From the Guidelines
The initial management approach for a 17-year-old who is 6 weeks pregnant involves providing non-directive counseling about all available options: continuing the pregnancy, adoption, or termination, while maintaining confidentiality and ensuring the patient's autonomy, as per the latest guidelines 1. The GP should offer immediate referral to antenatal care if she wishes to continue the pregnancy, or prompt referral to abortion services if termination is preferred. Early pregnancy assessment should include:
- Confirmation of pregnancy with a urine test
- Estimation of gestational age based on last menstrual period
- Assessment for any warning signs such as vaginal bleeding or abdominal pain that might indicate ectopic pregnancy or miscarriage The GP should also discuss:
- Folic acid supplementation (400mcg daily) as recommended by the American Academy of Family Physicians 1
- Lifestyle modifications including smoking cessation and alcohol avoidance
- Screen for mental health concerns Safeguarding assessment is essential, particularly given the patient's age, to identify any potential coercion or abuse. Throughout this process, the clinician should maintain a non-judgmental approach, provide emotional support, and ensure the young woman has adequate information to make informed decisions about her pregnancy while respecting her autonomy, as emphasized in the Society for Maternal-Fetal Medicine consult series 1. Additionally, the GP should assess the patient's overall health, including any pre-existing medical conditions, and provide guidance on managing these conditions during pregnancy, as outlined in the standards of care in diabetes-2024 1.
From the Research
Initial Management Approach
The initial management approach for a 17-year-old lady who is 6 weeks pregnant, according to NICE guidelines and RCGP curriculum, involves several key steps:
- Confirming the pregnancy and estimating the gestational age
- Providing information on healthy pregnancy habits, including diet and supplementation
- Discussing the importance of folic acid supplementation to prevent neural tube defects
Folic Acid Supplementation
Folic acid supplementation is a crucial aspect of pregnancy management, as it has been proven to decrease the risk of neural tube defects 2, 3, 4, 5. The recommended daily dose of folic acid supplementation is 0.4 to 0.8 mg (400 to 800 μg) for persons who are planning to or could become pregnant 3.
- Women who could become pregnant should be advised to take a multivitamin containing 0.4 mg to 1.0 mg of folic acid daily 2
- Women in intermediate- to high-risk categories for neural tube defects should be advised to take high-dose folic acid (4.0 mg-5.0 mg daily) supplementation 2
Dietary Advice
In addition to folic acid supplementation, women should be advised to maintain a healthy nutritional diet, as recommended in Canada's Food Guide to Healthy Eating 2.
- Good or excellent sources of folic acid include broccoli, spinach, peas, Brussels sprouts, corn, beans, lentils, and oranges 2
Screening and Testing
Women who become pregnant should be advised of the availability of noninvasive screening tests and invasive diagnostic tests for congenital birth defects, including neural tube defects 2.
- Maternal serum "triple marker screen" at 15 to 20 weeks, ultrasound at 16 to 20 weeks, and amniocentesis after 15 weeks of pregnancy if a positive screening test is present 2
Risk Assessment
A three-generation pedigree on the families of both the pregnant woman and the biological father should be obtained to identify increased risk for congenital birth defects 2.
- Signs or symptoms of vitamin B12 deficiency should be considered before initiating folic acid supplementation of doses greater than 1.0 mg 2