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A Scoping Review of Adolescent Prenatal Care Research

By

Madison Andrews

Senior Honors Thesis School of Nursing

University of North Carolina at Chapel Hill

April 13, 2020

Approved:

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Abstract

Even though the overall rate of adolescent and teen pregnancy has dropped 64% in the United States in the last 20 years, the United States still has one of the highest rates of teen pregnancies among western-developed countries. Utilization of prenatal care (PNC) can lead to better perinatal outcomes for both mother and baby, however pregnant adolescents receive the least amount of prenatal care compared to other pregnant women. The aim of this scoping review was to examine the focus and extent of published adolescent prenatal care research in the United States between 2010 and 2020, with nurses in the PNC model. After extensive database searches, seven (n=7) studies met the inclusion criteria. Findings were categorized into 8 themes: types of PNC, PNC utilization, barriers and stigma related to PNC, types of disciplines involved with PNC, PNC setting and geographic location, sociodemographic characteristics of the pregnant adolescent, and maternal and infant variables and outcomes. Most of the research focused on the type of PNC received and maternal and infant outcomes; findings suggested that a group PNC model was an optimal choice for pregnant adolescents. PNC utilization was primarily associated with healthy perinatal outcomes for mother and baby. Further research on adolescent PNC is needed because we found a paucity of current studies, research designs were primarily

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A Scoping Review of Adolescent Prenatal Care Research

Pregnancy in adolescence, defined as pregnancy between the ages of 11 to 19 years, is a health issue that occurs in high, middle and low income countries (WHO, 2018). Most literature focuses on the issue of adolescent pregnancies in underdeveloped or developing countries, however, adolescent or teenage pregnancy is still prevalent in developed countries, including the United States. Teenage pregnancy, a subcategory under adolescent pregnancy, focuses on pregnancy among the ages of 15 to 19 years. Even though the overall rate of teen pregnancy has dropped 64% in the United States since 1991 (CDC, 2019), the United States still has one of the highest rates of teen pregnancies among all western-developed countries (Sedgh et al., 2015). The birth rate for teen pregnancies in the United States dropped 7% from 2016 to 2017, however the birth rate was still significant with 18.8 births per 1,000 women in this age group (CDC, 2019).

Adolescents who become pregnant often lack education about reproductive health, resources and support. When teen birth rates in the United States are broken down into categories such as race or ethnicity and geographic location, disparities arise. American Indian, Hispanic, and Black adolescents have the highest rate of teen pregnancy, while White and Asian

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Risks of Adolescent Pregnancy

In an adolescent pregnancy, the age of the mother puts both herself and the child at risk. There are higher risks of perinatal complications for both mother and baby, such as a higher risk for eclampsia, systemic infections, emergency caesarean section, intrauterine growth restriction, preterm birth, low birth weight, and neonatal gastroschisis (WHO, 2018; Fleming et al., 2013). Adolescent pregnancy and childbirth complications are leading contributors to maternal mortality and lasting health problems. Furthermore, the age at which the pregnancy occurs can have lasting social and economic effects on the mother such as social stigma, lack of social support, loss of educational opportunities, and lack of access to resources (WHO, 2018; Patch, 1990).

Prenatal Care

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and/or quality prenatal care such as negative attitudes or relationships with health care, organizational barriers, financial barriers, structural barriers, as well as social and cultural barriers (Kinsman & Slap, 1992; Roozbeh, Nahidi, & Hajiyan, 2016). Research findings demonstrate if prenatal clinical services are tailored to the adolescent, prenatal education and service utilization improve and better outcomes occur for pregnant adolescents and their children (Daley, Sadler & Reynolds, 2013).

Research Aim

The underutilization of prenatal care, types of prenatal care, and the barriers related to prenatal care with pregnant adolescents are topics that have been addressed in the literature. However, much of the research was conducted more than ten years ago when adolescent pregnancy rates were higher. Current research that focuses on adolescent prenatal care are primarily conducted in underdeveloped and developing regions of the world. A comprehensive overview of what is known about the extent and focus of adolescent prenatal care research in present day United States is needed. Hence, the aim of this scoping review is to examine and summarize current evidence on prenatal nursing care available to pregnant adolescents. More specifically, this scoping review will use Arksey and O’Malley’s framework (2005) to examine the current state of adolescent pregnancy prenatal care research published between 2010 and 2020.

Method

Scoping Reviews

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research question, 2) identifying relevant studies, 3) selection of studies, 4) charting the data, 5) collating, summarizing, and reporting the results, and 6) optional consultation with stakeholders. Enhancements proposed by Levac et al. (2010) and Peters et al. (2017) are based on Arksey and O'Malley's original framework, however they propose that consultation with stakeholders

become a required component of the methodology. Because of time constraints, consultation was not conducted as part of our scoping review, therefore we used Arksey and O'Malley's

framework as our main methodology.

