Inhalation is the most common route of exposure to chemicals in the typical University working environment. The use of safe work procedures and facilities such as local exhaust ventilation will provide protection. Skin absorption and ingestion are generally less significant routes of exposure, provided safe work procedures are observed. Everyone is required to use appropriate safe work procedures in accordance with the applicable Material Safety Data Sheets (MSDS) when handling chemicals.

Exposure to chemicals at levels below recognized exposure limits should not present a risk to you or your foetus during pregnancy or while breast feeding, however once you know you are pregnant, you are encouraged to advise your supervisor, or the UWA Medical Centre or your own medical practitioner as soon as possible. If you have any concerns about a chemical you are using, or the procedures for its safe use during pregnancy or while you are breast- feeding, you should seek advice straight away.

Working with Animals

If you work with animals you have an increased risk of acquiring infections from these animals. While maintaining safe work procedures can reduce the risk of infection, special care must be taken to prevent infections that could have serious effects on foetal development. For example, cats may harbour Toxoplasma gondii while pregnant sheep may carry Chlamydia psittaci. If you work with cats or sheep, or with any animal that you may feel may adversely affect your pregnancy, you should seek advice straight away.

Working with Ionising Radiation

Levels of exposure to ionising radiation that do not present a hazard to a pregnant woman may be of concern to the developing foetus, particularly between 8-25 weeks gestation. As many women are uncertain of their conception during the early weeks of pregnancy, special consideration must be given to the use of ionising radiation. It is very important for you and your foetus that you notify your Supervisor, Radiation Safety Officer or the Safety and Health Office as soon as you can, to ensure that your work is assessed and modifications promptly made to reduce any radiation exposure.

If you work includes using ionising radiation and you become pregnant, you have a choice to either continue working with ionising radiation or take on other tasks. It is possible to work with ionising radiation provided that the Radiation Safety Officer and / or the Safety and Health Office has undertaken an assessment and has defined the actions that must be taken to ensure that the risk to you and your foetus is as low as possible. If you work with non- ionising radiation and you are pregnant, or planning to become pregnant, then you should seek advice.

Undertaking Manual Handling

Pregnancy brings many changes that are limited to the duration of the pregnancy and a short time following.

A review of tasks undertaken to identify a potential manual handling hazards, needs to be assessed. Some practical control measures that can be implemented include:

• Review the work tasks undertaken to avoid heavy work duties, in particular avoidance of extremely heavy physical exertion in early pregnancy and a reduction of the physical workload after the third month and again after the six month of pregnancy
• Provision of rest breaks during the day and
• Changing working hours (by agreement)

Working with Computers

A good posture always is one in which you are comfortable and well supported by properly adjusted furniture.

Immunisation

Although the use of many vaccines during pregnancy is contradicted on theoretical grounds, there is no convincing evidence that pregnancy, in itself, should constitute an absolute contraindication to the use of standard vaccines.

Pregnant employees should not be assigned to the direct care of patients with HIV/AIDs.

If you are considering becoming pregnant, you should speak with your doctor about the kind of work you do and your immunisation status. Ideally you should have all the vaccinations you require for your work environment prior to becoming pregnant.

Most vaccinations should not be given during pregnancy but some are regarded as safe while breastfeeding. If you have any concerns about immunisation that may be required for your work, you should seek advice straight away.

Breast- feeding and vaccination: There is no evidence of risk to the breast- feeding baby if the mother is vaccinated with any of the live or inactivated vaccines. Breast-feeding does not adversely affect immunisation and is not a contraindication for the administration of any vaccine to the baby.

Vaccine Immunisation

Cholera. There is no evidence of risk to the fetus. Cholera vaccine may be given to pregnant and lactating women

Diphtheria. Is safe in pregnancy and lactation

Hepatitis B. Is recommended for pregnant women at risk of hepatitis B

Immunoglobulins. No known risk to the fetus from passive immunisation of pregnant
women with Immunoglobulins

Influenza. Considered safe in pregnancy

Japanese Encephalitis. Is recommended for pregnant women at risk of acquiring JE

Meningococcal. No documented adverse events in pregnant women

Infections

MMR or rubella vaccine. All pregnant women should be tested for immunity to rubella, and susceptible women should be vaccinated immediately after delivery

Poliomyelitis vaccine. Can be administered to pregnant women who are at substantial risk of exposure to poliomyelitis infection

Q Fever. Review with medical practitioners

Rabies. Can be used as required

Tetanus. Is safe in pregnancy and lactation

Typhoid. Should be based on an assessment of the real risk of disease

Yellow Fever vaccine. Pregnant women who must travel to an area where the risk of yellow fever is high should receive yellow fever vaccine

Your Role in Ensuring a Safe Pregnancy

Speak with your treating doctor prior to becoming pregnant about the kind of work you do and your concerns.

Related posts:

1. Drugs and Pregnancy – “Oh My”
2. Genital Herpes during Pregnancy
3. Cramping During Pregnancy

Cramping In Early Pregnancy

During each of my three pregnancies, I experienced cramping during early pregnancy. During my first pregnancy this cramping concerned me to no end. I experienced cramping from pregnancy weeks 2 through about week 12. Sometimes my cramps were so severe I was confident I was going to have a miscarriage or get my period.

When I had my third child, I knew I was pregnant because I had cramping that was really bad right before I was supposed to get my period, but I had no period. Why does the body cramp so badly? There are many reasons. First, many different changes are occurring in your body during early pregnancy. As your body prepares for ovulation, you may feel cramping on one or both sides of your abdomen.

Then, if implantation occurs and you successfully conceive, your uterus starts to stretch and grow. This can cause cramping ranging from very mild to moderate depending on the woman. I always thought the pain was quite bad.

Sometimes cramping in early pregnancy can be a sign of miscarriage. If you are having other unusual symptoms, including spotting or bleeding or abdominal pain, you should always, always contact your doctor. You should even contact your doctor if you are not sure your cramping is normal. Why? Your doctor can check you out and put your mind to ease. That is after all, what your doctor is there for, to help you through your pregnancy.

You may find resting or light exercise may lessen early pregnancy cramping. Many women report having the most cramping between weeks five and six of their pregnancy. Many other symptoms also start to appear around this time, including breast tenderness, nausea and fatigue.

Cramping In Late Pregnancy

Some women will experience pregnancy cramping throughout their pregnancy. You may notice cramping increases when you engage in vigorous activity. If you are exercising and notice cramping, you should back off your exercise and rest for a while. You don’t want to stress your uterus too much.

Your uterus also continues to grow throughout your pregnancy, and this can be a source of cramping later in pregnancy. Some women find after about their 28th week of pregnancy they start feeling short, rhythmic type cramps that come and go with no distinct pattern. If you have had more than one baby, you might notice these cramps earlier in your pregnancy.

These cramps, cramps that don’t follow any pattern but feel like a tightening across your lower abdomen and then release, are often Braxton Hicks contractions. These are not real contractions, like the type you will have for labor, but practice contractions that help your body prepare for the rigors of labor.

You should always be on the lookout however, for signs of preterm labor. These may include contractions that are regular and last for more than an hour, cramping accompanied by bleeding or abdominal pain or leaking from the vagina. If you experience any of these symptoms get to your doctor right away.

Most of the time Braxton Hicks contractions are harmless. You might notice they are more intense toward the later part of your pregnancy. I know I always thought Braxton Hicks were the real thing UNITL I started labor, and then I realized what cramping was all about!

When to See Your Doctor

You should never hesitate to call your doctors office if you have any questions during your pregnancy, whether related to cramping or other problems. Here are some reasons however, you should talk or go see your doctor:

• You have rhythmic contractions that last one minute or more for an hour that don’t stop and are less than 37 weeks.

• You experience regular contractions that seem to get worse or uncomfortable and you are less than 37 weeks pregnant.

• You experience cramping with bleeding at any time during your pregnancy.

• You experience cramping with sharp, intense abdominal pain, nausea or other symptoms.

• You experience cramping and fever.

• You aren’t sure if your cramps are normal or not.

Remember, your doctor is always available to help you during your pregnancy. You will not appear foolish or silly for asking your doctor whether your cramps are normal. Chances are high your doctor has heard the question before. Take heart, and take it easy, and enjoy your pregnancy!

Related posts:

1. MISCARRIAGE
2. Ectopic Pregnancy
3. Sex and Pregnancy: Overcoming Your Most Common Fears

Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women with bladder control problems can regain control through pelvic muscle exercises, also called Kegel exercises.

Pelvic Fitness in Minutes a Day

Exercising your pelvic floor muscles for just 5 minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.

The part of your body including your hip bones is the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back, and sides of the pelvis bone.

Two pelvic muscles do most of the work. The biggest muscle stretches like a hammock. The other muscle is shaped like a triangle. These muscles prevent leaking of urine and stool.

How do you exercise your pelvic muscles?

Find the right muscles. This is very important. Your doctor, nurse, or physical therapist will help make sure you are doing the exercises the right way.

You should tighten the two major muscles that stretch across your pelvic floor. They are the “hammock” muscle and the “triangle” muscle. Here are three methods to check for the correct muscles.

1. Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles.
2. Imagine that you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a “pulling” feeling, those are the right muscles for pelvic exercises.
3. Lie down and put your finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.

Don’t squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or other muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscle. Don’t hold your breath.

Repeat, but don’t overdo it. At first, find a quiet spot to practice-your bathroom or bedroom-so you can concentrate. Lie on the floor. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Work up to 10 to 15 repeats each time you exercise.

Do your pelvic exercises at least three times a day. Every day, use three positions: lying down, sitting, and standing. You can exercise while lying on the floor, sitting at a desk, or standing in the kitchen. Using all three positions makes the muscles strongest.

Be patient. Don’t give up. It’s just 5 minutes, three times a day. You may not feel your bladder control improve until after 3 to 6 weeks. Still, most women do notice an improvement after a few weeks.

Exercise aids. You can also exercise by using special weights or biofeedback. Ask your health care team about these exercise aids.

Hold the Squeeze ’til After the Sneeze

You can protect your pelvic muscles from more damage by bracing yourself.

Think ahead, just before sneezing, lifting, or jumping. Sudden pressure from such actions can hurt those pelvic muscles. Squeeze your pelvic muscles tightly and hold on until after you sneeze, lift, or jump. After you train yourself to tighten the pelvic muscles for these moments, you will have fewer accidents.

