(721) Optimising Teenage Pregnancy in Contemporary Practice – Declining Incidence with Excellent Outcomes

Objective: As the busiest obstetric hospital in Europe, with an established specialist Teenage Pregnancy Service for the past 17 years, we sought to evaluate trends in incidence of teenage pregnancy and their outcomes.

Study Design: This hospital maintains a prospectively collected, fully anonymized, database of all pregnancy outcomes based on maternal age. We reviewed the database for incidence of teenage pregnancy (19 years or less at EDD), vaginal delivery rates, caesarean delivery rates and perinatal mortality in this specialist clinic. Comparisons were made with total deliveries in each year and the Cochran-Armitage Test of Trend was used to determine statistical significance over time.

Results: Figure 1 summarises the number of teenage pregnancies at our centre during the 17 years of operation of this specialist clinical service. There has been a significant decrease in the incidence of teenage pregnancy, declining from 6.1% of all deliveries in 2005 to 1.6% in 2021 (p < 0.001). There has been a significant increase in the engagement rate of patients with this specialist clinic, with 75.7% of all teenage pregnancies completing their care in this clinic in 2021, compared with 35.1% in 2005 (p < 0.001). Of note, the overall hospital cesarean delivery (CD) rate increased from 25.6% in 2005 to 37.3% in 2021, but during this time period the CD rate amongst the teenage population averaged 15% over the 17 years, without evidence of trend (p=0.608). Perinatal mortality remained very low throughout the 17 year time period, with an average 1.8 losses per annum (0.4%).

Conclusion: It is reassuring to note such a significant drop in teenage pregnancies over the last 17 years in the largest obstetric hospital in Europe, in which approximately 10,000 pregnancies per annum are managed. The very high engagement rate with this specialist service, together with the relatively low cesarean delivery rate and low incidence of perinatal loss, supports the continued role of specialist teenage pregnancy services even as the incidence falls. Ongoing education to optimise contraceptive availability in this cohort remains crucial.