Scoping reviews have various purposes, including to examine the extent, range, and nature of research activity, to determine the value for undertaking a full systematic review, to summarize and disseminate research findings, and to identify research gaps in the existing literature (Arksey & O’Malley, 2005). After conducting a preliminary review of the literature about adolescent prenatal care, we decided the purpose of this scoping review was to summarize and disseminate research findings, and to identify research gaps in the existing literature.

Research Question

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Search Databases and Terms

A literature search for relevant literature related to adolescent prenatal care research was conducted of manuscripts published in the last ten years. An experienced health sciences

librarian provided consultation and guidance to help identify relevant databases and search terms. Databases used to conduct the literature search included PubMed, CINAHL, and PsycINFO. These databases were chosen as they contained studies relevant to the research question and study purpose. Search terms included the MeSH, or Medical Subject Headings, terms 'pregnancy in adolescence,' 'adolescent,' 'prenatal care,' and 'United States.' By utilizing MeSH terms, we did not have to worry about word variations, word endings, plural or singular forms, or synonyms. These search terms were utilized together to identify relevant studies with detailed information on our specific research topic. All studies published between January of 2010 and January of 2020 were included.

Study Selection and Inclusion and Exclusion Criteria

Inclusion and exclusion criteria were established prior to study selection. Articles were included if they were: a) a research study written in English, b) conducted in the United States, c) published between January 2010 and January 2020, d) published in a peer-reviewed journal, e) focused on a population of pregnant adolescents, and f) included nurses in the study. Articles were excluded if a) they were not written in English, b) conducted outside of the United States, c) published before January 2010, d) not published in a peer-reviewed journal, e) focused on populations other than pregnant adolescents, or f) did not include nurses in the study.

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health sciences librarian. Through Covidence, articles were first screened by title and abstract review based on the inclusion and exclusion criteria listed above. If articles met the inclusion criteria in the title and abstract screening, they were then screened for full- text review. Full-text reviews were also based on the inclusion and exclusion criteria, and articles that did not meet the criteria were then excluded, noted with the reasoning of exclusion.

Charting the Data

Articles screened for full text review were organized into an electronic matrix. Data were collected to help identify key findings and implications from each study. Data extracted included author, year published, methodology of study, major findings and results of study, implications and importance of study as noted by authors, and use of study as a citation in future studies (see Table 1).

Results

Description of the Search

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retrospective cohort studies, two cross-sectional studies, and two descriptive pilot studies. Overall, the studies meeting our inclusion criteria had a low level of strength and rigor in study design as compared to systematic reviews or meta-analyses.

Following the analysis of extracted data from the included studies, the synthesized results are presented in eight categories: types of prenatal care, prenatal care utilization and attendance, barriers and stigma related to prenatal care, types of disciplines utilized for prenatal care,

geographic location of the population, sociodemographic characteristics of the adolescent, maternal outcomes and variables, and infant outcomes and variables.

Types of PNC

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PNC Utilization and Attendance

Five of the seven studies in this review (n = 5; 71.4%) utilized prenatal care utilization or attendance as a measure or focus of their study (Anderson & Rahn, 2016; Coley & Aronson, 2013; Griswold et al., 2013; Ickovics et al., 2016; Trotman et al., 2015). Four studies

operationalized prenatal care utilization by measuring how many visits were attended (Anderson & Rahn, 2016; Griswold et al., 2013; Ickovics et al., 2016; Trotman et al., 2015). Coley & Aronson (2013) measured prenatal care utilization with Kotelchuck's Adequacy of PNC Utilization Index (1994).

Anderson and Rahn (2016) found that 31.8% of participants (n = 67) did not receive the minimum number of visits recommended by the American College of Obstetricians and

Gynecologists; furthermore, 2.8% of the participants (n = 6) received no prenatal care at all. Studies comparing two models of prenatal care found that participants in a group model were more likely to have better prenatal care visit attendance than those in traditional models.

Barriers and Stigma Related To PNC

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care, such as limited access to prenatal care for the adolescent population, limited transportation to prenatal care visits, and limited resources to obtain tangible items needed by participants.

Types of Disciplines Involved With PNC

Members of various disciplines can participate in prenatal care visits. One analysis strategy was to determine what type of discipline or disciplines were utilized in prenatal care for pregnant adolescents. Having the nursing profession involved in the study was one of the

inclusion criteria of our study so all seven studies (n = 7; 100%) included a RN in their study. Only two of the seven studies (n = 2; 28.5%) discussed using multiple professions in their prenatal care models (Ickovics et al., 2016; Weber Yorga & Sheeder, 2015). Ickovics et al. noted that prenatal case management was performed by registered nurses (RNs), nurse practitioners (NPs), and certified social workers (CSWs). Weber Yorga and Sheeder (2015) noted that a multidisciplinary prenatal care program was utilized, but did not specify the type of disciplines. Griswold et al. (2013) noted that a school nurse and midwife developed a prenatal care at school program and functioned as facilitators for all sessions. All other studies used the term 'provider,' without specifying physician, nurse practitioner, physician assistant, registered nurse or social worker. In addition, these four studies were unclear about whether or not a multidisciplinary team was utilized or not.

