SAN DIEGO – Adolescents who participated in a centering pregnancy program were more likely to obtain long-acting reversible contraception and were less likely to have postpartum depression, compared with their peers in two control groups, results from a single-center study demonstrated.
"Although the number of adolescent pregnancies each year has declined, it’s still a major issue facing our teens," Dr. Gayatri Chhatre said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Dr. Gayatri Chhatre
"The United States has the highest teen pregnancy rate in the Western industrialized world, with 418,870 teen pregnancies in 2012 alone [Curr. Opin. Pediatr. 2012;24:446-52]. This is a huge problem because adolescents in pregnancy are at increased risk for adverse outcomes, including gestational morbidity and mortality, low-birth-weight infants, excessive weight gain in pregnancy, and most importantly, repeat unintended pregnancy," said Dr. Chhatre, a fourth-year resident at Washington (D.C.) Hospital Medical Center.
One way to address this issue, she said, is with centering pregnancy (CP), a program developed by nurse practitioner Sharon Schindler Rising in the 1990s. Dr. Chhatre described CP as "a model of care that aims to provide all components of prenatal care in one accessible process. Visits are divided into one-on-one time with providers, as well as group discussions with 8-12 women at similar gestational ages on various topics ranging from what to expect in pregnancy to what to expect postpartum and contraception options."
For the current study, Dr. Chhatre and her associates reviewed 150 adolescent females aged 21 years and younger who received prenatal care through the ob.gyn. clinics at the medical center between 2008 and 2012. Fifty of the patients participated in a CP program while patients in two other groups served as time- and age-matched controls: 50 who received single-provider prenatal care (SPPC) and 50 who received multiple-provider prenatal care (MPPC).
Outcome measures evaluated included weight gain during pregnancy, missed prenatal care appointments, feeding method, postpartum follow-up, and postpartum contraception. The researchers used chi-square analysis to compare outcomes between the three groups at a two-tailed alpha of 0.05.
Dr Chhatre reported that the only statistically significant difference in demographics was a slightly higher proportion of African American patients in the CP group than in the MPPC group (96 vs. 88%, respectively). No difference in preexisting medical conditions, nulliparous status, or substance abuse was observed among the three groups.
More than half of patients in the CP group (62%) met Institute of Medicine guidelines for weight gain during pregnancy, compared with 37% of those in the MPPC group and 40% of those in the SPPC group, a difference that was statistically significant compared with both control groups. However, there were no differences between the three groups in the rates of preterm delivery, cesarean section, or admission to the neonatal intensive care unit.
Adolescents in the SPPC group were more likely to solely breast-feed compared with those in the CP or MPPC groups (50% vs. 40% and 20%, respectively), while patients in the CP group were significantly more likely to include breast-feeding with their bottle-feeding compared with those in the MPPC or SPPC groups (32% vs. 14% and 10%, respectively). In addition, a significantly higher proportion of patients in the CP group were compliant with the 6-week postpartum visit compared with those in the SPPC group (68% vs. 42%; the rate for the MPPC group was 49%).
The researchers also found that patients in the CP group were significantly more likely to obtain postpartum long-acting reversible contraception than patients in the MPPC or SPPC groups (76% vs. 53% and 54%, respectively). Patients in the CP group also were significantly less likely to have a repeat pregnancy within 12 months than were patients in the MPPC group (2% vs. 17%).
Finally, no patients in the CP group received a diagnosis of postpartum depression, compared with 4% of those in the MPPC group and 2% of those in the SPPC group, a difference that reached statistical significance.
Dr. Chhatre said that she had no relevant financial conflicts to disclose.