ADOLESCENT PREGNANCY AND CHILDBIRTH OUTCOMES: A HOLISTIC CARE PROGRAM AT THE PRIMARY CARE UNIT OF A NATIONAL TERTIARY REFERRAL CENTER

摘要

Adolescent pregnancy is associated with high risk of negative consequences for both mother and infant. We implemented a comprehensive holistic care program (HCP) that aims to improve pregnancy outcomes in adolescents who receive antenatal care (ANC) at a primary care unit (PCU) in Bangkok, Thailand. The HCP was developed by a multi-disciplinary team, with trained nurse practitioners providing care to adolescents during and after pregnancy at the PCU of Siriraj Hospital. A retrospective chart review of pregnant adolescents aged 10-19 years who participated in the HCP was conducted. Of the 70 adolescent who received HCP care, the median age at first ANC visit was 17 (IQR: 16-18) years and 11 (14.5%) adolescents had history of induced abortion. Thirty-eight (54.3%) adolescents did not use any type of birth control and 41 (58.6%) reported a history of substance use, with 9 of those continuing substance use during pregnancy. Six adolescents were depressed and required psychiatric consultation. Median number of ANC visits was 8 (IQR: 6-11), and median maternal weight gain was 8.6 (IQR: 6.2-12.1) kilograms. Sixty-three (82.9%) babies were full-term births, with median gestational age of 39 (IQR: 38-39) weeks. Of those, 7 (11.1%) had birth weight less than 2,500 grams. Pregnant adolescents evaluated in this study demonstrated high-risk sexual and behavioral tendencies. However, after receiving parenting education, a majority of adolescents expressed confidence in their ability to nurture their babies and assume the responsibilities associated with the motherhood role. This finding may suggest improved child-rearing skills and lower incidence of child maltreatment.