PNC Setting and Geographic Location

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2015) focused on both urban and rural populations, including various prenatal care case management programs across the country. In this study, 71 % (n=90) of the PNC case

management programs were in government agencies such as a state or local health department, regardless of the geographic location.

Sociodemographic Characteristics of the Pregnant Adolescents

Four of the seven studies (n = 4; 57.1%) examined sociodemographic characteristics in relation to adolescent prenatal care (Anderson & Rahn, 2016; Coley & Aronson, 2013; Issel et al., 2015; Weber Yorga & Sheeder, 2015). The various sociodemographic variables analyzed are shown in Table 2. Anderson and Rahn’s (2016) main focus was to understand how

sociodemographic factors related to the utilization of prenatal care. Anderson and Rahn looked at age of the participant, race and/or ethnicity, history of violence, and history of child abuse or trauma. The only demographic found to significantly impact utilization of prenatal care was age of the participant. Pregnant adolescents younger than 17 years had on average 7.33 prenatal care visits compared to adolescents older than 17 years who averaged 9.96 visits (p = 0.02).

Coley and Aronson (2013) analyzed race and ethnicity and whether or not adequate prenatal care use protected against racial disparities. They found that higher prenatal care utilization did not reduce racial disparities related to infant outcomes like birth weight or gestational age at birth.

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demographic and psychosocial variables between the two groups. Their research analyzed the two populations based on type of PNC on multiple variables including age, race/ethnicity, education, BMI, gravidity and parity, social support, history of depression, history of substance use, stress, and reason for pregnancy. Of the four studies that focused on sociodemographic factors, age and race/ethnicity were the most likely to be analyzed.

Maternal Outcomes and Variables

Six of the seven studies (n = 6; 85.7%) looked at maternal variables and outcomes related to prenatal care research for pregnant adolescents (Anderson & Rahn, 2016; Griswold et al., 2013; Ickovics et al., 2016; Issel et al., 2015; Trotman et al., 2015; Weber Yorga & Sheeder, 2015). The maternal variables and outcomes examined by the studies are shown in Table 3. Anderson and Rahn (2016) found that prenatal depression occurred more often among pregnant adolescents who had experienced a childhood trauma. Griswold et al. (2013) conducted a pilot study to evaluate whether a school prenatal care model improved school attendance, knowledge regarding prenatal care, satisfaction with care delivery, and maternal preparation. They found that school attendance increased by 5.7% compared to school attendance among pregnant adolescents the year before, prenatal knowledge improved by 42%, and 92% of students felt prepared after attending the pilot program.

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Issel et al. (2015) compared types of problems experienced by the mother during the prenatal period and which types of interventions were utilized by the prenatal case manager for adolescent mothers versus adult mothers in their retrospective cohort study. Adolescent

participants experienced more problems more frequently related to pregnancy health, family problems, education/job, transportation, and housing than the adult population. Case managers spent significantly more time with adolescents than with adults on education, assessment, coaching, and monitoring. Time spent with adolescent clients was significantly more than time spent with adult clients (56.6 minutes vs. 50.3 minutes; p = 0.001).

Trotman et al. (2015) assessed different health behaviors in the antepartum and postpartum period between group prenatal care clients and traditional prenatal care clients. Group prenatal care clients were more likely to be compliant with PNC visits and meet weight gain guidelines by the Institute of Medicine than traditional prenatal care clients (Trotman et al., 2015). Group prenatal care clients also had improved health behaviors in the postpartum period than traditional care clients, including increased compliance with 6-week postpartum visits, increased rate of exclusive breastfeeding, and less occurrence of postpartum depression.

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interested in group prenatal care. Those who were not interested were more likely to smoke (33.9% vs. 12.8%) and more likely to have planned the pregnancy (47.1% vs. 19.8%).

Infant Outcomes and Variables

Three of the seven included studies (n = 3; 42.8%) focused on various infant outcomes related to adolescent prenatal care (Anderson & Rahn, 2016; Coley & Aronson, 2013; Ickovics et al., 2016). Infant complications, birth trauma, birth weight, preterm birth, and NICU admission were examined, and all three studies examined gestational age (See Table 4). Anderson and Rahn’s findings (2016) did not correlate the role of prenatal care with reducing infant

complications, birth trauma, or difference in gestational age at birth. Furthermore, they did not find any statistically significant maternal demographic characteristic associations with infant outcomes. However, they did find that Black adolescents reported the most infant complications (34.7%; n = 37 ) compared with White adolescents (30.7%; n = 32) (Anderson & Rahn, 2016).