Points to Remember

• Weak pelvic muscles often cause bladder control problems.
• Daily exercises can strengthen pelvic muscles.
• These exercises often improve bladder control.
• Ask your doctor of nurse if you are squeezing the right muscles.
• Tighten your pelvic muscles before sneezing, lifting, or jumping. This can prevent pelvic muscle damage.

Related posts:

1. Pregnancy Workouts At Home
2. Pregnancy and Exercise
3. Common Pregnancy Symptoms: Hemorrhoids and Varicose Veins

Hormones Play a Big Role

While you are pregnant, your body undergoes a great deal of changes. Your hormone levels change and result in changes in your body. One of these changes is that you often have an increased amount of progesterone. This can cause the blood vessels to relax, leading to varicose veins. Sometimes, if the blood vessels relax, the two halves of the valves in the veins will separate just a small amount, and won’t meet back up to block the back-flow of blood. When this happens, you’ll see varicose veins.

Family History

Family history is hard to run away from – and it is often the leading indicator of problems that you will have. If you have a history of varicose veins in your family, you’re more likely to have varicose veins. This isn’t something that you can afford or alter, unfortunately. The flip side is, of course, relevant as well. If you don’t have a family history of varicose veins, then you are less likely to have them yourself. It is important to note, as well, that varicose veins tend to get worse with each pregnancy. If you have a family history, and you had them during your first pregnancy, chances are good that you’ll have them in increasing strength in subsequent pregnancies.

Uterus Pulls

The increased blood that you have in your body during pregnancy places extra burden on your veins. In addition, as your uterus grows, it creates pressure on the major veins in your pelvic area. This pressure then adds more pressure to the large vein on the right side of your body called the inferior vena cava. This added pressure pushes on the leg veins and may result in varicose veins during pregnancy.

Additional Problems

Researchers have found a few other reasons that women may have varicose veins during pregnancy. If you are having multiple births, then you are more likely to develop varicose veins. This is partly due to the added pressure on your uterus and the added blood in your system. While this situation can’t be changed, there are others that can. If you are overweight or stand on your feet for long periods of time while pregnant, you are more susceptible to varicose veins. Both of these situations put added pressure on your veins and can lead to varicose veins.

Prevention and Solutions…

While you certainly can’t alter your family history or change your growing uterus, there are certain actions that you can take to help with varicose veins. When people tell you to put your legs up while pregnant – they may not realize that they are actually giving you varicose vein help. It is very important to put your legs up while pregnant, as it gives your veins a break and releases the pressure that is on them. You should try to make sure that you go into your pregnancy at a healthy weight and that you eat well while pregnant. The good news with varicose veins is that they usually disappear after the baby has arrived. They tend to improve three to four months after you’ve given birth. While you are still dealing with the varicose veins, it’s best to wear support hose, to exercise often and to avoid standing for long periods of time.

If you find that the varicose veins don’t go away, you’ll want to talk to a doctor to discuss treatment. In general, however, varicose veins are simply one of the many bumps in the road along the pregnancy path. Keep your sense of humor while dealing with this, and any other trying situation during pregnancy, and know that you are working to a great end – a new baby!

Related posts:

1. Common Pregnancy Symptoms: Hemorrhoids and Varicose Veins
2. Lack of Energy and Varicose Veins…
3. Pregnancy and Air Travel – Flying When Pregnant

It can also come in handy after you’ve had your baby, when it’s not as easy to go for a fitness walk or to an exercise class with your baby in tow. You should try to formalize a great routine now and also use it after baby is born.

Firstly, find a good spot in your house that may inspire you to work out whenever you have some free time. Maybe some place near the TV so you can catch up on your favorite shows and workout at the same time.

You might also want to opt for an exercise video or even some home equipment like a treadmill or elliptical trainer. Although the latter can be a serious investment, the cost is often no more than that of a one-year gym membership, a swim card for the local pool, or a year’s worth of drop-in aerobic classes.

Plus, you won’t have a built-in excuse not to exercise when the weather is bad or you can’t find a baby sitter.

Make sure that you keep plenty of water close by and keep your house relatively cool while you are working out. If you should feel faint or dizzy at any time, stop immediately and grab some water. Also make sure you have plenty of room to stretch and cool down afterwards. Flexibility and keeping your heart rate at a relatively low level are both very important.

Home exercises during your pregnancy

Stretching Exercises

Stretching makes the muscles limber and warm. Here are some simple stretches you can perform before and after exercising.

#Neck rotation: Relax your neck and shoulders. Drop your head forward. Slowly rotate your head to your right shoulder, back to the middle and over the left shoulder. Complete four, slow rotations in each direction.
#Shoulder rotation: Bring your shoulders forward and then rotate them up toward your ears and then back down. Do four rotations in each direction.
#Swim: Place your arms at your sides. Bring your right arm up and extend your body forward and twist to the side, as if swimming the crawl stroke. Follow with the left arm. Do the sequence ten times.
#Thigh shift: Stand with one foot about two feet in front of the other, toes pointed in the same direction. Lean forward, supporting your weight on the forward thigh. Change sides and repeat. Do four on each side.
#Leg shake: Sit with your legs and feet extended. Move the legs up and down in a gentle shaking motion.
#Ankle rotation: Sit with your legs extended and keep your toes relaxed. Rotate your feet, making large circles. Use your whole foot and ankle. Rotate four times on each side.

Tailor Exercises
Tailor exercises strengthen the pelvic, hip and thigh muscles and can help relieve low back pain.

#Tailor sit: Sit on the floor with your knees bent and ankles crossed. Lean slightly forward and keep your back straight but relaxed. Use this position whenever possible throughout the day.
#Tailor press: Sit on the floor with your knees bent and the bottoms of your feet together. Grasp your ankles and pull your feet gently toward your body. Place your hands under your knees. Inhale. While pressing your knees down against your hands, press your hands up against your knees (counter-pressure). Hold for a count of five.

Kegel Exercise
Kegel exercises help strengthen the muscles that support the bladder, uterus and bowels. By strengthening these muscles during your pregnancy you can develop the ability to relax and control the muscles in preparation for labor and birth. Kegel exercises are also highly recommended during the postpartum period to promote the healing of perineal tissues, increase the strength of the pelvic floor muscles and help these muscles return to a healthy state, including increased urinary control.

To do Kegels, imagine you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor and are practicing Kegel exercises. While doing Kegel exercises, try not to move your leg, buttock or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises. (So you can do them anywhere!)

Kegel exercises should be done every day. We recommend doing five sets of Kegel exercises a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of five and then relax. Repeat this ten times for one set of Kegels.

Related posts:

1. Why Exercise Pelvic Muscles?
2. Varicose Veins & Pregnancy
3. Common Pregnancy Symptoms: Hemorrhoids and Varicose Veins

Pregnancy is accompanied by an increase in progesterone levels, which relaxes the walls of the veins, increasing the risk of blood vessel swelling and symptoms such as hemorrhoids and varicose veins. Blood volume increases during pregnancy, further increasing the chance of hemorrhoids and varicose veins.

In addition, pregnancy puts pressure on veins as the uterus expands and the fetus grows. This enlarges blood vessels in the anus and the legs, adding yet another factor that contributes to hemorrhoids.

Constipation is another of the more common pregnancy symptoms, and can contribute to hemorrhoid formation due to bowel straining. The combination of all these factors sharply increases the odds that a pregnant woman will experience varicose veins or hemorrhoids.

Varicose Veins and Pregnancy Symptoms

Varicose veins occur when blood vessels become congested and blood leaks back into the veins. The veins enlarge in response, become swollen and are raised above the skin surface. Varicose veins are purple or blue in color, and resemble tangled cords. During pregnancy, varicose veins may develop on the back, the inside of the legs and the calves.

Although unsightly, varicose veins are not usually painful. If pregnancy symptoms include painful varicose veins or veins that are swollen, red or tender, report the symptoms to your doctor as soon as possible.

Like many other pregnancy symptoms, varicose veins usually diminish after the pregnancy. However, some varicose veins may remain after pregnancy.

Hemorrhoids and Pregnancy Symptoms

Hemorrhoids are among the most uncomfortable pregnancy symptoms. Essentially, hemorrhoids are varicose veins that develop in the anus, and sometimes in the vagina. Hemorrhoids can be painful, especially when sitting or having a bowel movement.

Symptoms of hemorrhoids during pregnancy include:

• anal pain
• bright red blood on toilet paper or stool
• itchiness in the anus or vagina
• pain during bowel movements
• tender, firm lumps near the anus.

On occasion, hemorrhoids may be visible outside the anus, indicated by a swollen mass that is soft to the touch.
While many non-prescription treatments for hemorrhoids exist, consult your doctor before using any of them during pregnancy. Some may have adverse affects on the fetus.

Treating Hemorrhoid Symptoms

Taking ten to twenty minute sitz baths several times a day can provide relief from symptoms of hemorrhoids. Some women find relief using cold compresses or ice packs, and you can medicate the ice pack with witch hazel. In other cases, a hot compress reduces symptoms, or you can try alternating hot and cold compresses.

Preventing Hemorrhoids and Varicose Veins

Of course, the best strategy is to avoid having varicose veins or hemorrhoids in the first place. You may not be able to completely avoid them during pregnancy, but the following tips can reduce the risks:

• Avoid standing for long periods.
• Don’t cross your legs.
• Don’t hold bowel movements: go when you need to.
• Drink plenty of water.
• Eat a high fiber diet.
• Elevate your legs when resting.
• Exercise regularly.
• Practice regular Kegel exercises.

Related posts:

1. Varicose Veins & Pregnancy
2. Lack of Energy and Varicose Veins…
3. Natural Hemorrhoids Treatment

OVERVIEW

Pregnancy rates among adolescent females have fallen steadily since 1990, from 116.9 pregnancies per 1,000 women aged 15-19 in 1990 to 75.4 pregnancies per 1,000 female teens the same age in 2002.

