Am J Obstet Gynecol. 2017 Jun 12. pii: S0002-9378(17)30746-9. doi: 10.1016/j.ajog.2017.06.010.

A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers

Stevens J, Lutz R, Osuagwu N, Rotz D and Goesling B

Abstract

Background: Most interventions designed to reduce teen pregnancy rates have not focused on pregnant and/or parenting adolescents. Therefore, a large randomized controlled trial was conducted regarding a motivational interviewing program entitled Teen Options to Prevent Pregnancy in a low income sample of adolescent mothers. This program recommended monthly sessions between a participant and a registered nurse over 18 months. This program also featured facilitated birth control access through transportation assistance and a part-time contraceptive clinic.

Objective: The impact of this program on rapid repeat pregnancies at 18-months post-enrollment was evaluated.

Study design: Five hundred ninety-eight adolescent females were enrolled from seven obstetrics/gynecology clinics and five postpartum units of a large hospital system in a Midwestern city. Each participant was enrolled at least 28 weeks pregnant or less than 9 weeks postpartum. Each participant was randomized to either the Teen Options to Prevent Pregnancy intervention or a Usual Care control condition. Intervention participants averaged 4.5 hours of assistance. Participants were contacted by blinded research staff at 6 months and 18 months to complete self-report surveys. Differences in outcomes between the intervention and control groups were assessed using ordinary least-squares regression.

Results: There was an 18.1 percent absolute reduction in self-reported repeat pregnancy in the intervention group relative to the control group (20.5% versus 38.6%; p <0.001). There was a 13.7 percent absolute increase in self-reported long-acting reversible contraception use in the intervention group relative to the control group (40.2% versus 26.5%, p = 0.002). There was no evidence of harmful effects of the intervention on sexual risk behaviors, such as having sexual intercourse without a condom or greater number of partners.

Conclusions: The Teen Options to Prevent Pregnancy program represents one of the few evidence-based interventions to reduce rapid repeat teen pregnancy. This relatively brief intervention may be a viable alternative to more time-intensive programs that adolescent mothers may be unable or unwilling to receive.

Comment: Teen pregnancy can be a life-changing disaster for a girl, and a repeat may be even more so. This study shows how intensive intervention late in pregnancy or early postpartum, with motivational interviews, advice and contraceptive counseling can significantly reduce recurrence of teenage pregnancies. (HMV)