Coley and Aronson (2013) noted that higher prenatal care utilization did not reduce racial disparities related to infant outcomes, including birth weight and gestational age. Black

adolescents had a significant, negative association with birth weight and gestational age. Although prenatal care utilization did not have protective effects for reducing racial disparities, higher prenatal care utilization led to higher birth weights and gestational ages for the overall population.

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Discussion

The objective of this scoping review was to examine and summarize current research related to prenatal care available to pregnant adolescents, as well as to identify gaps in the existing literature. Once the literature was reviewed and data were synthesized, it became clear that focused research was limited for this topic. Even though key findings and results from each study contribute to the existing knowledge related to prenatal care of pregnant adolescents, there are multiple gaps in recently published literature. Research aims differed for the included studies in this scoping review. This section summarizes the findings of the scoping review, gaps

identified in the literature, limitations of our review, and recommendations for future research and practice.

Summary of Findings

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positive outcomes related to group prenatal care utilization suggests that this type of prenatal care is the optimal model of prenatal care for this population.

In terms of prenatal care utilization, studies comparing group prenatal care models to traditional models of prenatal care emphasized the better outcomes seen in group attendance versus traditional care attendance as well (Griswold et al., 2013; Ickovics et al., 2016; Trotman et al., 2015). Anderson and Rahn’s (2016) results reinforce the idea that the adolescent population receives minimal prenatal care compared to other populations (Child Trends, 2019; Kinsman & Slap, 1992; Osterman & Martin, 2018). Coley & Aronson's findings that prenatal care utilization did not significantly impact racial disparities in birth outcomes may suggest that while important, prenatal care utilization may not be the most significant factor associated with better maternal and infant outcomes for the adolescent population.

Another predominant focus of research in the included studies of this scoping review was pregnant adolescent sociodemographic factors. Four of the seven studies analyzed various sociodemographic variables, but age and race/ethnicity were overwhelmingly the most common (Anderson & Rahn, 2016; Coley & Aronson, 2013; Issel et al., 2015; Weber Yorga & Sheeder, 2015). Anderson and Rahn's (2016) findings that adolescents who are younger (below 17) receive less prenatal care reinforces evidence that adolescents and their babies, as a whole, are a vulnerable population (Child Trends, 2019; Kinsman & Slap, 1992; Roozbeh et al., 2016). Coley & Aronson (2013) found that racial disparities existed regardless of age or type of prenatal care, suggesting that sociodemographic characteristics play a significant role in the outcomes related to prenatal care for pregnant adolescents. Black adolescents had a significant, negative

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utilization. Hence, minority adolescent populations are likely to be especially vulnerable to poor outcomes.

Existing literature places a predominant focus on both the maternal and infant outcomes related to prenatal care utilization in pregnant adolescents (Allen, Gamble, Stapleton, & Kildea, 2012; Daniels, Robson, Flatley, & Kumar, 2017; Fleming et al., 2013; Leppert, Namerow, & Barker, 1986). Maternal outcomes were focused on in all but one of the seven studies and outcomes discussed varied. The numerous variables discussed as a maternal outcome within the literature suggests that prenatal care has many implications related to the improved health behaviors and outcomes of the adolescent throughout her pregnancy and postpartum. The majority of studies found that there were better maternal outcomes when group prenatal care was utilized versus traditional prenatal care, reinforcing the conclusion that group prenatal care is a better model for the adolescent population (Griswold et al., 2013; Ickovics et al., 2016; Trotman et al., 2015; Weber Yorga & Sheeder, 2015). Findings from three of the seven included studies support the finding that prenatal care utilization could have positive associations for infant outcomes (Anderson & Rahn, 2016; Coley & Aronson; Ickovics et al., 2016). These findings further reinforce the understanding that adolescents have a need for prenatal care not just for maternal outcomes, but for infant outcomes as well. Anderson and Rahn's findings (2016) were the only results that failed to support the role of prenatal care in the reduction of infant

complications or birth trauma, possibly suggesting that prenatal care utilization is only just one component of a multifaceted solution to adequate prenatal care and outcomes for this population.

Gaps in the Literature

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highest in rural areas such as the southeast (Coley & Aronson, 2013 ; Issel et al., 2015; Office of Adolescent Health, 2019). Conducting research in rural areas requires sufficient resources which may be difficult for research teams to obtain.

