ABSENCE OF NEGATIVE ATTITUDES TOWARD CHILDBEARING AMONG PREGNANT TEENAGERS - A RISK FACTOR FOR RAPID REPEAT PREGNANCY

Objective: To test the hypothesis that adolescent mothers who conceive again during the first postpartum year express more positive attitude s toward childbearing while pregnant than do adolescent mothers who po stpone further childbearing. Method: Prospective, cross-sectional, pop ulation-based survey. Design: A racially diverse group of 200 consecut ively enrolled, poor, pregnant 13- to 18-year-old patients in an adole scent-oriented maternity program were interviewed to determine why the y had not used contraceptives prior to the index conception. The study participants were followed up prospectively for the first postpartum year. The data analysis included t tests, chi(2) tests, analysis of va riance, and logistic regressions. Results: The repeat pregnancy rate w as 11.5% during the first postpartum year. As hypothesized, those who became pregnant again were more likely to have expressed positive atti tudes toward childbearing during the index pregnancy (60.9% vs 39.6%; P=.05; odds ratio=2.38; 95% confidence interval, 0.96-5.90). In additi on, those who conceived again were more likely to have had a prior mis carriage, dropped out of school, abused illicit substances, moved away from home, and reported inadequate family support during the index pr egnancy, and were less likely to plan to use levonorgestrel (Norplant) following delivery. The best model for predicting repeat pregnancy in cluded education status, postpartum plans for Norplant use, and miscar riage history. Having a positive attitude toward childbearing during p regnancy was not included in the final model because it did not contri bute to the model or affect any of the other parameters in the model. Conclusions: The sexually active teenaged mother who does not use cont raception poses a perplexing diagnostic dilemma. The differential diag nosis is a long, complex one that includes ambivalent feelings about p ostponing future childbearing. This study demonstrates an indirect ass ociation between positive attitudes toward childbearing during pregnan cy and repeat adolescent pregnancy. Our finding that this association operates through common linkages between maternal educational and cont raceptive plans and both positive attitudes toward childbearing and re peat adolescent pregnancy suggests that interventions specifically tar geting these underlying causes could reduce the unsafe sexual practice s that persist among the participants in comprehensive adolescent-orie nted maternity programs.