Pre-existing diabetes, hypertension, and other ongoing conditions are tough enough to manage in children as they blossom into adolescents and then young adults. To make matters more complex, hospitalists on occasion encounter pregnant teenagers with chronic illnesses.
The physicians and nurses on a pediatric floor might not be comfortable with obstetrics, or they might lack the equipment for monitoring fetal heart tones. In such instances, a pregnant teen would be best served in an adult hospital with obstetric services, says Heather Toth, MD, director of the med-peds residency program at the Medical College of Wisconsin in Milwaukee.
At times, however, a non-pediatric hospital might be hard-pressed to find a blood pressure cuff snug enough for a smaller patient. Collaboration between adult and pediatric providers is essential to iron out these types of kinks, Dr. Toth says.
It’s understandable if “internal-medicine hospitalists get nervous about pregnant patients,” says Rob Olson, MD, an OBGYN hospitalist at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., and editor of ObGynHospitalist.com. Because adolescents’ emotions can be more magnified, “you’ve got all the drama of their teen life as well as the complications of the pregnancy.”
Like adult expectant mothers, teens present with pregnancy-related complications, most commonly preeclampsia, as well as premature labor. Gestational diabetes and urinary tract or kidney infections also occur, says Laura Elizabeth Riley, MD, director of labor and delivery at Massachusetts General Hospital in Boston.
“We take care of pregnant teens with medical conditions just as we would adults,” Dr. Riley says, adding that pediatric hospitalists typically don’t get involved in care on a maternity ward.
OBGYNs are in charge of pregnant teens. If complications arise, a maternal fetal medicine specialist would intervene, says Patrice M. Weiss, MD, chair of the Patient Safety and Quality Committee at the American Congress of Obstetricians and Gynecologists.
The degree of a pregnancy complication is related to the severity of a patient’s underlying medical condition. Teen pregnancies already are considered high-risk due to young age, says Dr. Weiss, who is the OBGYN chair and professor at the Carilion Clinic/Virginia Tech Carilion School of Medicine in Roanoke.
Preventing teen pregnancies is the biggest challenge, followed by some expectant mothers’ reluctance to seek prenatal care and keep appointments, says Tod Aeby, MD, generalist division director of obstetrics, gynecology, and women’s health at the University of Hawaii at Manoa’s John A. Burns School of Medicine in Honolulu.
—Laura Elizabeth Riley, MD, director of labor and delivery, Massachusetts General Hospital, Boston
“Parents in denial, angry, or embarrassed about their pregnant teen can also be another barrier to early and consistent care,” Dr. Aeby says.
In his experience, many of the chronic conditions affecting these adolescents fall in the categories of mental health (eating disorders, depression, schizophrenia, bipolar affective disorder) or autoimmune diseases (lupus or Type 1 diabetes). Asthma and obesity also are prevalent in Hawaii, so hospitalists should consider regional factors.
“Many pregnant teens do well with pregnancy—they are young and healthy,” says Dr. Riley of Mass General. “Some have a host of social issues, which can complicate pregnancy, so it is important that their social supports be evaluated prior to discharge with a newborn.”