Second, even though utilization of prenatal care was analyzed in the selected studies, the use of additional valid and reliable tools to measure prenatal care adequacy and utilization is needed. Coley & Aronson (2013) utilized Kotelchuck's Adequacy of Prenatal Care Utilization Index (1994) as a measuring tool whereas researchers of the other studies counted prenatal visits for prenatal care utilization.

Third, it was surprising that only two studies examined the role of multidisciplinary teams (Ickovics et al., 2016; Weber Yorga & Sheeder, 2015) even though it is well known that multidisciplinary teams can lead to improved outcomes and more patient and clinician

satisfaction (Fleming et al., 2013; Fleming, N., Tu, X., & Black, A.Y., 2012).

Fourth, barriers and lack of access to prenatal care was not a predominant focus examined in the research studies included in this scoping review. While Anderson & Rahn (2016) and Weber Yorga & Sheeder (2015) noted that pregnant adolescents may experience a fear of judgment from providers, further research is needed to ascertain clinician bias and stigma towards adolescents. Limited access to PNC and external barriers to prenatal care were

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Fifth, the infant outcomes explored in the studies in the scoping review were limited to immediate outcomes of birth, like birth weight, gestational age, and NICU admissions (Anderson & Rahn, 2016; Coley & Aronson, 2016; Ickovics et al., 2016). Future studies could explore additional infant outcomes, such as growth chart trends in infancy, feeding difficulties, type and prevalence of developmental delays and chronic health conditions during the infant’s first 12 months.

Limitations of the Scoping Review

Limitations exist that may impact the results and implications of our scoping review. One of the inclusion criteria was nurses. It is possible that studies exist that did not specifically discuss nurses in the PNC model but would have met the other inclusion criteria and contributed to the number of studies in this scoping review. To expand the number of included studies, this scoping review could be replicated by not including nurses as a specific inclusion or exclusion criteria. Another limitation was that every possible attempt was made to search for studies that met our inclusion criteria in salient databases. However, it is possible that some databases we did not search could have yielded additional studies to include so that the number of studies we included in the scoping review was more than seven. Due to time constraints, we were not able to randomly sample article abstracts to check for any discrepancies in determining whether to include or not include them in the scoping review.

Recommendations

Implications for Future Research and Clinical Practice

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not current as they were not conducted in the last five years. There is a need for current, ongoing studies about prenatal care for pregnant adolescents, as statistics and trends related to adolescent pregnancy in the United States are ever changing. While currently there is an overall decreasing rate of adolescent pregnancy in the United States since the last 10 years, this rate may fluctuate. Pregnant adolescents and their babies need ongoing attention to assure the healthiest outcomes (CDC, 2019; Sedgh et al., 2015). In short, more research is needed on pregnant adolescent prenatal care to help health professionals provide the most effective care possible.

In addition to the need to expand the body of science about adolescent PNC, this scoping review found that most studies were descriptive in study design and did not test hypotheses or interventions. There was only one randomized controlled trial (Ickovics et al., 2016), suggesting that the science examining adolescent prenatal care is not well developed. Studies that met our inclusion criteria were cited by others as seen in Table 1. However, none of the included studies cited any of the other included studies, thereby not building and strengthening a body of research evidence on pregnant adolescent prenatal care. Ickovics et al. (2016), was the article cited the most at 54 times, most likely because it tested an intervention using a random research design, it had the strongest study design and thereby makes a stronger impact on related research.

Although scoping reviews do not appraise the quality of evidence within included studies, the absence of well-controlled studies is a limitation of this review and indicates that further research is needed to effectively draw conclusions from findings in the literature.

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provide inclusive care by challenging their own biases and advocating for evidence-based findings to help reduce clinician bias towards pregnant adolescents. Adolescents remain a vulnerable population that desperately needs effective practice to promote prenatal care that can enhance maternal and infant outcomes.

Prenatal care utilization does not fully account for sociodemographic disparities and barriers related to lack of access to care and/or resources, as suggested by the results of this review. Future studies and practice should focus on minimizing these barriers and creating interventions to reduce these disparities to help modify prenatal care based on the specific needs of this population.

Group prenatal care is an optimal choice of prenatal care for this population as it provides multiple benefits for both mom and baby in the antepartum and postpartum periods. Further research should strive to answer how group prenatal care improves outcomes. Additional research that explores time and resources to facilitate high school graduation, social inclusion and support that results in a sense of belonging among pregnant adolescents is warranted.

Conclusion

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References

Allen, J., Gamble, J., Stapleton, H., & Kildea, S. (2012). Does the way maternity care is provided affect maternal and neonatal outomes for young women? A review of the research

literature. Women Birth, 25(2), 54 – 63. doi:10.1016/j.wombi.2011.03.002.

Anderson, C.A., & Rahn, B. (2016). Factors related to the seeking and contribution of prenatal care among ethnically diverse adolescents. Journal of Child and Family Studies, 25, 2211 - 2222. doi:10.1007/s10826-016-0378-9.

Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19-32.

doi:10.1080/1364557032000119616.

Banke-Thomas, O.E., Banke-Thomas, A.O., & Ameh, C.A. (2017). Factors influencing

utilization of maternal health services by adolescent mothers in low- and middle-income countries: a systematic review. BMC Pregnancy and Childbirth, 17(1).

doi:10.1186/s12884-017-1246-3.

Bortoletto, P., Dethier, D., Evans, M.L., & Tracy, E.E. (2018). Parental consent: an unnecessary barrier to adolescent obstetrical care. American Journal of Obstetrics and Gynecology, 219(5), E1 – E5. doi:10.1016/j.ajog.2018.08.029.

Centering Healthcare Institute. (2020). CenteringPregnancy. Retrieved from

https://www.centeringhealthcare.org/what-we-do/centering-pregnancy.

Centers for Disease Control and Prevention. (2019). About teen pregnancy. U.S. Department of Health & Human Services. Retrieved from

(25)

Child Trends. (2019). Late or no prenatal care. Retrieved from https://www.childtrends.org/indicators/late-or-no-prenatal-care

Coley, S.H., & Aronson, R.E. (2013). Exploring birth outcome disparities and the impact of prenatal care utilization among North Carolina teen mothers. Women's Health Issues, 23, 287 - 294. doi:10.1016/j.whi.2013.06.004.

Daley, A.M., Sadler, L.S., & Reynolds, H.D. (2013). Tailoring clinical services to address the unique needs of adolescents from the pregnancy test to parenthood. Current Problems in Pediatric and Adolescent Health Care, 43(4), 71 - 95. doi:10.1016/j.cppeds.2013.01.001. Daniels, S., Robson, D., Flatley, C., & Kumar, S. (2017). Demographic characteristics and

pregnancy outcomes in adolescent- Experience from an Australian perinatal centre. The Australian and New Zealand Journal of Obstetrics and Gynaecology, 57(6), 630 – 635. doi:10.1111/ajo.12651.

Dobkin, L.M., Perrucci, A.C., & Dehlendorf, C. (2013). Pregnancy options counseling for adolescents: overcoming barriers to care and preserving preference. Current Problems in Pediatric and Adolescent Health Care, 43(4), 96 – 102.

doi:10.1016/j.cppeds.2013.02.001.

Fleming, N., Ng, N., Osborne, C., Biederman, S., Yasseen, A.S., Dy, J., Rennicks White, R., & Walker M. (2013). Adolescent pregnancy outcomes in the province of Ontario: A cohort study. Journal of Obstetrics and Gynaecology Canada, 35(3), 234 - 245.

(26)

Fleming, N., Tu, X., & Black, A.Y. (2012). Improved obstetrical outcomes for adolescents in a community-based outreach program: a matched cohort study. Journal of Obstetrics and Gynaecology Canada, 34(12), 1134 – 1140. doi:10.1016/S1701-2163(16)35460-3. Griswold, C.H., Nasso, J.T., Swider, S., Ellison, B.R., Griswold, D.L., & Brooks, M. (2013). The

prenatal care at school program. The Journal of School Nursing, 29, 196 - 203. doi:10.1177/1059840512466111.

Ickovics, J.R., Earnshaw, R., Lewis, J.B., Kershaw, T.S., Magriples, U., Stasko, E., ... Tobin, J.N. (2016). Cluster randomized controlled trial of group prenatal care: Perinatal outcomes among adolescents in New York City health centers. American Journal of Public Health, 106, 359 - 365. doi:10.2105/APJH.2015.302960.

Issel, L.M., Gilmet, K., Chihara, I., & Slaughter-Acey, J. (2015). Adolescent and adult clients in prenatal case management: Differences in problems and interventions used. Maternal and Child Health Journal, 19, 2673 - 2681. doi:10.1007/s10995-015-1789-8.

Kinsman, S.B., & Slap, G.B. (1992). Barriers to adolescent prenatal care. Journal of Adolescent Health, 13(2), 146 - 154. Retrieved from

https://www.jahonline.org/article/1054-139X(92)90082-M/pdf

Kotelchuck, M. (1994). The adequacy of prenatal care Utilization index: Its US distribution and association with low birthweight. American Journal of Public Health, 84, 1486–1489.

Leppert, P.C., Namerow, P.B., & Barker, D. (1986). Pregnancy outcomes among adolescent and older women receiving comprehensive prenatal care. Journal of Adolescent Health Care, 7(2), 112 – 117. doi:10.1016/s0197-0070(86)80006-7.

(27)

National Institute of Child Health and Human Development. (2017). What is prenatal care and why is it important? National Institute of Child Health and Human Development. Retrieved from

https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care Office of Adolescent Health. (2019). Trends in teen pregnancy and childbearing. U.S.