Teens aged 15 to 17 experienced a decline in pregnancy rates of more than thirty percent, from 74.2 pregnanciesper 1,000 in 1990 to 42.3 pregnancies per 1,000 in 2002. The rates for teens aged 18 to 19 also declinedbetween 1990 (172.4 per 1,000) and 2002 (125.6 per 1,000). While the teen pregnancy rate hassignificantly declined since 1990, the United States continues to have a higher teen pregnancy rate than many countries in the western industrialized world. For example, data collected in the mid-nineties from 46developed countries indicate that the teen pregnancy rate in the U.S. is higher than all but one of the countries examined, and is more than four times the rate in Germany, France, Italy, and Spain. Moreover, the teen birth rate in the U.S. in 2002 was more than double the rate for Canada.

Regardless of the declines, teen pregnancy continues to be a serious problem that carries significant social costs for the teenagers, their children and society. Teen mothers are more likely than other young women their age to drop out of school, live in poverty and rely on public assistance, and their children tend to grow up in economically and educationally disadvantaged households. Consequently, it is important that teen pregnancy prevention efforts address the numerous factors linked to the experience of a pregnancy.

One such factor is childhood sexual abuse, for which some evidence exists to suggest a significant association with adolescent pregnancy and childbearing.

Definition of and trends in childhood sexual abuse

The Children’s Bureau defines childhood sexual abuse as “a type of maltreatment that refers to the involvement of the child in sexual activity to provide sexual gratification or financial benefit to the perpetrator, including contacts for sexual purposes, molestation, statutory rape, prostitution, pornography, exposure, incest, or other sexually exploitative activities.” In general, child sexual abuse refers to sexual acts, sexually motivated behaviors, or sexual exploitation involving children, including both touching and nontouching offenses involving varying degrees of violence. According to the National Child Abuse and Neglect Data System (NCANDS) of the Children’s Bureau, of the estimated 899,000 children determined by Child Protection Services to be victims of maltreatment in 2005, 9.3 percent (or approximately 83,000 children) were sexually abused. Among children who had been victims of maltreatment, a higher percentage of white victims (9%) had been sexually abused as compared with Hispanic (7%) and African-American (6%) victims. Reported cases of child sexual abuse steadily rose throughout the 1980s to a peak of 149,800 substantiated cases in 1992, dropped throughout the rest of the 1990s, and declined by a total of 49% by 2004. Reported cases of sexual assault among teenagers also decreased by 67% from 1993 through 2004. These statistics may reflect either an actual decline in the incidence of child sexual abuse due to public awareness or other factors, stricter laws against child abusers, or they could simply reflect a lower incidence of reporting or substantiation of cases. The rate of childhood sexual abuse (1.2 per 1,000 children younger than age 18) remained constant between 2000 and 2004, while the number of victims fluctuated between 84,398 and 88,688 during this period. The NCANDS collects case-level data on all children who received an investigation or assessment by a Child Protective Services (CPS) agency.

However, because not all sexual abuse cases are reported, other research suggests that rates of childhood sexual abuse are actually much higher. Survey data, which measure the number of people who report that they have ever experienced abuse (as opposed to those who have had an experience of abuse that was reported to and substantiated by a CPS agency), show high levels of childhood sexual abuse. For example, data from the Adverse Childhood Experiences Study in 1995-1997, a survey of more than 17,000 adult 1 members of a large health care organization, show that 21% of those surveyed, including 25% of women and 16% of men, reported ever having experienced sexual abuse as children. The higher retrospective reporting of childhood sexual abuse in survey data compared with data collected by CPS agencies may be due, in part, to different definitions of childhood sexual abuse and the fact that respondents in surveys report retrospectively across their full childhood history compared with annual estimates in CPS data. However, the much higher incidence of childhood sexual abuse reported in surveys suggests that a high percentage of these experiences are never reported.

Conceptual framework

The negative effects of sexual abuse on children are broad and include injury, disease, fear, anxiety, depression, anger, hostility, inappropriate sexual behavior, poor self-esteem, substance abuse, and difficulty with close relationships. Not only do victims of abuse experience immediate negative effects, but victims who experience sexual abuse during childhood may be vulnerable to negative outcomes in the years following abuse, including post-traumatic stress symptoms, substance abuse, gynecological complications, sexually transmitted diseases and unintended pregnancy. This literature review focuses specifically on the link between childhood sexual abuse and teen pregnancy and childbearing.

Childhood sexual abuse is hypothesized to be a risk factor for adolescent pregnancy through both direct and indirect associations. First, sexual abuse has been argued to be directly associated with teenage pregnancy in both retrospective studies in which teens report both sexual abuse experiences and teen pregnancy and in prospective studies following victims of abuse over time.

Second, sexual abuse has also been found to be indirectly associated with teen pregnancy, operating through sexual risk behaviors that may explain some of the association with teen pregnancy. Numerous studies indicate that experiencing sexual abuse is associated with early initiation of sexual activity, failure to use contraception, multiple sexual partners, substance use and abuse, and other risk factors, all which are associated with a higher likelihood of experiencing a teen pregnancy. Therefore, an assessment of the link between childhood sexual abuse and teen pregnancy should examine both direct and indirect pathways.

Purpose of this literature review

The purpose of this literature review is to examine the relationship between childhood sexual abuse and teen pregnancy by addressing four specific research questions:

1) What is the link or correlation between childhood sexual abuse and teen pregnancy?;

2) Is childhood sexual abuse an underlying causal factor of teen pregnancy?;

3) How do research findings differ across various groups, and for which subpopulations and target groups is the research most sparse?; and

4) What factors mediate the relationship between childhood sexual abuse and teen pregnancy? To do this, we identified the most relevant, methodologicallyand analytically-sound articles we could find that address our research questions. We rely mainly on multivariate studies, but report some bivariate findings that we found to be particularly salient. (We have indicated in the text if a certain finding was based on bivariate studies only.) While we focus our examination on articles published between 2000 and 2006, we also include a number of strong articles published prior to 2000 that we consider to make important contributions to this area of study. To examine what is known about the important mediators between childhood sexual abuse and teen pregnancy, we identified a number of studies that analyze the association between childhood sexual abuse and outcomes known to be significantly associated with the experience of a teen pregnancy (e.g., age at first sex, number of sexual partners, contraceptive use, substance abuse, and mental health).

Examining the relationship between childhood sexual abuse and teen pregnancy is important for a number of reasons. First, practitioners have identified childhood sexual abuse and its relationship with teen pregnancy as a critical issue in the field of teen pregnancy prevention and reproductive health, and this report provides up-to-date information on the current state of the research. Second, the attention we give to mediating factors is of key importance because they represent potential areas of intervention for programs. Finally, we summarize what we do not know about this issue and provide possible directions for future research. This comprehensive summary of research on the relationship between childhood sexual abuse and teen pregnancy will serve as important background information for practitioners in the field of teen pregnancy prevention.

WHAT EXISTING RESEARCH TELLS US

Child sexual abuse and teen pregnancy

In their 2002 literature review on the association between child maltreatment and teen pregnancy, Blinn-Pike, et al. described 15 studies published after 1989 that examine this relationship. While the authors searched for articles that examined the consequences of all types of child abuse, they found that most work on this subject addressed sexual abuse while relatively few studies addressed nonsexual abuse. They found that, while many studies did find a positive association between child abuse and teen pregnancy, too many were methodologically flawed, lacked a theoretical focus, or did not adequately account for potential confounding factors for the authors to conclude that a causal link exists. For example, the authors suggest that future research more thoroughly apply existing theoretical models from a diverse set of disciplines to the study of the mechanisms through which abuse may be linked to teen pregnancy, in order to help programs and policy-makers address the problems of abuse and teenage pregnancy. Our literature review expands upon their work by including additional, more recent articles and exploring in greater detail the link between childhood sexual abuse and teenage pregnancy and its mediators. Furthermore, our review focuses on child sexual abuse specifically, instead of child abuse more broadly. The studies examined in our review link a teenage pregnancy to many different forms of sexual abuse, including forced sex, nonconsensual sexual contact, sexual experience with an adult, events that the respondent considered to be sexual abuse, any kind of sexual touching, and substantiated incidents of sexual abuse reported to protection services agencies.

Our review of the literature reveals that childhood sexual abuse and teen pregnancy have been found to be significantly and positively associated in a number of bivariate and multivariate studies.

Only a few studies, however, have used prospective, longitudinal data in the analysis of the relationship between child sexual abuse and adolescent pregnancy. A prospective study measures exposure (e.g. experience of sexual abuse) in a sample of individuals and then follows the individuals forward in time, monitoring possible outcomes (e.g. teen pregnancy). Prospective studies are methodologically strong as they allow researchers to tease out causal relationships by controlling for confounding factors assessed prior to the abuse and because recall error and distortion are minimized. The balance of evidence from these prospective studies reveals a positive association between childhood sexual abuse and teen pregnancy, although one study indicates no association between sex abuse and teen pregnancy. The remaining studies use retrospective and cross-sectional data, which operate in reverse of

prospective studies by examining exposure to a suspected risk factor in relation to an outcome already established at the beginning of the study. Prospective studies, when conducted with rigor, can be helpful for determining causality. In general, it is much more challenging to assess associations using retrospective studies because data are usually collected at one point in time. However, given the nature of sociobehavioral research, researchers are often limited to using a retrospective design. A limitation of both types 3 of studies is that many use small convenience samples or samples with higher than average reports of child maltreatment.  Nonetheless, retrospective studies offer important insights into the association between childhood sexual abuse and teen pregnancy. The majority of these retrospective studies point to a positive association between childhood sexual abuse and teen pregnancy, whereas only a few have found no link between sexual abuse and teen pregnancy.

Findings from retrospective studies indicate that any type of sexual abuse may be associated with teen pregnancy and, furthermore, that particular details of child abuse experiences matter, such as age at which abuse occurs, the identity of the perpetrator, severity of the abuse, and the use of violence or force.

For example, males who are younger when they experience sexual abuse have a higher risk of subsequently impregnating a teenager, and females who are younger when abuse occurs tend to be younger at their first pregnancy, as compared to males and females who were older when they experience sexual abuse. Females who have been sexually abused by a boyfriend are at an increased risk of a teen pregnancy, but the same is not true for those who were sexually abused by a friend, family member, or stranger. More severe forms of abuse (e.g., rape or incest) are related to a greater risk of teen pregnancy as compared with less severe forms of abuse (e.g., unwanted sexual touching or attempted rape). The use of force or threats during an incident of sexual abuse appears to be particularly traumatic, as males who experience sexual abuse accompanied by threats or violence from the perpetrator show an increased risk of impregnating a teenager compared to those whose abuse was not accompanied by threats of violence.

