Factors associated with adolescents' risk for late entry into prenatal care

Abstract

Risk factors for late entry into prenatal care were examined among 533 pregnant adolescents younger than 18. Forty-seven percent entered prenatal care after 12 weeks' gestation. Logistic regression analysis indicated that adolescents who no longer had contact with their baby's father were 4.2 times as likely as those who did to enter prenatal care after the first trimester. Adolescents with no history of abortion were 3.2 times as likely to enter care late as those who had had an abortion. Young women who had not used alcohol in the last 30 days and those with only one sex partner in the last 12 months were more likely than adolescents exhibiting riskier behavior to receive care late (odds ratios of 2.7 and 1.6, respectively). Odds of late entry into care were also elevated for those who were unemployed (1.9), black or white (1.9 and 1.7, respectively) and less educated (1.2).

PIP: As many as 55% of pregnant US adolescents enter prenatal care late or not at all. This study investigated the risk factors associated with delayed entry into prenatal care in 533 low-income pregnant adolescents under 18 years of age (mean age, 15.9 years) who presented to a hospital-based adolescent obstetric clinic in Galveston, Texas, in 1992-94. 24% reported a previous pregnancy and 6% had had an abortion. The average gestational age at presentation for prenatal care was 14.6 weeks. 280 adolescents (53%) entered care at 12 weeks or earlier; the remaining 253 (47%) initiated care in the second (n = 199) or third trimester (n = 54). Logistic regression analysis indicated that adolescents who no longer had contact with the baby's father were 4.2 times (95% confidence interval (CI), 2.0-8.6) as likely as those with such contact to enter prenatal care after the first trimester. Those with no history of abortion were 3.2 times (95% CI, 1.7-6.0) as likely to enter care late as those with an abortion history. Teens who had not used alcohol in the 30 days preceding the survey were 2.7 times (95% CI, 1.3-5.7) while those with only 1 sex partner in the last 12 months were 1.6 times (95% CI, 1.1-2.4) more likely than those with riskier behaviors to receive care late. The odds of late entry were also elevated among unemployed teens (1.9; 95% CI, 1.1-3.5) and those with lower educational attainment (1.2; 95% CI, 1.04-1.4). Finally, compared with Mexican Americans, Blacks were 1.9 times (95% CI, 1.2-3.2) and Whites were 1.7 times (95% CI, 1.1-3.0) as likely to enter care late. The need for early entry to prenatal care should be stressed whenever adolescents come into contact with the health care system as well as in school-based health education courses.