Department of Health & Human Services. Retrieved from

https://www.hhs.gov/ash/oah/adolescent-development/reproductive-health-and-teen-pregnancy/teen-pregnancy-and-childbearing/trends/index.html

Office on Women's Health. (2012). Prenatal care fact sheet. U.S. Department of Health and Human Services. Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Osterman, M.J.K., & Martin, J.A. (2018). Timing and adequacy of prenatal care in the United States. National Vital Statistics Reports, 67(3). Hyattsville, MD: National Center for Health Statistics. Retrieved from

https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_03.pdf

Patch, L.K. (1990). Adolescent pregnancy: Psychosocial issues. Indiana Med, 83(1), 30 - 33. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2406335

Peters, M.D.J., Godfrey, C., McInerney, P., Baldini Soares, C., Khalil, H., & Parker, D. (2017). Chapter 11: Scoping reviews. Joanna Briggs Institute Reviewer's Manual. Retrieved from https://reviewersmanual.joannabriggs.org/

(28)

Sedgh, G., Finer, L.B., Bankole, A., Eilers, M.A., & Singh, S. (2015). Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health, 56(2), 223 - 230. doi:10.1016/j.jadohealth.2014.09.007

Trotman, G., Chhatre, G., Darolia, R., Tefera, E., Damle, L., & Gomez-Lobo, V. (2015). The effect of centering pregnancy versus traditional prenatal care models on improved adolescent health behaviors in the perinatal period. Journal of Pediatric and Adolescent Gynecology, 28, 395 - 401. doi:10.1016/j.jpag.2014.12.003.

Weber Yorga, K.D, & Sheeder, J.L. (2015). Which pregnant adolescents would be interested in group-based care, and why? Journal of Pediatric and Adolescent Gynecology, 28, 508 - 515. doi:10.1016/j.jpag.2015.03.006.

World Health Organization. (2018). Adolescent pregnancy. World Health Organization.

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Figure 1. PRISMA Diagram

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta Analyses:The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097

Studies included in quantitative synthesis

(meta-analysis) (n = 0) Studies included in qualitative synthesis

(n = 7)

Full-text articles excluded, with reasons

(n = 61) Full-text articles assessed

for eligibility (n = 68)

Records excluded (n = 152) Records screened

(n = 220)

Records after duplicates removed (n = 220)

Additional records identified through other sources

(n = 69)

Id en tifi ca tio n

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In cl ud ed Sc re en in g

Records identified through database searching

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Table 1. Data Summary of Included Studies in Scoping Review

Purpose/Objective Methodology Major Findings Implications/

Importance Frequency of Reference After Publication Anderson & Rahn, 2016

To explore PNC utilization and confounding factors (infant complications, psychological birth trauma, violence, and depression) in ethnically diverse adolescents.

Cross-sectional descriptive study with 260 adolescents at public county hospital; timed interviews and surveys completed within 72 hours of delivery

31.8% participants received less than the suggested # of PNC visits. Utilization of PNC did not contribute to infant complications or birth trauma. Black adolescents were most at risk for infant complications, depression, and birth trauma despite

obtaining the most PNC visits.

Recommend increased assessments of violence, depression, and other psychosocial factors during PNC visits.

Suggests that adolescents receive inadequate amount of PNC visits, but that confounding psychosocial and demographic factors can affect outcomes

regardless of PNC utilization.

Cited by 1

Coley & Aronson, 2013

To answer does PNC utilization carry protective effects for reducing disparities in adverse birth outcomes between African-American and White teen mothers

Cross-sectional examination at 10,515 adolescents in NC using birth data records and Kotelchuck’s Adequacy of Prenatal Care Utilization Index

Higher PNC utilization led to higher infant birth weight and gestational age for the overall teen population, but did not produce protective effects in reducing racial disparities in birth weight or gestational age.

While PNC utilization does increase chance of better birth outcomes, racial disparities cannot be accounted for in PNC utilization.

Cited by 15

Griswold et al., 2013

To test the effectiveness of the Prenatal Care at School (PAS) program compared to the Rochester Adolescent Maternity Program (RAMP) used in

Pilot study with 28 adolescent students in Rochester, NY school district using a nine-session PAS curriculum created by school nurse and midwife

14.2% increase in school attendance and 92% attendants felt encouraged to attend school through PAS. 5.7% increase in PNC attendance compliance

PAS combined two PNC approaches (group PNC and school-based PNC) to enhance both school attendance and PNC outcomes for urban teens.

(31)

previous years through variables like improved school attendance, PNC attendance, students’ knowledge regarding PNC, and students’ preparation for childbirth.

through PAS compared to RAMP’s group PNC program and 13% increase as compared to RAMP’s traditional PNC program. 42% improvement in knowledge of PNC with RAS and 92% felt PAS encouraged them to stay in school.

