- Email: [email protected]
To Have or to Hold: Use Patterns and Pregnancy Rates in Adolescent Mothers Given Advance Ecps or Ecp Prescriptions
NASPAG 22nd Annual Clinical Meeting
mothers with scores $10. Scores were unstable #3 weeks postpartum (Kappa 5 0.2). Thereafter the prevalence and incidence of scores $10 fell from 16.5% at 2 months to 10.3% and 5.7% at four months. Prevalence rose to 18.5 % at the 6 month visit; incidence declined to 1.9%. Repeat screening only detected 2 (5.7%) mothers with scores $10. Conclusions: Electronic cueing improved compliance with the detection and referral phases of screening for maternal depression at well-child visits. Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months. If this is impossible, screening at the 6 month well visit is preferable to the 4 month visit. doi:10.1016/j.jpag.2008.01.014
To Have or to Hold: Use Patterns and Pregnancy Rates in Adolescent Mothers Given Advance Ecps or Ecp Prescriptions Stephanie Teal, MD, MPH, Jeanelle Sheeder, MSPH, and Catherine Stevens-Simon, MD University of Colorado at Denver and Health Sciences Center, Denver, Colorado
Background: Randomized controlled trials have demonstrated that the advanced provision of emergency contraceptive pills (ECPs) increases their use without deterring the use of condoms or highly effective contraceptives or incurring risky sexual behavior or the acquisition of sexually transmitted diseases. The purpose of this study was to examine the effect of two advance provision intervention strategies (ECP packets vs. prescription) on unprotected sexual intercourse, ECP use, and pregnancy rates in an adolescent maternity program. Methods: Study subjects (n 5 409) were enrolled consecutively between January 1, 2003 and December 31, 2005. They were selected from a cohort of 14-through-21.5 year old adolescent mothers who delivered living infants during the enrollment period. 210 (51%) were assigned to receive a prescription for ECPs (Rx group) and 199 (49%) to receive a packet of Plan BÒ (pack group) at their first postpartum visit. Outcome measures were episodes of unprotected sexual intercourse, ECP use, and pregnancy rates at 6 and 12 months postpartum. This study was approved by the Colorado Multiple Institutional Review Board.
63
Results: During the first 6 months of the study, 41% of the Rx group and 48% of the pack group reported at least one episode of unprotected sexual intercourse (p 5 0.2). 23% of the Rx group and 30% of the pack group used ECPs at least once (p 5 0.2). Matching episodes of unprotected sexual activity with ECP use revealed a majority of the mothers under-used ECPs (65%). By contrast, only a minority (7%) engaged in augmented use. There were no group differences in under or augmented use. The most common reason for not using ECPs was ‘‘just didn’t’’ (24%), followed by ‘‘didn’t remember’’ (22%), and ‘‘didn’t think needed’’ (13%). There were 19 pregnancies; 6% in the Rx group and 4% in the pack group. In the 2nd 6 months of the study, unprotected sex decreased (31%), ECP use decreased (12%), and pregnancies increased (10%). Again, there were no group differences. Conclusions: There were no clinically or statistically significant differences in unprotected sexual activity, ECP use, or pregnancy between the two groups. The power to detect a significant difference was 80%. Our data provides evidence that in a high-risk adolescent population immediate access to EC did not increase unprotected sex. However it also did not increase use of EC per episode of unprotected sex. The majority of adolescents in both groups did not use the ECPs they had access to, whether by actual pills or advance prescription. On questioning, this was not because of infrastructural barriers or concerns about safety and side effects, but because they failed to recognize the need to do so or lacked the motivation to decrease their risk of conception. Unintended pregnancy rates among adolescents will not decrease until the opportunity cost of adolescent pregnancy is seen by them to be too great. doi:10.1016/j.jpag.2008.01.003
A Pilot Clinical Decision Rule for Differential Diagnosis between Polycystic Ovarian Syndrome and Late Onset Congenital Adrenal Hyperplasia in Adolescent Females Christopher N. Barnes, M.S.1, Kupper Wintergerst, M.D.2, S. Paige Hertweck, M.D.3,
