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Teenage pregnancy

Early sexual debut and lack of knowledge about contraceptive methods is a time bomb, exploding with a variety of problems, from sexually transmitted infections to teenage pregnancy. The definition of teenage pregnancy includes all pregnant girls between the ages of 13 and 19. About 11% of all pregnancies in the world occur in girls aged 15 to 19 years. Of these, 95% of teenage births occur in low- and middle-income countries. Global health statistics show that complications during pregnancy and childbirth are the second cause of death for girls aged 15-19years all over the world [1, 3, 6].

The factors leading to teenage pregnancy are fairly obvious: lack of knowledge about reproductive health, contraceptive methods and their correct use [6]. Prevention of unwanted pregnancy is important in any age group, but if pregnancy has occurred, the obstetrician-gynecologist should be aware of the most common complications.

Teenage pregnancy is strongly associated with the risk of preterm birth and, consequently, low birth weight. Other complications such as preeclampsia, pregnancy-associated hypertension, anemia, and infectious complications are less common [1, 2, 3]. In addition, adolescent girls often resort to unsafe abortion methods, which contribute to increased maternal mortality and morbidity and lead to long-term health problems [6].

Particular attention should be paid to preterm birth, as newborns born prematurely often require intensive care due to morphofunctional immaturity. To assess the risk of preterm birth in adolescents, it is necessary to take into account the age of menarche, physical development, the size of the body and cervix, as well as the presence of bad habits [2].

The age of menarche, or the age of the first menstruation, is one of the most important indicators of sexual development, signaling that the reproductive system is ready for pregnancy. However, it takes an average of 2-3 years to establish adequate hormonal regulation of the menstrual cycle. Adolescents who become pregnant within 2 years of menarche are more likely to bleed during the first 8 weeks of pregnancy, as maintenance of pregnancy during this period depends on adequate levels of maternal gonadal hormones, in particular, low levels of progesterone in the luteal phase are associated with an increased risk vaginal bleeding in the first trimester, pregnancy loss and preterm birth [2]. Also, insufficient secretion of hormones affects placentation, which further leads to the formation of fetoplacental insufficiency and, as a result, low birth weight, fetal hypoxia and preeclampsia [2].

The onset of menarche is not an indication of physical and reproductive maturity. The uterus of a girl at 12–13 years old is smaller than that of a healthy woman of reproductive age, and by the age of 17 should double in size. The thickness of the endometrium and the size of the cervix also change, which also plays an important role [4].

Table 1 | Size of the uterus in girls from 1 to 17 years [4]

The size of the cervix should be given special attention. Normally, shortening of the cervix occurs shortly before childbirth. Cervical length ≤ 2.5cm at term up to 29weeks is often classified as short and is regarded as a risk factor for spontaneous and infection-related preterm birth [2]. The cervix in teenage girls barely reaches 2.5 cm by the age of 15-16.

The association between a short cervix and infection-mediated preterm labor is particularly important, as failure to use barrier methods of contraception not only contributes to pregnancy but also to infection. Given that adolescent girls rarely go to the gynecologist for the diagnosis and treatment of STIs, it is likely that by the time of registration for pregnancy, inflammation will spread to the endometrium and appendages. This becomes a risk factor for two complications of pregnancy at once - premature birth and intrauterine infection of the fetus.

The immaturity of the protective function of the vagina also contributes to infection [2]. In an adult healthy woman, the pH of the vagina is in the range of 3. 8–4.5, which is ensured by the activity of lactobacilli and bifidobacteria. Breaking down the glycogen contained in the surface cells of the vaginal epithelium to lactic acid, lactobacilli create an acidic environment that is detrimental to many microorganisms. The number of lactobacilli and, accordingly, the formation of lactic acid decreases with a decrease in the level of estrogens in the body. In girls, the formation of vaginal microbiocenosis occurs by the age of 14–16, and before this period they are most vulnerable to infection [2,8].

Microbial proteases, collagenases, elastase and mucinases and/or the inflammatory response they elicit are believed to damage the connective tissue that forms the cervical matrix and placental membranes, indirectly stimulating the synthesis and premature release of placental corticotropin-releasing hormone. It can be assumed that this hormone provokes preterm labor by accelerating the maturation of the placenta, increasing the sensitivity of the myometrium to oxytocin, and stimulating the synthesis and release of tissue-damaging factors [2].

Do not underestimate the tendency of adolescents to use alcohol, tobacco and drugs, including during pregnancy. The use of alcoholic beverages most often leads to the development of fetal alcohol syndrome and damage to the nervous system with the further formation of mental retardation in children. Smoking during pregnancy is associated with an increased risk of ectopic pregnancy, miscarriage, placental abruption, preterm birth and low birth weight. The use of any narcotic and psychoactive substances by a pregnant woman further leads to a delay in the mental and physical development of the child [5].

Sources:

1. Abebe A. M. et al. Teenage Pregnancy and Its Adverse Obstetric and Perinatal Outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018 //BioMed Research International. - 2020. - T. 2020.
   
2. Stevens-Simon C., Beach R. K., McGregor J. A. Does incomplete growth and development predispose teenagers to preterm delivery? A template for research // Journal of Perinatology. - 2002. - T. 22. - No. 4.
   
