Teen pregnancy: Guiding patients from diagnosis to counseling
Laurie L.Hornberger, M.D., M.P.H., FAAP
AAP Clinical Report
Here are three common clinical scenarios where the possibility of adolescent pregnancy
must be considered:
Sidney is a 17-year-old girl presenting for her annual sports preparticipation exam.
Her last menstrual period (LMP) was seven weeks ago. She is unconcerned as she says
it’s not unusual for her periods to be irregular.
Amelia is a 15-year-old whose mother is concerned about her behavior, including a
change in friends and frequent alcohol use. Her LMP was five weeks ago.
Dana is a 16-year-old girl on isotretinoin who has not been reliably taking her birth
control pills prescribed along with the acne medication. “I am not that sexually active,”
Pediatricians need to ensure that they and their offices are prepared to address pregnancy
— not only to make the diagnosis but also to counsel the patient and her family when
test results are positive. The AAP Committee on Adolescence has updated its policy
statement Options Counseling for the Pregnant Adolescent Patient and developed a new clinical report, Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient, to guide the pediatrician through the diagnosis of pregnancy, sharing the diagnosis
with the patient and her family, reviewing her management options and making appropriate
Adolescent pregnancy can easily be overlooked and its diagnosis delayed. Patients
frequently do not realize their risk for pregnancy and may not recognize its signs
and symptoms. Pediatricians should record the LMP as a vital sign at each visit and
routinely meet with patients confidentially to inquire about sexual activity.
Pregnancy needs to be in the differential diagnosis of complaints such as fatigue
or nausea and in the case of a late menstrual period. Urine pregnancy tests should
be available in all offices and performed whenever pregnancy enters the differential,
even if the sexual history may not suggest it.
Confidentiality, support network
In many cases, it is beneficial to share the results of a positive pregnancy test
with the adolescent alone. This may allow her to express her emotions, reactions and
questions more freely. While cognizant of the legal rights of the adolescent to confidentiality,
the pediatrician is encouraged to work with the teen to identify supportive adults
who can assist her with the challenges ahead. In most cases, this will be her parent(s)
but might be another relative or adult friend as well as the adolescent’s partner
Presenting all options
With the adolescent and her identified support, the pediatrician should provide options
counseling. Since its first policy statement on the subject in 1989, the Academy continues
to affirm that pregnant adolescents should be counseled in a nonjudgmental, developmentally
appropriate manner about all legal pregnancy options. These include:
carrying her pregnancy to delivery and raising the baby;
carrying her pregnancy to delivery and making an adoption or kinship care plan; or
terminating her pregnancy.
No one may be better suited to provide this counseling than the patient’s pediatrician.
He or she knows the patient and her family, and can lead the discussion in a compassionate
manner that is tailored to the adolescent’s developmental and social needs. Pediatricians
are not expected to know detailed information on all these options but should be able
to offer each as a viable choice and provide reliable sources for more information
or services, as requested by the patient.
The Academy recognizes that discussions regarding premarital sex, teen pregnancy and
parenting, adoption and abortion can be difficult for some, and may evoke strong personal
feelings or moral conflicts. Consequently, some pediatricians may feel limited in
their ability to fully present all pregnancy options to an adolescent. While medical
providers may decline to perform a service based on claims of conscience, they should
be prepared to refer their patients promptly for that service. Pediatricians are encouraged
to reflect on this issue and if necessary, investigate potential resources for such
referrals. Caution is advised when referring to “pregnancy crisis centers” as these
frequently do not offer unbiased, medically accurate information.
Although the U.S. teen pregnancy rate is falling to record lows, it remains among
the highest of all developed countries. With more than half a million adolescents
in the U.S. becoming pregnant each year, pediatricians are likely to encounter this
diagnosis in their practice.
It is important that all pediatricians routinely discuss reproductive health with
their adolescent patients, be alert to the possibility of pregnancy, and be prepared
to provide balanced, accurate information on all management options if the diagnosis
Dr. Hornberger, the lead author of the policy and clinical report, is the liaison
from the AAP Section on Adolescent Health to the Committee on Adolescence.