Not all studies distinguish sexual abuse from other types of child abuse; instead, research has shown that child abuse in general, and the number of types of abuse experiences, are positively associated with the risk of teen pregnancy. However, one study found that while experiencing any type of abuse (sexual, emotional, or physical) is associated with teen pregnancy, when the types of abuse are analyzed separately, only physical abuse is still associated with teen pregnancy. It is important to note, however, that this study’s sample included only 100 females in a geographically limited area.

Researchers have offered numerous explanations for the relationship between childhood sexual abuse and teen pregnancy. Some have suggested that pregnancies are planned by abused girls to free themselves from a bad family situation, while others have argued that experiencing sexual abuse as a child socializes teens to form distorted views of sex, such as having higher levels of preoccupation with sex, or feelings of ambivalence or aversions to sex, in adolescence that cause them to engage in more high-risk sexual behaviors. Abuse in childhood can be seen as a traumatic experience that affects healthy social development into adolescence, or one that leads to feelings of low self-esteem for which having a child of one’s own may compensate. Furthermore, pregnancy could be a direct result of unwanted intercourse, and one study found that this was the case for 13% of the pregnant or parenting teens in their sample of mostly low-income Hispanic females recruited from a parenting teen program in San Antonio, Texas.

For the small number of studies that found no relationship between childhood sexual abuse and teen pregnancy, the authors suggest that their findings could be due to the characteristics or size of the sample.

Others argue that sexual abuse does not emerge as a particularly salient predictor of teen pregnancy because it is not one type of abuse alone, but rather an accumulation of negative family experiences and all types of abuse, that leads to negative consequences later in life. Moreover, some suggest that confounding factors explain the relationship that others have found between child abuse and pregnancy because other experiences, such as sexual history, family structure, and disadvantage, better predict teen pregnancy than sexual abuse experience.

Overall, our review of the literature exposes a weakness in the research on the relationship between childhood sexual abuse and teen pregnancy by revealing that most of the data used in the studies are retro-4 spective and cross-sectional in nature. As such, it is difficult to establish a causal relationship between sexual abuse and teen pregnancy. Prospective study designs can provide more evidence for establishing causality, yet only a few studies have used longitudinal, prospective data in their analyses. On balance, most of the existing studies do suggest a significant association between sexual abuse and teen pregnancy, but more prospective studies are needed to better understand the complex relationship between sexual abuse and subsequent teen pregnancy. However, although we cannot definitively conclude that sexual abuse is a causal predictor of teen pregnancy, it is clear by the findings summarized above that experiencing childhood sexual abuse is, at minimum, an important marker in the experience of adolescent pregnancy, and it likely contributes to a constellation of risk factors that increases the likelihood of adolescent pregnancy.

Subgroup findings

Whereas some studies that conducted analyses for males and females separately find that sexual abuse and teen pregnancy are positively associated for both groups, some evidence exists from both a small, longitudinal bivariate study and a larger, cross-sectional multivariate study that child sexual abuse is a stronger risk factor for teen pregnancy among males than females. Saewyc, et al. (2004), offer two explanations for this finding: first, males experiencing abuse often report more dysfunctional family environments compared to females, which may lead to lower levels of support for males following sexual abuse; second, males could be more concerned with adhering to a cultural perception of masculinity and feel a sense of emasculation following sexual abuse. Thus, fathering a child could be a means of restoring masculinity. Alternatively, since many sexual abuse perpetrators are men, one study hypothesizes that male children who have been abused may be more likely to have been abused by males, and thus have to cope with sexual identity issues in addition to the sexual abuse experience. These findings suggest that the research literature’s focus on female teenage parents may obscure consequences for male victims of sexual abuse. The potential heightened consequences of sexual abuse for males highlight the need for more pregnancy prevention programs to target both male and female victims of sexual abuse.

The association between childhood sexual abuse and teenage pregnancy may also vary between racial/ethnic groups, although we found only one study that explicitly tested this association and it used bivariate analyses. The authors found that experiencing rape (the woman was forced to have sex) has a greater association with risk of a teen pregnancy for white women than for other women, whereas being coerced into having sex (the woman was pressured in some other way to have sex) has a greater association with the risk of pregnancy for minority women (Mexican-American, African-American, and American- Indian) as compared with white women. The authors suggest further research to explore racial/ethnic differences in the association between forced sex, rape, and teen pregnancy. In addition, although not specifically testing differences across racial/ethnic groups, studies using samples of low-income African Americans,  Hispanics or of at-risk street youth have found an association between sexual abuse and teen pregnancy among these populations.

There are other subpopulations of interest for which research is lacking. For example, we could not find any studies that examined whether the relationship between childhood sexual abuse and teen pregnancy differs among teens of low and high socioeconomic status. In sum, prior research on childhood sexual abuse and teenage pregnancy is lacking in details about the effect of abuse on different subgroups. For example, although some studies show that childhood sexual abuse is more harmful for males, we can only speculate on why this is true. More studies that focus on males in particular, or that compare males and females, are needed. Additionally, we could find almost no research that examines how the association between sexual abuse and teen pregnancy varies by racial and ethnic groups. Considering that prevalence and 5 characteristics of both sexual abuse and teenage childbearing vary by race/ethnicity, it is likely that the relationship between the two vary by race/ethnicity as well. Clearly, more research is needed to examine differences between racial and ethnic groups in the consequences of childhood sexual abuse and to explain why the effects of sexual abuse may differ. More attention to subgroup analyses would make an important extension to the existing literature.

WHAT WE KNOW ABOUT MEDIATING FACTORS

In addition to research showing a direct relationship between sexual abuse and teenage pregnancy, the literature offers evidence linking sexual abuse to other outcomes that serve as mediators of teen pregnancy.

For example, childhood sexual abuse is not only linked with teen pregnancy risk, but also with riskier sexual behaviors and with greater substance use (which, in turn, are associated with greater risk of teen pregnancy). Knowledge about the role of mediating factors is of key importance because they represent potential areas of intervention for programs. In this next section, we examine what is currently known about the link between sexual abuse and potential mediating factors.

Childhood sexual abuse and sexual activity

A growing body of research examining the consequences of childhood sexual abuse has shown that abuse is associated with risky sexual behaviors in adolescence and young adulthood. Findings from prospective studies indicate that childhood sexual abuse is associated with having sex at a younger age, using birth control less consistently, and having a higher risk of experiencing revictimization. Other research has shown a positive association between childhood sexual abuse and composite measures of risky sexual behavior, which include behaviors such as having unprotected sex and having a high number of sexual partners. Retrospective research has also positively linked sexual abuse with early sexual initiation,  having a greater number of sexual partners,  having older sexual partners, and revictimization. Also, although the findings are less consistent, some studies have also found a link between childhood sexual abuse and reduced contraceptive use and condom use. Research consistently shows that these sexual behaviors are, in turn, associated with a greater risk of pregnancy among teens (see Kirby et al. 2005 for a review), and, therefore, operate as mediators in the relationship between sexual abuse and teen pregnancy.

In some studies that specifically examine mediating mechanisms, mediating variables such as early sex account for any relationship between child sexual abuse and teen pregnancy. For example, Stock, et al. (1997) found that experiencing sexual abuse was positively associated with teen pregnancy because it increased the likelihood that teens engaged in high-risk sexual behaviors, like initiating sex at an early age or having multiple sexual partners, while Smith (1996) found that the link between sexual abuse and teen pregnancy was explained by risky behaviors such as poor school performance, substance use, and early sexual experience. Others have argued that sexual experience is more important than child sexual abuse in predicting teen pregnancy. Therefore, it is important to examine how each of these factors – childhood sexual abuse, sexual activity during adolescence, and teenage pregnancy -might be interrelated. Below, we summarize what is known about the relationship between childhood sexual abuse and certain risky sexual activities that may serve as mediators of teen pregnancy risk.

Age at first sex. Research consistently links childhood sexual abuse with a younger age at first sexual intercourse. More specifically, studies show that sexual abuse is positively associated with being younger at first sex, and with having sex before age 14, before age 15, and by age 16.

Furthermore, experiencing any type of abuse has been found to be associated with a younger age at first sex 6 for females, and the number of types of abuse is associated with a younger age at first sex for males. Although it is possible that an early first intercourse could have been a non-voluntary sexual experience, research that specifically examined the transition to first voluntary or wanted intercourse found that sexual abuse and first voluntary intercourse are positively correlated. Having sex at a younger age has been consistently shown to be associated with a greater risk of a teen pregnancy, in part because teens who become sexually active earlier have a longer amount of time in which to become pregnant.

Number of sexual partners. Research on childhood sexual abuse has also found that victims of sexual abuse tend to have a greater number of sexual partners during adolescence and a greater number of lifetime sexual partners for adult men and women than those who have never been abused. Other studies have found a positive association between sexual abuse and the number of partners in the last three months for females and males. Teens who have had more sexual partners are more likely to become pregnant, again, in part due to increased opportunity for pregnancy with greater frequency of sexual activity.

Age of first sexual partner. Research shows that women who experienced sexual abuse are more likely to have had their first sexual experience with a much older partner. Similarly, experiencing some type of abuse (sexual, physical, or emotional) is associated with having a larger age difference with first sexual partner for women. We did not find any studies that examined whether sexual abuse is related to age of sexual partners among men. Researchers have suggested that sexual abuse and partner age are related because experiencing sexual abuse with older perpetrators might make victims more likely to experience voluntary sexual relationships with similarly older partners. Another explanation is that female victims of sexual abuse might seek father-figures in their male partners or may be more easily exploited compared to those who were never abused. Having an older sexual partner is associated with a greater risk of experiencing a teen pregnancy, especially for teens who have their first sexual experience at a young age. It is possible that this is a result of a higher likelihood that these relationships are either casual or coercive, in which case teens have been shown to use contraception less within these types of relationships and thus are more likely to become pregnant.