3. Ganchimeg T. et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study //BJOG: An International Journal of Obstetrics & Gynaecology. - 2014. - T. 121.
   
4. Gurkin Yu.L. Pediatric and Adolescent Gynecology: A Guide for Physicians. - M: LLC "Medical Information Agency", 2009.
   
5. Forray A. Substance use during pregnancy //F1000Research. – 2016. – V. 5.
   
6. Teenage pregnancy. 2020. URL: https://www.who.int/
   
7. Whitworth M., Cockerill R., Lamb H. Antenatal management of teenage pregnancy //Obstetrics, Gynaecology & Reproductive Medicine. - 2017. - T. 27. - No. 2.
   
8. Kokhreidze N.A., Kravchenko M.E. Formation of the vaginal microflora in the age aspect // J. Children's Hospital, 2002, 3: 45–47.

5 new novels for teens: about early pregnancy, family secrets and adventures

Recently we talked about teenage reading with literary critic Alexander Arkhangelsky, and he even "allowed" children to read bad books - just to read. We do not mind, but just in case, we also offer good novels for high school students. They are exciting, dynamic, without tediousness, but at the same time - smart and subtle.

1. The Boy in the Tower by Polly Ho-Yen

Imagine the kindest book in the post-apocalyptic genre, and here it is in front of you - the comforting reading of 2020.

The protagonist of the story, a cute boy named Adi, lives in good old London. But his familiar world is collapsing in the truest sense of the word: houses begin to fall due to unusual plants sprouting from the ground. Adi finds himself isolated in his tower with his deeply depressed mother. Opposite their skyscraper, there once stood the same tower, where the hero's girlfriend, Gaia, lived on the seventeenth floor. Now this tower is gone, just as there is no news about the fate of the girl.

Despite the gloomy surroundings and ominous events, the book is full of light and hope. The text is easy to read, the chapters are short, the plot unfolds quickly - this does not let either adults or children get bored. "The Boy in the Tower" is quite possible to read in a couple of evenings when you want something exciting and at the same time not overloaded with hidden meanings, intrigues or allusions.

This is just the kind of book that will appeal to both children and their parents. And especially for those who are now experiencing the second wave of self-isolation.

2. Revive Me, Tahira Mafi

Juliet is a girl with the gift to kill by touch. The whirlwind of events in the first three books of the series (the whole dystopia is called "Shatter Me") elevated her to the post of Supreme Commander. The fourth book tells about the internal problems of the characters and the difficulties in their relationships.

The first half of the book is not as dynamic as fans of the series are used to, and the reader is a little perplexed. But the second half and the final are again intriguing and addictive, leaving you to wait for the continuation.

The style of the book remains unchanged - sharp, with an anguish and presence effect. It seems that the reader is standing next to the characters or peeping over their shoulder for their actions. Revive Me is one of the notable examples of the teenage dystopia genre, which deals not only with global problems, but also with human relationships and the inner world of the characters.

3. Not Pregnant, Jenny Hendrix and Ted Kaplan

It would seem that the plot is as old as the world. Boyfriend deliberately ruined condoms so that his girlfriend would get pregnant. And if you consider that the main character Ronnie is a member of the National Society of Honors, takes a place in the list of the best graduates and plans to enter a prestigious university in the fall, the intensity of events becomes clear.

The heroine of the book, high school student Ronnie, goes to another state to have an abortion. She is joined by an old friend, in a relationship with which Ronnie is not going smoothly: the girls are in for a crazy trip, and until the end of the book the reader will not know whether the heroine decides to have an abortion or still leave the child.

Friendship and trust, child-parent relationships through the eyes of a teenager, condemnation by society - the authors not only ask these questions, but also give answers to them. Worthy teenage literature, which, perhaps, should be read by adults if they want to better understand their child.

4. Survival List by Courtney Scheinmel

The suicide of her older sister leaves seventeen-year-old Sloan emotionally devastated: no suicide note and no clear reason for the tragedy. Sloane finds a list with her sister's incomprehensible initials and cryptic addresses, and the search for answers to questions leads her to California.

This story is full of mysteries, but not in a detective sense, but in an everyday sense. This is a story about family secrets - why they arise and how they affect family members. Why do once loving people become unpleasant to each other. Why do we think that older brothers and sisters are better than us, and is it really so.

A travel novel, a search novel that can push for reflection, evoke ambivalent feelings due to the complexity of the topics raised, but definitely will not leave you indifferent.

5. The Smells of Strange Homes by Bonnie-Sue Hitchcock

Ruth, Dora, Alice and Hank are four teenagers who take turns narrating. Their childhood is spent against the backdrop of polar nights, northern frosts and deer hunting. Each of the children is faced with non-childish problems and desires: to preserve honor, escape from their father, perform on stage and run away as far as possible.

Despite the fact that the characters of the novel are many kilometers away from a warm and well-fed civilization, they feel close in spirit and very familiar, as if you once communicated live.

The book helps to believe that in life everything ends well, no matter how difficult and hopeless the situation may seem. Losing something, the heroes get something more important in return.

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