Ickovics et al., 2016

To compare group PNC model to traditional individual PNC on birth, neonatal, and reproductive outcomes.

Cluster RCT at 14 health centers in NY with 1148 pregnant adolescents using structured interviews, intervention

comparisons, medical records, and surveys.

Group PNC participants were less likely to delivery small for gestational age infants (11%) compared to individual PNC (15.8%). There was no difference in total # PNC visits between the study groups. The more group PNC visits women had, the better the outcomes

(gestational age, birth weight, time spent in NICU, etc.)

Article focuses on how group PNC can create better birth and neonatal outcomes as compared to traditional PNC in pregnant adolescents.

Suggest further research should answer how group PNC improves

outcomes: is it additional time for

education, social inclusion/support, etc.?

Cited by 54

Issel et al., 2015

To explore the difference in problems and interventions between adolescents and adults receiving PNC Case Management

Cohort study following Medicaid-reimbursed PCM programs in 22 states with N = 3947. Paper questionnaires and NILT were used to measure eight types of PNC interventions between the groups.

Adolescents

experienced on avg. 3.9 PNC problems

compared to 3.2 problems in adults. Adolescents were more likely to experience problems with pregnancy health, family, education/job, transport, and housing.

Provides insight on how PNC/PCM programs can achieve optimal experiences by looking at the common client problems and types of interventions needed for distinct age groups like pregnant adolescents.

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Case managers spent more time/encounter with adolescents (56.6 min) than adults (50.3 min) with educating, assessing, and coaching.

Trotman et al., 2015

To explore maternal health behaviors and pregnancy outcomes in the Centering

Pregnancy/CPPC model compared to traditional PNC models (single provider/SPPC and multiprovider/MPPC) in pregnant adolescents.

Retrospective cohort studying in DC following n = 150 at MWHC Obstetrics and Gynecology clinic. Health behaviors and pregnancy outcomes were measured from electronic medical records.

CPPC group was most likely to comply with prenatal and postpartum visits, as well as meet the weight gain guidelines during pregnancy than SPPC and MPPC groups. Both MPPC and SPPC groups were more likely to have postpartum depression than CPPC group, and the CPPC group was on average older.

Centering Pregnancy PNC model is a viable option to encourage health behaviors in this high-risk population. Trotman et al.’s study reinforces idea of group PNC as an optimal choice for pregnant adolescents.

Cited by 21

Weber Yorga & Sheeder, 2015

To determine if pregnant adolescents interested in GPNC have different

demographic/psychosoc ial characteristics than those who prefer individual PNC, and explore factors that influence the PNC model patients prefer.

Pilot Study in CO with n = 153 in which all were part of Colorado Adolescent Maternity Program (CAMP) utilizing surveys and open-ended

questionnaires.

61.4% were interested in group PNC and 38.6% were not. Reasons for preferring group PNC included group belonging, receiving additional education, and having fun. Those not interested were more likely to smoke and reasons for not preferring group PNC included concerns about group belonging, preferring individual PNC, and

Weber Yorga & Sheeder focus on the types of PNC

adolescents may prefer and the reasons or characteristics as to why. This reinforces the idea of barriers of adolescent PNC and the idea of modifying PNC based on the

populations needs.

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Table 2. Sociodemographic Characteristics of the Adolescent Results Anderson & Rahn Coley & Aronso n Griswold et al. Ickovics et al. Issel et al. Trotman et al. Weber Yorga & Sheeder

Age x x x

Race/Ethnicity x x x

History of Violence

x History of

Child Abuse x History of Depression x History of Substance Use x Education x BMI x

Social Support x

Gravidity and Parity x Reason for Pregnancy x

Table 3. Maternal Outcomes and Variables Results Anderson & Rahn Coley & Aronso n Griswold et al. Ickovics et al. Issel et al. Trotman et al. Weber Yorga & Sheeder Prenatal Depression x School attendance x PNC knowledge x Student Satisfaction/ Preparation x Repeat Pregnancy x x

Condom Use x

Unprotected Sexual Intercourse

x

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Management Problems Case Management Interventions x Weight Gain during Pregnancy x Family Involvement x Antepartum Admissions x Induction of Labor x 6 Week Postpartum Visit Compliance Breastfeeding x Postpartum Depression x Interest in Group PNC x

Table 4. Infant Outcomes and Variables Results Anderso n & Rahn Coley & Aronson Griswol d et al.

Ickovics et al. Issel et al. Trotman et al. Weber Yorga & Sheeder Gestational

age x x x

Infant

Complications x Birth Trauma x

Birth weight x

Preterm birth x

NICU admission

Figure

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References

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