Revictimization. Experiencing sexual abuse during childhood is also associated with a greater likelihood of experiencing unwanted sex, rape or assault, or intimate partner violence in adolescence, although relatively few studies have examined this relationship. Women who experienced childhood sexual abuse are more likely to experience some form of sexual assault, including subsequent rape or attempted rape, and unwanted or coerced contact, during adolescence. Women who have been sexually abused as children or adolescents are also more likely to experience intimate partner violence as adults. Thus many women who have been sexually abused as children also experience “revictimization” or subsequent sexual abuse in adolescence or adulthood. Researchers have suggested that low levels of sexual self-esteem, higher concerns about sex, and dysfunctional or uncommitted sexual behaviors (such has having sex out of loneliness, or having sex with many partners) are consequences of childhood sexual abuse that can lead to revictimization. Since coercive sex and rape during the teenage years is associated with a greater risk of experiencing a teen pregnancy, revictimization among victims of child sexual abuse could potentially lead to an especially high risk of experiencing a teenage pregnancy.

Contraceptive and condom use. Research has examined the relationship between sexual abuse and later contraceptive use. Many studies have found that women who have ever experienced sexual abuse are less likely to use contraception at first sex and at last sex, and are more likely to have ever had sex without birth control. Similarly, some studies have found that women who had been sexually abused are less likely to consistently use birth control and more likely to never use birth control.However, the connection between sexual abuse and condom use is not clear, as studies have reported conflicting results. Some studies have found that both male and female adolescents who experienced sexual abuse or forced sex were more likely to never or rarely use condoms, and to not have used a condom at last sex. Another found that childhood sexual abuse was associated with having a higher number of unprotected sexual experiences in the last three months, but not with condom use at last sex, although those who experienced childhood sexual abuse were less likely to use a condom at last sex with a steady partner as compared with those with no history of abuse. The authors suggest that this finding is possibly a result of condom use rates being higher already with nonsteady partners, leading to little variance in this measure by sexual abuse history. However, other research has found no association between having sex without condoms and a history of forced sex, forced sexual contact, or any other type of child abuse. Contraception and condoms clearly protect against pregnancy, so sexually active teens who more consistently use contraception are less likely to become pregnant.

It is not yet clear as to why teens who were sexually abused as children would be less likely to later use contraception or condoms, and researchers have only been able to hypothesize a reason for a connection.

It is possible that the mental and emotional consequences of sexual abuse lead to riskier behaviors in general, or lower levels of self-esteem in adolescence, which could provide teens with less power to negotiate contraceptive or condom use. However, another possible explanation for the different rates of contraceptive use for abused and non-abused teens is that teens who had been sexually abused may be deliberately using no contraceptive method in order to get pregnant. In fact, one bivariate study found that teen girls who had been sexually abused were more likely to report that they were trying to conceive and that their boyfriends were encouraging them to get pregnant, and another study found that those who had been sexually abused were more likely to have gotten pregnant intentionally.

Explanations of mediating role. Researchers and theorists have suggested a number of pathways to explain the relationship between childhood sexual abuse and sexual risk-taking in adolescence. Some have suggested that sexual abuse leads to a preoccupation with or aversion to sex, which can manifest itself in later inappropriate sexual behaviors. Researchers also have noted that stigma or shame experienced by a child following sexual abuse may be internalized, and the victim can generalize the abusive experience to other sexual experiences or the perpetrator to other sexual partners. Others cite long-lasting negative mental health consequences of childhood abuse and the ways in which victims cope with these consequences (such as substance use) as factors associated with a greater likelihood of sexual risk-taking behaviors among victims of sexual abuse.

Child sexual abuse and other risk factors

A number of other risk factors (e.g., trading sex for money, alcohol or drugs, substance use/abuse, poor mental health and attitudes about sex) have been identified as being associated with childhood sexual abuse and teen pregnancy. Both bivariate and multivariate analyses indicate that the experience of  childhood sexual abuse is associated with trading sex for alcohol, drugs or money. While trading sex for alcohol, drugs, or money has not been explicitly linked with teen pregnancy in past research, teens who engage in prostitution do seem more likely to engage in a variety of other risky sexual behaviors that may lead to an unintentional pregnancy.

Substance use and abuse have also been linked to the experience of sexual abuse during childhood.

Teens who experienced sexual abuse as children are at greater risk of smoking or using or abusing drugs and alcohol. In addition to long-term substance use, studies have also found that childhood sexual abuse is also positively associated with substance use prior to or during sex. Substance use and abuse 8 are consistently associated with a higher risk of pregnancy among teens.

Several research studies have found an association between childhood sexual abuse and poor mental health outcomes. For example, childhood sexual abuse has been found to be associated with greater emotional and behavioral problems, low self-esteem and negative self-image, depression and suicide contemplation among teens. However, a few studies find little difference between the abused and nonabused respondents in terms of self-esteem or depressed mood, for at least some populations.

Poor mental health has been shown to be associated with a higher risk of having a teen pregnancy. Specifically, low self-esteem and attempted suicide have been shown to be linked to a higher risk of teen pregnancy,  while depression has been linked to less contraceptive use and a higher likelihood of having a teen birth.

Attitudes about sex are also associated with the experience of childhood sexual abuse. Abused women are more preoccupied with sex, more sexually averse and sexually ambivalent, and they report more negative interactions with their romantic partners (in bivariate analyses) and greater sexual concerns than non-victimized women. The impact of sexual abuse on sexual attitudes may differ by gender.

Women who have been sexually abused as children are more likely to have higher scores on the sexual concerns scale than men who have been sexually abused as children. Moreover, girls who experienced sexual abuse report more intrusive thoughts, more hyper-arousal, more sexual anxiety, more personal vulnerability, and perceive the world as a more dangerous place than boys who also experienced abuse; whereas, boys report more eroticism than girls. It is possible that sexual anxiety, and more personal vulnerability, or negative interactions may lead to reduced communication between partners and thus a greater likelihood of unprotected sex and teen pregnancy.

CHILD SEXUAL ABUSE IN TEEN PREGNANCY

PREVENTION PROGRAMS

Although childhood sexual abuse has been found by a number of studies to be significantly associated with teen pregnancy and with important mediating factors, there is little evidence of pregnancy prevention programs that specifically address this issue. In fact, we found little published work on evaluations of current teen pregnancy prevention programs that address childhood sexual abuse in their curricula, and no evaluations on the components of the curriculum that specifically address sexual abuse. This is striking, given that program practitioners have identified childhood sexual abuse and its relationship with teen pregnancy as a critical issue in the field of teen pregnancy prevention.

We did, however, find general information on and evaluations of two programs that address sexual abuse among adolescents in their curricula. The first program, Project Taking Charge was developed by the American Association of Family and Consumer Sciences and the Office of Adolescent Pregnancy Prevention Program. It is a six- to nine-week abstinence-based program for early adolescents in grade 7 that advocates delaying the onset of sexual activity and other high risk behaviors. One component of the curriculum incorporates discussions of sexual abuse and prevention. A quasi-experimental evaluation of Project Taking Charge found a marginally significant negative association with sexual initiation. However, because discussions about sexual abuse were only one component of a broader program, it is unclear how these discussions are connected to teen pregnancy prevention. Another program that addresses sexual abuse is Wise Guys, a prevention program for adolescent males (targeting those in the 7th and 8th grades) offered by the Family Life Council of Greater Greensboro in North Carolina. Wise Guys has given attention to sexual abuse and dating violence, and the program encourages young men to treat females with respect. A 9 quasi-experimental evaluation of Wise Guys found the program was associated with increased contraceptive use among program participants compared with a control group. However, the program did not separately evaluate the effectiveness of messages about sexual abuse and dating violence, so it is not clear how this program links these discussions with pregnancy prevention. We also found a study that analyzes the impact of an HIV intervention program targeting troubled youth, including victims of abuse, on HIV knowledge, but it does not appear that this program addresses sexual abuse or pregnancy directly. These findings indicate the need for more pregnancy prevention programs that address childhood sexual abuse and for evaluation of how programs incorporating messages and discussion about sexual abuse are associated with risky sexual behaviors that may lead to teen pregnancy.

CONCLUSION

This literature review set out to answer four specific research questions. Our first question asked if there is a link between childhood sexual abuse and teen pregnancy. Overall, the bulk of research on the association between childhood sexual abuse and teen pregnancy suggests that childhood sexual abuse is significantly associated with the experience of a teen pregnancy.

Our second question involved childhood sexual abuse as an underlying causal factor of teen pregnancy.

Findings from a number of prospective studies reveal a positive association between childhood sexual abuse and subsequent teen pregnancy, although one study indicates no association between sex abuse and teen pregnancy. It is also important to note the data limitations inherent to such a sensitive and difficult topic. Although findings from most prospective studies indicate a significant and likely causal association between childhood sexual abuse and teen pregnancy, and results from other retrospective studies indicate significant associations between childhood sexual abuse and teen pregnancy, more research is needed to explore the complex relationship between childhood sexual abuse and subsequent risk of teen pregnancy. Other impediments to reaching solid conclusions are that measures of sexual abuse are inconsistent across studies; many studies use self-report data by an individual instead of substantiated reports of sexual abuse as the primary source of information; detailed questions on sexual abuse in large scale representative surveys are uncommon; most studies do not include comparison or control samples; and many studies use small or unrepresentative samples in their analyses. Each of these methodological issues hinders our ability to draw definitive conclusions about the underlying causality of childhood sexual abuse.

Third, we were interested in how research findings differ across various groups and in identifying subpopulations and target groups for which the research is most sparse. While some studies found that sexual abuse and teen pregnancy were positively associated for both males and females, others found that child sexual abuse was a stronger risk factor for teen pregnancy among males than females, highlighting the need for practitioners to give at least equal attention to both male and female teens who have suffered sexual abuse in the past. We found only one (bivariate) study that tested the association between childhood sexual abuse and teenage pregnancy across racial/ethnic groups, and we could not find any studies that examined the relationship between childhood sexual abuse and teen pregnancy across socioeconomic status.

These few studies indicate the dearth of research that examines the impact of sexual abuse on important subpopulations and emphasize the need for researchers to conduct more rigorous investigations among larger samples that will help pregnancy prevention practitioners understand if particular subgroups are in need of more targeted interventions.

