Absence of negative attitudes toward childbearing among pregnant teenagers. A risk factor for a rapid repeat pregnancy?
C. Stevens-Simon, L. Kelly and D. Singer
Department of Pediatrics, University of Colorado Health Science Center, Denver, USA.
OBJECTIVE: To test the hypothesis that adolescent mothers who conceive
again during the first postpartum year express more positive attitudes
toward childbearing while pregnant than do adolescent mothers who postpone
further childbearing. METHOD: Prospective, cross-sectional,
population-based survey. DESIGN: A racially diverse group of 200
consecutively enrolled, poor, pregnant 13- to 18-year-old patients in an
adolescent-oriented maternity program were interviewed to determine why
they had not used contraceptives prior to the index conception. The study
participants were followed up prospectively for the first postpartum year.
The data analysis included t tests, chi 2 tests, analysis of variance, and
logistic regressions. RESULTS: The repeat pregnancy rate was 11.5% during
the first postpartum year. As hypothesized, those who became pregnant again
were more likely to have expressed positive attitudes toward childbearing
during the index pregnancy (60.9% vs 39.6%; P = .05; odds ratio = 2.38; 95%
confidence interval, 0.96-5.90). In addition, those who conceived again
were more likely to have had a prior miscarriage, dropped out of school,
abused illicit substances, moved away from home, and reported inadequate
family support during the index pregnancy, and were less likely to plan to
use levonorgestrel (Norplant) following delivery. The best model for
predicting repeat pregnancy included education status, postpartum plans for
Norplant use, and miscarriage history. Having a positive attitude toward
childbearing during pregnancy was not included in the final model because
it did not contribute to the model or affect any of the other parameters in
the model. CONCLUSIONS: The sexually active teenaged mother who does not
use contraception poses a perplexing diagnostic dilemma. The differential
diagnosis is a long, complex one that includes ambivalent feelings about
postponing future childbearing. This study demonstrates an indirect
association between positive attitudes toward childbearing during pregnancy
and repeat adolescent pregnancy. Our finding that this association operates
through common linkages between maternal educational and contraceptive
plans and both positive attitudes toward childbearing and repeat adolescent
pregnancy suggests that interventions specifically targeting these
underlying causes could reduce the unsafe sexual practices that persist
among the participants in comprehensive adolescent-oriented maternity
programs.
