A 16-year-old girl, gravida 1 para 0, at 10 weeks gestation comes to the office for an initial prenatal visit. The patient reports mild nausea and vomiting in the morning but is able to drink and eat small meals in the afternoon. She had vaginal spotting a week ago, but the bleeding has resolved. The patient has no chronic medical conditions and has had no surgery. She takes a prenatal vitamin daily. She was using oral contraceptive pills imperfectly but stopped when she realized she was pregnant. The patient's mother had 3 pregnancies, all of which ended in uncomplicated vaginal deliveries at term. The patient has no known drug allergies and does not use tobacco, alcohol, or illicit drugs. Blood pressure is 110/60 mm Hg and pulse is 68/min. BMI is 24 kg/m². Speculum examination shows a closed cervix and no vaginal bleeding or lesions. Bimanual examination reveals a 10-week-size uterus and no adnexal masses. A pelvic ultrasound confirms a 10-week intrauterine gestation with normal fetal heart rate. This patient is at increased risk for which of the following pregnancy complications?

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Explanation: 11ec2b69_c03f_0a10_8f63_1fe4bdc990dc_MD0005_00 Adolescent pregnancy, occurring in patients age <19, is associated with an increased risk for maternal complications such as hydatidiform mole, preeclampsia, anemia, and postpartum depression. Fetal complications associated with adolescent pregnancy include gastroschisis, omphalocele, preterm birth, low birth weight, and perinatal mortality.gastroschisis, omphalocele Although some socioeconomic factors are more common in adolescents who become pregnant (eg, less education, lower economic status), studies that correct for some of these factors still demonstrate an increased risk of adverse outcomes. Because of pubertal changes, adolescents have increased nutritional requirements. Daily caloric, calcium, and iron requirements are increased even further during pregnancy. Inadequate nutrition during pregnancy likely contributes to the increased risk of many complications. Therefore, inadequate nutrition and physiologic immaturity are likely the underlying etiologies for preterm labor in this population. Adolescents who deliver preterm do not appear to be at increased risk for preterm delivery in subsequent pregnancies beyond the teenage years. (Choice A) Risk factors for breech presentation include placenta previa, multiple gestation, polyhydramnios, and advanced maternal age (eg, >35). breech presentation (Choice B) Risk factors for gestational diabetes mellitus (GDM) include a family history of diabetes mellitus, a history of GDM in a previous pregnancy, obesity, multiple gestation, and maternal age >25. (Choice C) Neural tube defects are associated with inadequate folate intake and antiepileptic use (eg, carbamazepine). Despite the association between adolescence and inadequate nutrition, adolescent pregnancy is not associated with an increased risk for neural tube defects. This is likely due to the enrichment of refined grains (eg, white flour), which provides the daily requirements of folic acid for average-risk patients (0.4 mg). Neural tube defects (Choice D) Risk factors for placenta previa include a previous placenta previa, multiple gestation, prior cesarean delivery, and advanced maternal age. placenta previa Educational objective: Adolescent pregnancies are associated with an increased risk of fetal complications, including gastroschisis, omphalocele, preterm birth, low birth weight, and perinatal mortality. Maternal complications include preeclampsia and postpartum depression. Inadequate nutrition and physiologic immaturity are likely etiologies for many of these complications. References: Adverse maternal and neonatal outcomes in adolescent pregnancy. (http://www.ncbi.nlm.nih.gov/pubmed/26327561) Labor and delivery outcomes among young adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/25935776)

A 16-Year-Old Girl, Gravida 1 Para 0, at 10 Weeks