Finally, we were interested in the factors that mediate the relationship between childhood sexual abuse and teen pregnancy. It is clear that childhood sexual abuse has a positive association with risky sexual behaviors in adolescence, such as having sex at an earlier age having more sexual 10 partners, having older sexual partners, revictimization (such as experiencing unwanted or coerced sex, rape, or intimate partner violence), and exchanging sex for money, alcohol, and drugs. Moreover, childhood sexual abuse also seems to have a clear connection with emotional problems

and substance use in adolescence. Each of these mediators have been found to be associated with a higher likelihood of experiencing a teen pregnancy. Because of the numerous possible mediating effects, it is difficult to disentangle direct and indirect effects to determine the precise causal pathways between childhood sexual abuse and teen pregnancy. However, the information presented on mediating factors is of key importance because they represent potential areas of intervention for programs. For example, given that we know that childhood sexual abuse is not only associated with teen pregnancy risk, but also with greater substance use (which, in turn, is linked to a greater risk of teen pregnancy), then programs serving sexually abused teens can also address the risks associated with substance use as one additional strategy for reducing the likelihood of teen pregnancy among youth who have been sexually abused.

This literature review adds to current knowledge by examining the most recent research available on child sexual abuse and teen pregnancy, by examining possible mediators between the two, and by pointing to a need for further research in this area. Although the balance of the literature indicates a connection between sexual abuse and teen pregnancy, we found only 11 articles published since 2000, highlighting the lack of recent studies that address this issue. The shortage of peer-reviewed articles, especially those that are prospective and address subgroup differences, is itself an important finding and is indicative of the need for more data collection and analysis on this important issue. We have also found that there have been few recently published evaluations of teen pregnancy prevention programs that address childhood sexual abuse in their curricula and none that explicitly evaluate the effectiveness of the sexual abuse components of the programs. Our literature review should be used as a catalyst for programs to incorporate attention to childhood sexual abuse into their curricula and evaluate the effectiveness of such program components.

Despite the methodological limitations that exist in the current body of research, the findings discussed in this review offer useful insights for program providers. The consequences of sexual abuse on risky sexual behavior and teenage pregnancy are especially relevant for programs working to prevent teen pregnancy. Even if studies cannot determine causality with certainty, it is still important to know that prior sexual abuse is an important marker of risk. Program providers want to know if a teen is at high risk of becoming pregnant, and the evidence is clear that sexually abused girls are a group at an elevated risk of pregnancy – even if this is due to riskier family backgrounds or other mitigating factors that might explain away any direct association between sex abuse and pregnancy.

However, it is not only important for a provider to know whether a program participant has been a victim of abuse in order to measure risk, but it is also important because abused teens may have distinct problems as a result of the abuse. For example, victims of sexual abuse, as found in this literature review, are more likely to suffer from mental health problems and to use substances as a coping mechanism. Thus, program providers may need to pay particular attention to the underlying causes of these mental health and substance abuse problems in order to focus their prevention efforts on these issues. Also, victims of sexual abuse may face challenges to their self-esteem or preoccupations with sex that make them more easily exploited as teenagers. Program providers could work to instill in these teens feelings of empowerment and control over their sexual relationships.

Due to the higher risk of pregnancy among teens who have experienced childhood sexual abuse, it is essential for program providers to address the unique issues facing teens who have experienced childhood sexual abuse. At minimum, program providers should be aware of the link between sexual abuse and teen pregnancy. If appropriate, intake interviews could include questions about whether a teen has ever experienced sexual abuse, and program providers should put training and capacity building projects in place to prepare staff members to recognize signs of sexual abuse and work with teens who report experiencing abuse. Programs and counselors should refer these teens to programs that are able to help them cope with their experiences. The connection between childhood sexual abuse and revictimization in adolescence indicates that programs should also work with teens to help prevent their being a victim of abuse during adolescence.

For example, program staff could stress the seriousness of abuse and encourage teens to seek help if they are in an abusive relationship. Finally, because childhood sexual abuse is linked to substance abuse and poor mental health, program providers must face the challenge of working with teens with multiple problems and risk behaviors.

The dearth of existing research on this topic points to an urgent need for a more comprehensive body of rigorous studies on the association between sexual abuse and teen pregnancy. This will require several steps. First, policy makers, program providers, and researchers are in need of an agreed-upon definition of what qualifies as sexual abuse, in order to make clear assertions about its consequences. Second, our ability to draw conclusions about the consequences of childhood sexual abuse would be greatly enhanced with the addition of more prospective, longitudinal studies and studies that control for confounding factors in the analyses. This is critical in order to disentangle the general effects of family and background characteristics from the specific effects of sexual abuse. Otherwise, analyses may report spurious relationships. Moreover, the addition of more qualitative research on the issue would greatly enhance this field of research. We were only able to identify one qualitative study that examined the association between child sexual abuse and teen pregnancy. Qualitative research would be beneficial because it would allow researchers to explore, more specifically, the impact of childhood sexual abuse on adolescent outcomes, and would allow for a more comprehensive understanding of why a link may exist between childhood sexual abuse and adolescent risky sexual behaviors and pregnancy. Third, findings from studies that use nationally representative samples and incorporate stricter control variables would enable researchers to generalize findings on the link between sexual abuse and teenage pregnancy to the larger population. Fourth, we currently need more studies that examine the complex pathways between sexual abuse, mental health, substance use, sexual risk-taking, and teen pregnancy, in order to better understand how these factors are interrelated.

Fifth, more research is needed to assess the association between childhood sexual abuse and teen pregnancy across subgroups and target populations. Finally, more information is needed on appropriate interventions to improve outcomes among sexually abused teens and about prevention efforts to reduce the incidence of sexual abuse. With all of this information, better prevention and intervention programs can be designed, and the impacts of these programs can be evaluated.

Related posts:

1. Parenting Tips: The Parent-Teen Struggle
2. Causes of Teen Depression
3. Childhood Obesity Health Risks, Diagnosis and Treatment

Skin changes during pregnancy

So what can you do if, pre-pregnancy, you had a shapely body and unblemished skin but are nowbombarded by a myriad of changes that prove to be too much to handle, such as acne breakouts or stretch marks? The most important thing is not to panic; help is on its way. As this chapter takes you through the various skin changes that occur during pregnancy, it will provide clear, concise and effective solutions and tips, ranging from practical advice to scientifically proven treatments that are safe for the pregnant woman.

Skin changes such as acne, itchiness and other kinds of skin blemishes are the inevitable outward signs of the transformations that take place in your body during pregnancy. These changes, which are caused by the hormonal ups and downs brought about by being pregnant, may be considered normal by some but not by others-a lot of pregnant mothers-to-be, especially those who are going through this experience for the first time, consider such changes to be abnormal or, using a more clinical term, ‘pathologic’. Some of these conditions may only be present during pregnancy but they can persist long after the baby has been delivered.

In some instances, they can even be permanent. As our hormone levels fluctuate during pregnancy, they can produce a wide array of skin changes that range from mild (such as oilier skin) to severe (such as stretch marks and chloasma). Many, irregardless of their duration, remain a cause of concern especially for expectant or new mothers. For example, no expectant mother likes the idea of living with angry acne even if it is only for nine months. If proper skincare is carried out during this period, however, having beautiful and glowing skin is an attainable goal.

The condition of our skin during pregnancy may also be affected by certain positive and negative habits that we have. For instance, it may be worsened by habits such as smoking or drinking. (It goes without saying that stopping smoking and/or drinking not only benefits your unborn baby but also your overall well-being.)

Each and every one of us who is expecting goes through different kinds of skin changes. Some experience only one type of change, while others may experience two or more. Because of this, it is important to be aware of all the possible changes that may occur so that you will be better prepared to cope with them. It will not do any harm to prepare in advance. What is bad is if you already know what might happen but choose to sit back and do nothing. You should also be aware that some changes may be present during the first pregnancy but not during the second, while others may appear for the first time only in subsequent pregnancies.

Acne

During early pregnancy, some women develop acne, especially those of us who were prone to breakouts during our menstrual periods before conceiving. On the other hand, some find that their acne problems improve while they are pregnant.

The increased levels of hormones during pregnancy can cause increased oiliness or dryness of the skin.

There is no way to predict how these hormonal changes will affect individuals. As a rule of thumb, however, acne usually surfaces or worsens during the first trimester and improves as the pregnancy progresses, possibly because of increased levels of oestrogen.

Here are some tips and solutions that may help prevent breakouts or help you manage the condition:

• Good skin cleansing is the best way to avoid or treat acne breakouts. Wash your face with a mild pHbalanced cleanser (you can also use a cleanser with mild AHA properties) two or three times a day. Do not wash too often or your skin may become dry, thus aggravating the problem. Do not overscrub either as this may leave the skin looking red and angry, and worsen breakouts. Using a toner with mild AHA properties can also be beneficial for oily and acne-prone skin.
• Topical treatments such as benzoyl peroxide (which comes as a cleansing liquid or bar, lotion, cream or

gel) can be helpful in treating acne. Benzoyl peroxide cream or lotion should be applied once or twice daily on the affected areas only. For a start, however, use this medication once a day to see how your skin reacts to it. The cleansing liquid or bar may be used to wash the affected area. Do note that skin irritation is the most common side effect of benzoyl peroxide. This is more likely to occur if the concentration of benzoyl peroxide is high, but it tends to decrease with continued use. Benzoyl peroxide is available over the counter.

• Azelaic acid is another effective anti-acne treatment. Interestingly, it was first investigated in the 1970s as a treatment for pigmentation (brown patches) and was coincidentally found to be an effective acne treatment. It stops the growth of P. acnes, an acne-causing bacteria in the skin. It also helps to keep the skin pores clear. It comes as a gel or cream, and is usually applied to the skin twice a day, in the morning and in the evening. It is available only with a prescription from your doctor.
• Erythromycin belongs to the family of medicines called antibiotics. Topical antibiotics work directly by killing P. acnes. Topical erythromycin comes in the form of a gel, cream or solution and can be applied on the skin to help control acne.
• Most women find that combining the aforementioned treatments can improve results against acne. For example, combining 5% benzoyl peroxide cream and 3% erythromycin gel is highly effective.
• Generally, expectant mothers are advised to avoid oral medicines in case these have an effect on the foetus. Oral erythromycin, however, may be prescribed by a doctor for severe acne.
• Certain lasers, such as Smoothbeam, Aramis and the Vbeam, can also be used to treat acne. Another way of treating acne is LED Photomodulation-a light-based therapy that can improve skin healing and appearance. The device consists of light emitting diodes that emit a non-thermal, low energy light at pulsating frequency. Several sessions of lying under the blue light of such devices have been proven effective in clearing up acne-prone skin. I-Clear or Clearlight treatment also works by reducing the acnecausing bacteria in the skin.
• Despite the many acne medications and treatments around, the following should be avoided during pregnancy and if pregnancy is being contemplated-tetracycline, oral isotretinoin (Roaccutane), topical retinoids (tretinoin, isotretinoin and adapalene or differin), and salicylic acid preparations.