mothers with scores $10. Scores were unstable #3 weeks postpartum (Kappa 5 0.2). Thereafter the prevalence and incidence of scores $10 fell from 16.5% at 2 months to 10.3% and 5.7% at four months. Prevalence rose to 18.5 % at the 6 month visit; incidence declined to 1.9%. Repeat screening only detected 2 (5.7%) mothers with scores $10. Conclusions: Electronic cueing improved compliance with the detection and referral phases of screening for maternal depression at well-child visits. Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months. If this is impossible, screening at the 6 month well visit is preferable to the 4 month visit. doi:10.1016/j.jpag.2008.01.014
To Have or to Hold: Use Patterns and Pregnancy Rates in Adolescent Mothers Given Advance Ecps or Ecp Prescriptions Stephanie Teal, MD, MPH, Jeanelle Sheeder, MSPH, and Catherine Stevens-Simon, MD University of Colorado at Denver and Health Sciences Center, Denver, Colorado
Background: Randomized controlled trials have demonstrated that the advanced provision of emergency contraceptive pills (ECPs) increases their use without deterring the use of condoms or highly effective contraceptives or incurring risky sexual behavior or the acquisition of sexually transmitted diseases. The purpose of this study was to examine the effect of two advance provision intervention strategies (ECP packets vs. prescription) on unprotected sexual intercourse, ECP use, and pregnancy rates in an adolescent maternity program. Methods: Study subjects (n 5 409) were enrolled consecutively between January 1, 2003 and December 31, 2005. They were selected from a cohort of 14-through-21.5 year old adolescent mothers who delivered living infants during the enrollment period. 210 (51%) were assigned to receive a prescription for ECPs (Rx group) and 199 (49%) to receive a packet of Plan BÒ (pack group) at their first postpartum visit. Outcome measures were episodes of unprotected sexual intercourse, ECP use, and pregnancy rates at 6 and 12 months postpartum. This study was approved by the Colorado Multiple Institutional Review Board.
63
Results: During the first 6 months of the study, 41% of the Rx group and 48% of the pack group reported at least one episode of unprotected sexual intercourse (p 5 0.2). 23% of the Rx group and 30% of the pack group used ECPs at least once (p 5 0.2). Matching episodes of unprotected sexual activity with ECP use revealed a majority of the mothers under-used ECPs (65%). By contrast, only a minority (7%) engaged in augmented use. There were no group differences in under or augmented use. The most common reason for not using ECPs was ‘‘just didn’t’’ (24%), followed by ‘‘didn’t remember’’ (22%), and ‘‘didn’t think needed’’ (13%). There were 19 pregnancies; 6% in the Rx group and 4% in the pack group. In the 2nd 6 months of the study, unprotected sex decreased (31%), ECP use decreased (12%), and pregnancies increased (10%). Again, there were no group differences. Conclusions: There were no clinically or statistically significant differences in unprotected sexual activity, ECP use, or pregnancy between the two groups. The power to detect a significant difference was 80%. Our data provides evidence that in a high-risk adolescent population immediate access to EC did not increase unprotected sex. However it also did not increase use of EC per episode of unprotected sex. The majority of adolescents in both groups did not use the ECPs they had access to, whether by actual pills or advance prescription. On questioning, this was not because of infrastructural barriers or concerns about safety and side effects, but because they failed to recognize the need to do so or lacked the motivation to decrease their risk of conception. Unintended pregnancy rates among adolescents will not decrease until the opportunity cost of adolescent pregnancy is seen by them to be too great. doi:10.1016/j.jpag.2008.01.003
A Pilot Clinical Decision Rule for Differential Diagnosis between Polycystic Ovarian Syndrome and Late Onset Congenital Adrenal Hyperplasia in Adolescent Females Christopher N. Barnes, M.S.1, Kupper Wintergerst, M.D.2, S. Paige Hertweck, M.D.3,