PCPs offer ‘haven’ for female adolescents after pregnancy

Standardized clinic protocols related to healthy pregnancy counseling, testing for sexually transmitted infections and primary care follow-up throughout and immediately after pregnancy are needed to ensure that adolescent patients receive continuity of care, according to findings presented during the 2013 Society for Adolescent Health and Medicine Meeting.

Shamieka Virella Dixon, MD, currently with Teen Health Connection, department of pediatrics, division of adolescent medicine at Carolinas Medical Center in Charlotte, N.C., said primary care providers can “offer a haven for adolescent females to address issues of physical and reproductive health needs.”

Shamieka Virella Dixon

However, Dixon and colleagues reported that 38% of patients did not return to primary care after they delivered, miscarried or terminated the pregnancy, and the mean time to return was 5.3 months.

Dixon, a resident at Johns Hopkins University School of Medicine at the time the study was conducted, and colleagues examined provider testing and counseling practices of newly diagnosed pregnant adolescents and their return to primary care after delivery, termination or miscarriage during 2010.

The researchers used ICD-9 diagnosis codes of pregnancy, positive pregnancy test, spontaneous abortion variations, bleeding, and infections in pregnancy to identify 74 black females (mean age of 17.8 years) at a large urban academic center in Baltimore. Electronic medical records were then reviewed using standardized data extraction forms and recorded psychosocial history, pregnancy counseling, STI testing, pregnancy decision and return to primary care.

Chi-squared analyses were used to examine differences between girls that returned to primary care and those lost to follow-up.

Of those patients who returned to primary care, 37% had a repeat pregnancy between 12 and 24 months after their index pregnancy and 21% were not on contraception at their last clinic visit. Of the 72% of patients who carried their pregnancy to term, only 37.6% had documented counseling regarding healthy diets and abstinence from tobacco and drugs.

The mean age of adolescents who returned to care was 17 years, compared with nearly 19 years for those who did not return (P <.01). This was the first pregnancy for 70% of girls who returned to primary care vs. 40% of those lost to follow-up (P<.05). There were no significant differences in risk behaviors, STIs or contraceptive use, according to the researchers.

Thirty-five percent had a history of an STI, and an additional 11% had a history of pelvic inflammatory disease.

For more information:

Dixon SV. Abstract #196. Presented at: Society for Adolescent Health and Medicine 2013; March 13-16, 2013; Atlanta.

Disclosure: The study was funded by T32 HD052549 and LEAH #5T71MC08054.