Myths about acne

Myths about acne often aggravate our anxiety about this unwelcome problem so that we sometimes blame unrelated events for our acne problem. So let us get things straight before we draw any conclusions:

1. Acne is not caused by poor hygiene. We are always advised to avoid abrasive scrubbing and alcoholbased astringents that can dry and irritate the skin, especially if we have acne. This, however, does not mean that we should stop cleaning our face altogether. As mentioned earlier, washing twice or thrice daily with a pH-balanced cleanser, without over-scrubbing, and then pat drying is sufficient.

2. Acne has little relationship to diet. In other words, there is no conclusive evidence that chocolate, pizza or other such foods or soda drinks cause acne.

3. Cosmetics do not necessarily cause the development of acne lesions. As long as you use oil-free, noncomedogenic brands if you are prone to acne, these should not cause breakouts. It is also important to note that oil from hair products and suntan lotions can exacerbate acne.

4. Mechanical trauma can in fact make acne worse. Therefore, you should, at all times, avoid picking at acne lesions, because doing so may cause more inflammation and infection.

Skin changes such as acne, itchiness and other kinds of skin blemishes are the inevitable outward signs of the transformations that take place in your body during pregnancy.

Related posts:

1. Acne in pregnancy
2. How To Treat Acne During Pregnancy
3. Topical creams and antibiotic treatment for teenage acne

CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCY

Changes in the body during pregnancy are most obvious in the organs of the reproductive system.

a. Uterus.

(1) Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size:

(a) In length from 6.5 to 32 cm.

(b) In depth from 2.5 to 22 cm.

(c) In width from 4 to 24 cm.

(d) In weight from 50 to 1000 grams.

(e) In thickness of the walls from 1 to 0.5 cm.

(2) The capacity of the uterus must expand to normally accommodate a seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the fetal membranes.

(3) The abdominal contents are displaced to the sides as the uterus grows in size, which allows for ample space for the uterus within the abdominal cavity.

(a) Growth of the uterus occurs at a steady, predictable pace.

(b) Measurement of the fundal height during pregnancy is an important factor that is noted and recorded.

(c) Growth that occurs too fast or too slow could be an indication of problems.

(d) The size of the uterus usually reaches its peak at 38 weeks gestation. The uterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as “lightening.” This is more noticeable in a primigravida than a multigravida.

Appproximate height of the fundus at various weeks of pregnancy

NOTE: Remember a primigravida is a woman pregnant for the first time. A multigravida is a woman who has been pregnant more than once.

b. Cervix.

(1) The cervix undergoes a marked softening which is referred to as the Goodell’s sign.”

(2) A mucus plug, which is known as “operculum” is formed in the cervical canal. This is the result of enlarged and active mucus glands of the cervix. It serves to seal the uterus and to protect the fetus and fetal membranes from infection. The mucus plug is expelled at the end of the pregnancy. This may occur at the onset of labor or precede labor by a few days. When the mucus is blood-tinged, it is referred to as a “bloody show.”

(3) Additional changes and softening of the cervix occur prior to the beginning of labor.

c. Vagina. Increased circulation to the vagina early in pregnancy changes the color from normal light pink to a purple hue which is known as the “Chadwick’s sign.”

d. Ovaries.

(1) The follicle-stimulating hormone (FSH) ceases its activity due to the increased levels of estrogen and progesterone secreted by the ovaries and corpus luteum. The FSH prevents ovulation and menstruation.

(2) The corpus luteum enlarges during early pregnancy and may even form a cyst on the ovary. The corpus luteum produces progesterone to help maintain the lining of the endometrium in early pregnancy. It functions until about the 10th to 12th week of pregnancy when the placenta is capable of producing adequate amounts of progesterone and estrogen. It slowly decreases in size and function after the 10th to 12th week.

CHANGES OF THE SKIN DURING PREGNANCY

Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system. The following changes occur during pregnancy:

a. Linea Nigra. This is a dark line that runs from the umbilicus to the symphysis pubis and may extend as high as the sternum. It is a hormone- induced pigmentation. After delivery, the line begins to fade, though it may not ever completely disappear.

b. Mask of Pregnancy (Chloasma). This is the brownish hyper pigmentation of the skin over the face and forehead. It gives a bronze look, especially in dark-complexioned women. It begins about the 16th week of pregnancy and gradually increases, then it usually fades after delivery.

c. Striae Gravidarum (Stretch Marks). This may be due to the action of the adrenocorticosteroids. It reflects a separation within underlying connective tissue of the skin. This occurs over areas of maximal stretch–the abdomen, thighs, and breasts. It will usually fade after delivery although they never completely disappear.

d. Sweat Glands. Activity of the sweat glands throughout the body usually increases which causes the woman to perspire more profusely during pregnancy.

CHANGES OF THE BREASTS

a. In early pregnancy, the breast may feel full or tingle, and increase in size as pregnancy progresses. The areola of the nipples darken and the diameter increases. The Montgomery’s glands (the sebaceous glands of the areola) enlarge and tend to protrude. The surface vessels of the breast may become visible due to increased circulation and turns to a bluish tint to the breasts.

b. By the 16th week (2nd trimester) the breasts begin to produce colostrum. This is the precursor of breast milk. It is a thin, watery, yellowish secretion that thickens as pregnancy progresses. It is extremely high in protein.

c. Nursing implication: Inform the pregnant patient to wear a good, supporting bra.

CHANGES OF THE CIRCULATORY SYSTEM DURING PREGNANCY

a. Blood Volume.

(1) Blood volume increases gradually by 30 to 50 percent (1500 ml to 3 units). This results in decrease concentration of red blood cells and hemoglobin. This explains why the need for iron is so important during pregnancy.

(2) By the time pregnancy reaches term, the body has usually compensated for the decrease resulting in an essentially normal blood count.

(3) Blood count is interpreted as anemia by the physician if the hemoglobin falls below 10.5 grams per 100 ml and the hematocrit drops below 30 percent.

(4) Increased blood volume compensates for hypertrophied vascular system of enlarged uterus. It improves the placental performance. Blood lost during delivery, less than 500 cc is normal (300 to 400 cc is average).

b. Cardiac Output.

(1) Cardiac output increases about 30 percent during the first and second trimester to accommodate for hypervolemia. This is not a problem for patients with a normal heart. A patient with a diseased heart is especially at risk for cardiac decompensation 28 to 35 weeks of pregnancy when the blood volume and cardiac load are at their peak; also, during labor and immediately after delivery when rapid hemodynamic changes occur.

(2) Change in output is reflected in the heart rate. It usually increases by 10 beats per minute.

(3) Nursing implication. Patients with a diseased heart need to be advised to get plenty of rest and to report any shortness of breath or unusual symptoms to their physician.

c. Blood Pressure.

(1) Normally, the patient’s blood pressure will not rise.

(2) Nursing implications.

(a) The patient’s blood pressure should be checked carefully and often since a significant increase is one of the indicators of toxemia of pregnancy.

(b) When monitoring the blood pressure, be sure it is done under the same circumstances (that is, patient sitting and left arm).

d. Venous Return.

(1) The lower extremities are often hampered in the last months of pregnancy due to the expanding uterus restricting physical movement and interfering with the return of blood flow. This results in swelling of the feet and legs.

(2) Nursing implications.

(a) Advise the patient to rest frequently. This will improve venous return and decrease edema.

(b) Have the patient to elevate her feet and legs while sitting.

(c) Remind the patient not to lie in a supine position since this inhibits return blood flood flow as the heavy uterus presses on the vessels. This leads to the vena cava syndrome or supine hypotension. The patient may complain of feeling dizzy, nauseated, or weak.

Vena cava syndrome

CHANGES OF THE RESPIRATORY SYSTEM DURIN PREGNANCY

a. The respiratory rate rises to 18 to 20 to compensate for increased maternal oxygen consumption, which is needed for demands of the uterus, the placenta, and the fetus.

b. Women may feel out of breath and may need to sit a moment to catch their breath.

CHANGES OF BODY TEMPERATURE DURING PREGNANCY

a. A slight increase in body temperature in early pregnancy is noted. The temperature returns to normal at about the 16th week of gestation.

b. The patient may feel warmer or experience “hot flashes” caused by increased hormonal level and basal metabolic rate.

CHANGES OF THE URINARY SYSTEM DURING PREGNANCY

a. The kidneys must work extra hard excreting the mother’s own waste products plus those of the fetus. There is an increase in urinary output and a decrease in the specific gravity.

b. The patient may develop urine stasis and pyelonephritis in the right kidney. This is due to pressure on the right ureter resulting from displacement of the uterus slightly to the right by the sigmoid colon.

c. Frequent urination is a complaint during the first through third trimester. As the uterus rises out of the pelvic cavity in early pregnancy, pressure on the bladder decreases and frequency diminishes. When lightening occurs during the final weeks of pregnancy, pressure on the bladder returns to cause frequency.

CHANGES OF THE SKELETAL SYSTEM DURING PREGNANCY

a. There is a realignment of the spinal curvatures during pregnancy to maintain balance. It is due to the increase in size of the uterus and pressure on the abdominal wall. The patient walks with head and shoulders thrust backward and chest protruding outward to compensate. This gives the patient a “waddling” gait.

b. There is a slight relaxation and increased mobility of the pelvic joints, which allows stretching at the time of delivery of the infant.

Postural changes during pregnancy

CHANGES OF THE GASTROINTESTINAL SYSTEM DURING PREGNANCY

a. As mentioned, as the pregnancy progresses, the uterus enlarges. It rises up and out of the pelvic cavity. This action displaces the stomach, intestines, and other adjacent organs.

b. Peristalsis is slowed because of the production of the hormone progesterone, which decreases tone and mobility of smooth muscles. This slowing enhances the absorption of nutrients and slows the rate of secretion of hydrochloric acid and pepsin. Flare-up of peptic ulcers is uncommon in pregnancy. Slow emptying may increase nausea and heartburn (pyrosis). Relaxation of the cardiac sphincter may increase regurgitation and chance for heartburn. Movement through the large intestines is also slowed due to an increase in water consumption from this area. This increases the chance for constipation.

c. Nursing implications.

