenage pregnancy, it was evident that poor parenting, poverty and peer
influence are the major causes of teenage pregnancy. The study also revealed that most of
the teenage mothers drop out of school. The study therefore recommended that teenage
mothers should be helped in their psychosocial development and job skills development.

Gyan, C. (2013). The Effects of Teenage Pregnancy on the Educational Attainment of Girls at
Chorkor, a Suburb of Accra. Journal of Educational and Social Research.
https://doi.org/10.5901/jesr.2013.v4n3p53

Objective: To describe the needs and evidence-based practice specific to care of the
pregnant adolescent in Canada, including special populations. Outcomes: Healthy
pregnancies for adolescent women in Canada, with culturally sensitive and age-appropriate
care to ensure the best possible outcomes for these young women and their infants and
young families, and to reduce repeat pregnancy rates. Evidence: Published literature was
retrieved through searches of PubMed and The Cochrane Library on May 23, 2012 using
appropriate controlled vocabulary (e.g., Pregnancy in Adolescence) and key words (e.g.,
pregnancy, teen, youth). Results were restricted to systematic reviews, randomized control
trials/controlled clinical trials, and observational studies. Results were limited to English or
French language materials published in or after 1990. Searches were updated on a regular
basis and incorporated in the guideline to July 6, 2013. Grey (unpublished) literature was
identified through searching the websites of health technology assessment and health
technology-related agencies, national and international medical specialty societies, and
clinical practice guideline collections. Values: The quality of evidence in this document was
rated using the criteria described in the Report of the Canadian Task Force on Preventive
Health Care (Table 1). Benefits/Harms/Costs: These guidelines are designed to help
practitioners caring for adolescent women during pregnancy in Canada and allow them to
take the best care of these young women in a manner appropriate for their age, cultural
backgrounds, and risk profiles.

Fleming, N., O’Driscoll, T., Becker, G., Spitzer, R. F., Allen, L., Millar, D., … Spitzer, R. (2015).
Adolescent Pregnancy Guidelines. Journal of Obstetrics and Gynaecology Canada.
https://doi.org/10.1016/S1701-2163(15)30180-8

Substance abuse in pregnancy has increased over the past three decades in the United
States, resulting in approximately 225,000 infants yearly with prenatal exposure to illicit
substances. Routine screening and the education of women of child bearing age remain the
most important ways to reduce addiction in pregnancy. Legal and illegal substances and
their effect on pregnancy discussed in this review include opiates, cocaine, alcohol, tobacco,
marijuana, and amphetamines. Most literature regarding opiate abuse is derived from
clinical experience with heroin and methadone. Poor obstetric outcomes can be up to six
times higher in patients abusing opiates. Neonatal care must be specialized to treat
symptoms of withdrawal. Cocaine use in pregnancy can lead to spontaneous abortion,
preterm births, placental abruption, and congenital anomalies. Neonatal issues include poor
feeding, lethargy, and seizures. Mothers using cocaine require specialized prenatal care and
the neonate may require extra supportive care. More than 50% of women in their
reproductive years use alcohol. Alcohol is a teratogen and its effects can include
spontaneous abortion, growth restriction, birth defects, and mental retardation. Fetal
alcohol spectrum disorder can have long-term sequelae for the infant. Tobacco use is high
among pregnant women, but this can be a time of great motivation to begin cessation
efforts. Long-term effects of prenatal tobacco exposure include spontaneous abortion,
ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction,
preterm delivery, childhood respiratory disease, and behavioral issues. Marijuana use can
lead to fetal growth restriction, as well as withdrawal symptoms in the neonate. Lastly,
amphetamines can lead to congenital anomalies and other poor obstetric outcomes. Once
recognized, a multidisciplinary approach can lead to improved maternal and neonatal
outcomes. Copyright © Taylor & Francis Group.

Keegan, J., Parva, M., Finnegan, M., Gerson, A., & Belden, M. (2010). Addiction in pregnancy.
Journal of Addictive Diseases. https://doi.org/10.1080/10550881003684723