Patient Education for a Pregnant 16-Year-Old
Provide comprehensive, age-appropriate education covering contraception, STI prevention, pregnancy risks, nutrition, mental health screening, and postpartum planning, with emphasis on confidential, multidisciplinary care that addresses the unique developmental and medical needs of adolescent pregnancy. 1, 2
Immediate Educational Priorities
Pregnancy Options Counseling
- Discuss all pregnancy outcome options including abortion, adoption, and parenting in a nonjudgmental manner at the first visit. 2
- Ensure confidential services are available while observing state laws and mandatory reporting requirements. 1
Comprehensive Sexual Health Education
- Provide information about preventing pregnancy and STIs, including that abstinence is effective but also educate about all contraceptive methods. 1
- Emphasize consistent condom use with every sexual encounter to prevent STIs, even during pregnancy. 1, 2
- Educate about long-acting reversible contraception (LARC) methods as safe and highly effective for adolescents, beginning this discussion before delivery. 1, 2
Medical Risk Education
Pregnancy-Specific Risks
- Explain that adolescent pregnancies carry increased risks including preterm birth, preterm labor, preterm premature rupture of membranes, intrauterine growth restriction, low birth weight, and congenital anomalies. 2
- Teach recognition of preterm labor signs and symptoms, as adolescents have elevated risk. 2
- Discuss the need for more frequent prenatal visits in the second and third trimesters to monitor for complications. 2
Nutritional Requirements
- Conduct nutritional assessment and provide education about optimal weight gain during pregnancy. 1, 2
- Prescribe prenatal vitamins with at least 400-800 mcg of folic acid daily. 1, 3
- Recommend consuming two servings of fruit and three servings of vegetables daily. 1, 3
- Provide food supplementation if needed to reduce anemia and optimize birth weight. 2
Screening and Prevention Education
Infection Prevention
- Explain the need for routine STI screening at presentation, third trimester, and postpartum due to increased risk in adolescents. 2
- Educate about bacterial vaginosis screening and treatment, as it increases preterm birth risk. 2
- Discuss TORCH infection prevention (toxoplasmosis, rubella, cytomegalovirus, herpes simplex). 1, 3
- Update immunizations including hepatitis B, rubella, varicella, Tdap, HPV, and influenza as appropriate. 1, 3
Substance Use and Safety
- Screen repeatedly for alcohol use, substance abuse, and violence throughout pregnancy using validated tools. 2
- Advise complete abstinence from alcohol, tobacco, and illicit drugs. 1, 3
- Assess safety concerns regarding the partner, partner's friends, or others who may pose threats. 1
Mental Health
- Screen for depression and anxiety using the Edinburgh Postnatal Depression Scale in each trimester and postpartum. 2
- Explain that mood disorders are more common in adolescent pregnancy and require treatment. 2
- Provide information about available mental health resources and integrated care options. 4
Developmental and Social Support
Age-Appropriate Communication
- Adapt all education to the adolescent's developmental stage, emotional maturity, and cognitive level rather than chronological age alone. 1, 2
- Use concrete examples and repetition to reinforce key concepts. 1
- Create a supportive environment where the adolescent feels comfortable asking questions and revealing knowledge gaps. 1
Partner and Family Involvement
- Include fathers and partners in pregnancy care and prenatal/infant care education whenever possible. 2
- Encourage parents to discuss sexuality topics while respecting the adolescent's autonomy. 1
Multidisciplinary Care Access
- Explain the availability of multidisciplinary care including social services, nutrition counseling, mental health support, and lactation services at one accessible site. 2
- Provide information about school-based programs or group prenatal care models designed for adolescents. 5
Postpartum Planning
Contraception Education
- Begin discussing postpartum contraception before delivery, emphasizing LARC methods to prevent rapid repeat pregnancy. 1, 2
- Explain that LARC methods (implants and IUDs) are safe, highly effective, and appropriate for adolescents who have never given birth. 1
Breastfeeding Support
- Recommend breastfeeding and explain that adolescents are at high risk for early discontinuation. 2
- Arrange for lactation support services to be available immediately postpartum. 2, 5
Parenting Resources
- Provide information about postpartum care programs that support adolescent parents, improve parenting knowledge, screen for postpartum depression, and increase birth intervals. 2
- Discuss available community resources including WIC (Women, Infants, and Children) program access. 5
Special Considerations
Cultural Sensitivity
- Provide culturally appropriate care that respects the adolescent's background and beliefs. 2
- For Aboriginal or remote community patients, discuss options for giving birth close to home with family support. 2
Medication Safety
- Review all medications, supplements, and over-the-counter products for pregnancy safety. 1, 3
- Identify and discontinue teratogenic medications (ACE inhibitors, statins, certain anticonvulsants). 1, 6