(1) If the mother has difficulty with nausea and/or heartburn, advise her to eat small, frequent meals.

(2) The patient should eat a well- balanced diet high in protein, iron, and calcium for fetal growth; high fiber and fluids to prevent constipation.

(3) The mother should not lie flat for 1 to 2 hours after eating because this may cause heartburn and/or regurgitation.

CHANGES OF SELECTED GLANDS OF THE ENDOCRINE SYSTEM DURING PREGNANCY

a. Parathyroid Gland. This gland increases in size slightly. It meets the increased requirements for calcium needed for fetal growth.

b. Posterior Pituitary. Near the end of term, the posterior pituitary will begin to secrete oxytocin that was produced in the hypothalamus and stored there. It will serve to initiate labor.

c. Anterior Pituitary. At birth, the anterior pituitary will begin to secrete prolactin. This stimulates the production of breast milk.

d. Placenta. The placenta acts as a temporary endocrine gland during pregnancy. It produces large amounts of estrogen and progesterone by 10 to 12 weeks of pregnancy. It serves to maintain the growth of the uterus, helps to control uterine activity, and is responsible for many of the maternal changes in the body.

CHANGES IN BODY WEIGHT DURING PREGNANCY

a. Normal weight gain is about 24 to 30 pounds during pregnancy.

b. Weight gain in pregnancy.

(1) There is a slight loss of pounds during early pregnancy if the patient experiences much nausea and vomiting.

(2) She then gains 2 to 4 pounds by the end of the first trimester.

(3) A gain of a pound per week is expected during the second and third trimesters.

(4) Monitoring of weight gain should be done in conjunction with close monitoring of blood pressure.

(5) A lack of significant weight gain may be an indication of intrauterine growth retardation (IUGR) of the infant.

(6) Patients with multiple fetuses will require a higher caloric diet and expect a higher weight gain than a patient with only one fetus.

c. Adequate protein intake should be emphasized to the patient for development of the healthy fetus and proper diet reviewed at each prenatal visit.

Related posts:

1. Planning a Pregnancy
2. PRENATAL TESTING – OVERVIEW
3. Varicose Veins & Pregnancy

What is a miscarriage?

It is the spontaneous loss of a pregnancy that occurs during the first 20 weeks of pregnancy, most commonly before 12 weeks. After 20 weeks the loss of the pregnancy is called a stillbirth. About 1 in 7 recognised pregnancies will miscarry and about 1 in 3 women will experience a miscarriage during their reproductive life. A miscarriage may occur so early in a pregnancy that a woman may have been unaware that she was pregnant. These miscarriages are often unreported. Sometimes a doctor or nurse may refer to a miscarriage as a “spontaneous abortion”. “Abortion” is the common medical term given to all pregnancies that end before 20 weeks (both miscarriages and terminations). Miscarriage can be a difficult and traumatic experience for some women. For others, it may happen so early that the pregnancy was undetected.

Why does miscarriage occur?

It is generally unknown what causes miscarriages. Basically, miscarriage occurs because the foetus did not develop properly, probably because of a chromosomal or other genetic abnormality. The pregnancy is not normal and miscarriage is nature’s way of taking care of the problem.

What are the risk factors for miscarriage?

The vast majority of miscarriages occur early. It is important to note that a woman’s actions do not cause miscarriage. It is simply a badluck chance event and there is nothing she can do to prevent it. However, miscarriage risk increases if the woman has certain risk factors that include:

· Age Increasing maternal age is associated with chance of miscarriage – 1 in 10 for women aged 20, 1 in 7 for women aged 30, 1 in 3 for women aged 40 and 1 in 2 for women aged 45.

· Alcohol, drugs and cigarettes – Alcohol of >2 drinks per day doubles risk of miscarriage. Smoking reduces supply of oxygen to the placenta (lifeline of foetus) increasing risk of miscarriage, ectopic pregnancy, oxygenstarved baby, underdeveloped baby and premature delivery.

· Some medications – speak with your doctor about certain risky medications

· Obesity – women who are obese (BMI > 30) are twice as likely to miscarry.

· Underlying medical conditions – eg. Uncontrolled diabetes, kidney or thyroid problem, tendency toward blood clotting, connective tissue disorders (eg. lupus).

· Previous pregnancy – the risk of miscarriage increases with the number of previous pregnancies.

· Abnormalities of uterus / cervix · Foetal chromosome abnormalities

What are the signs of a miscarriage?

Signs and symptoms of miscarriage may vary considerably and may include vaginal bleeding, abdominal cramps and pain, loss of pregnancy symptoms, and the passage of tissue. Any vaginal bleeding during pregnancy is called a threatened miscarriage. However 25% of women who go on to have a normal baby have experienced some vaginal bleeding during the pregnancy. With miscarriage, significant vaginal bleeding may be severe enough to require a blood transfusion. Pain may be as severe as giving birth.

Contact your doctor immediately if you have any of the following symptoms:
- vaginal bleeding and cramps shortly after a late period
- gradual bleeding causing pain or pressure in the lower abdomen
- sudden, severe pain in the lower abdomen or pain on opening your owels
- severe pain that does not feel like period pain
- dark bleeding which starts after the pain
- faintness, nausea, dizziness and vomiting

Types of miscarriage

· Threatened miscarriage – is a pregnancy complicated by vaginal bleeding with little or no pain. This often continues to be a normal pregnancy.

· Incomplete miscarriage – a failed pregnancy where the uterus may still contain pregnancy tissue. You may need a D&C (dilatation & curettage) or vacuum aspiration to remove the remaining tissue. This can be done at any GCA clinic or at a hospital.

· Complete miscarriage – is a failed pregnancy where the uterus has expelled all the pregnancy tissue without the need for any other medical or surgical treatment.

· Missed miscarriage – is a failed pregnancy but with no symptoms (no bleeding or pain). This may go undetected for some time or until pregnancy symptoms have gone away or the uterus fails to enlarge.

· Blighted ovum – no foetus development but the pregnancy sac is present.

· Ectopic pregnancy – pregnancy is growing on the Fallopian tube instead of the uterus. This is a serious medical condition and may require prompt medical attention to prevent lifethreatening bleeding if rupture of the tube occurs. 1 in 200 pregnancies are ectopic.

· Septic miscarriage – is a failed pregnancy complicated by an infection in the uterus.

· Recurrent miscarriage – 3 or more failed pregnancies in a row.

Investigating miscarriage

Ultrasound is the most important tool for diagnosing miscarriage. A vaginal ultrasound is valuable in assessing very early pregnancy because the vaginal probe is much closer to the uterus and the pregnancy may be seen more clearly. Other tests include pregnancy and progesterone blood hormone levels. Pregnancy hormone levels should double every 48 hours in a normally progressing pregnancy. If the levels are rising slowly or falling, a failed pregnancy is likely (or ectopic).

How is miscarriage treated?

Often miscarriages may occur naturally without the need for medical treatment. At other times, a dilatation & curettage (D&C or “curette”) may be required to remove the pregnancy tissue, therwise bleeding and pain may continue and infection may develop. Sometimes oral medication (misoprostol) may be an alternative to a surgical procedure for some women with a very early failed pregnancy. Antibiotics may be required if infection is present. Some women may require iron supplements, or more rarely, a blood transfusion if bleeding was significant.

What happens after a miscarriage?

You may experience light bleeding for up to 2 weeks (on & off). If the bleeding is heavy or persistent, you are passing clots, you have persistent abdominal pain, you have a foulsmelling vaginal discharge, you have a temperature >38 degrees, you are not feeling better, then you should contact your doctor, GCA clinic or hospital immediately.

What should I do if I think I am having a miscarriage?

· Ring your doctor, GCA clinic or hospital and describe your symptoms. If you are alone and things are happening fast, then dial 000 for an ambulance. Never drive yourself to hospital.

· Have a partner, relative or friend with you, if possible.

· Soak up blood with pads or towels. Keep a record of the number of pads you use each hour and how soaked they were.

· You may require a D&C so don’t eat or drink anything. Your stomach needs to be empty if you have an anaesthetic.

· Save any tissue you pass. It may be very helpful in excluding ectopic pregnancy as the cause of the bleeding.

· Remember that a doctor or nurse or anyone in a hospital cannot prevent miscarriage.

What is my chance of having another miscarriage?

Since most miscarriages happen by chance, one miscarriage only slightly lowers your chance of having a successful pregnancy the next time. However, 2% of women will have 2 miscarriages in a row and <1% of women will have 3 (recurrent miscarriage). This may happen out of chance but there may be some underlying reasons.

There may be repeated chromosomal abnormalities from one parent or the other. Blood clots may block the placenta. The shape of the uterus or cervix may not allow the foetus to develop properly or cause it to deliver early. Tests and treatments may be available for many of these problems. This may be emotionally traumatic and frustrating. Expert doctors (gynaecologists and geneticists), counselling and hospital clinics are available to deal with recurrent miscarriage.

How will I feel after a miscarriage?

Women who have had a miscarriage can experience a wide range of emotion – it may cause profound grief and depression that may be brief or long lasting. It is natural to feel loss, sadness, anger and even guilt, despite the fact that the end result is out of your hands. Expert counselling is available. Speak with your doctor or local hospital.

When can I get pregnant again?

You may conceive again even before the next period. The next period is expected in 46 weeks after a miscarriage. Some people may want to try again immediately, while others prefer to wait. There may be a slightly higher chance of miscarriage again if conception occurs before the first period, but remember that the next pregnancy is likely to proceed normally even if you have had previous miscarriages. All women planning pregnancy should be taking folic acid (best started at least 1 month prior to conception and continued for first 3 months of pregnancy), be immune to rubella and stop consumption of alcohol, cigarettes and other recreational drugs. It is also important to have a pap smear every 2 years, preferably done when you are not pregnant.

Related posts:

1. Facts About Miscarriage
2. Cramping During Pregnancy
3. Ectopic Pregnancy