Health Behavior and Outcomes in Sequential Pregnancies of Black and White Adolescents

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Abstract
Objective. —To examine the relationships among parity, preterm delivery, fetal growth retardation, and prenatal care utilization in first and second adolescent pregnancies. Design. —A longitudinal, retrospective study in which obstetric, behavioral, and sociodemographic data were used to examine birth outcomes of 737 low-income black (80%) and white (20%) teenagers delivering first and second singleton infants at 20 or more weeks' gestation. Setting. —Public health clinics in Jefferson County, Alabama, between January 1983 and February 1990. Main Outcome Measures. —Mean birth weight, preterm delivery, fetal growth retardation, Apgar scores, and perinatal mortality. Main Results. —In their second pregnancies, adolescents presented 2.8 weeks later for care (P=.0001) and made fewer total clinic visits. Mean infant birth weight increased by 91 g (P=.0005). This increase was significantly associated with an increase in maternal prepregnancy body mass index. The rate of fetal growth retardation decreased (P=.0001) and the rate of preterm delivery increased (P<.02) in the second pregnancy. The rate of recurrence of fetal growth retardation was 13% and the rate of preterm delivery was 46%. Conclusions. —Poorer utilization of prenatal care and high risk for recurrence of adverse outcomes are characteristic of adolescents' second pregnancies and should be considered in teenage pregnancy intervention programs. (JAMA. 1993;269:1401-1403)

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