Search Results (320)

Adolescents with intellectual disabilities are often excluded from mainstream sexual reproductive health education and services. This exclusion is due to stigma and systemic barriers further increasing their vulnerability to exploitation, unintended pregnancies, and limited contraceptive access. Additionally, adolescent childbearing has been linked to an increased risk of long-term health and functional limitations. This study explored contraceptive awareness and decision-making among caregivers of adolescent learners with intellectual disabilities in selected Special Care Centres in Tshwane District Gauteng province. This exploratory, descriptive qualitative research utilised a purposive sampling method to select caregivers from five Special Care Centres to participate in focus group discussions. The sample size was 29 participants. Interviews were audio recorded and transcribed verbatim. Data were analysed using inductive thematic analysis on NVivo15 software and halted after reaching saturation. Intercoder reliability was achieved with consensus agreement among researchers. Three overarching themes, supported by two sub-themes emerged: (1) Caregivers’ understanding of contraception: (1.1) Perceived benefits and disadvantages of contraception; (1.2) Early exposure to contraceptive information. (2) Socio-economic influences on contraceptive decision-making: (2.1) Financial burden; (2.2) Preference for permanent contraceptive method. (3) Negotiating cultural expectations and practical caregiving realities: (3.1) Community acceptance of contraceptive use; (3.2) Willingness to forgo biological grandchildren. Caregivers’ awareness and decisions about contraception reflect not only their health knowledge but also the socio-economic pressures they face and the practical realities that shape choices within their communities. This study recommends disability-inclusive sexual reproductive health education that provides contextually relevant insights for strengthening community-based interventions among adolescents with intellectual disability. Full article

Youth in northern Ghana experience high rates of unintended pregnancy due to limited access to and use of sexual and reproductive healthcare (SRH) services. Peer-led interventions are effective in increasing the youth uptake of SRH services, but limited peer-led interventions have been developed for Ghana. This study explores youth (ages 15–24 years) and clinical provider perspectives on youth SRH to inform the co-design of a peer-led SRH counseling program in northern Ghana. We conducted a qualitative study using semi-structured interviews with 22 SRH providers and 27 youth. We then conducted an inductive thematic analysis and mapped themes onto the COM-B (Capability-Opportunity-Motivation-Behavior) model. Results revealed that youth capability to make informed and confident SRH decisions is constrained by a fragmented information environment. Although access to SRH services is increasing in the region, logistical and privacy barriers limit adolescents’ opportunities to engage in care. Religious and cultural norms stigmatize youth SRH care, though support for contraceptive use is growing among more educated sectors. Youth motivation to use SRH services is driven by a desire for autonomy but undermined by concerns about contraceptive side effects and anticipated stigma. This study supports the co-development of a contextually grounded peer counseling SRH intervention in northern Ghana. Full article

Overweight in childhood, adolescence and adulthood is now a world-wide epidemic. A variety of preventive and therapeutic measures are being developed with partial success. Since the pioneering studies of D.J. Barker linking maternal famine in pregnancy to long—term undesirable effects on the offspring—the “metabolic syndrome” that stems from long-lasting epigenetic changes, it became evident that there are many undesirable events which affect in-utero fetal growth and development. They often persist postnatally, through childhood and adulthood. The purpose of this review is to discuss the prenatal factors that may have long term effects on postnatal weight gain and obesity that are important contributors to the “obesity” epidemic. These prenatal undesired factors are pregestational and gestational diabetes, pre-pregnancy maternal obesity, excessive weight gain in pregnancy, placental dysfunction and maternal hormonal imbalances. They may affect fetal growth, generally causing excessive growth (macrosomia) and sometimes diminished growth (small for gestational age). These prenatal conditions are associated with epigenetic changes that may contribute to insulin resistance and subsequent metabolic alterations leading to increased food intake, overweight, and obesity. Studies also demonstrate that increased exposure in pregnancy to teratogens, like endocrine disruptors and cigarette smoking, may also affect prenatal and postnatal growth and adiposity. However, many the studies demonstrating the role of these factors are often weakened, as they mainly demonstrate associations and do not sufficiently consider possible confounding factors such as postnatal age, nutrition and lifestyle. Better understanding of these prenatal factors may support more effective prevention and management strategies for childhood overweight and obesity. Full article

Background/Objectives: Adolescent pregnancy remains a global public health challenge associated with adverse outcomes for both mothers and newborns. This study aimed to use two instruments and several multivariate techniques to identify a minimal set of variables that reproduces the instrument-based classification of adolescent pregnancy risk, while remaining parsimonious with the original instruments. Methods: A cross-sectional, quantitative methodological study was conducted among Colombian schoolgirls, comprising 160 adolescents in the face-validity phase and 319 in the risk-estimation and modeling phase. The IRENE and REND instruments, originally developed to assess the risk of adolescent pregnancy, underwent cultural adaptation, face validity and content validity. Subsequently, the instruments were administered to estimate the risk. Finally, Factor Analysis and Categorical Principal Component Analysis were applied as exploratory dimensionality reduction techniques to identify the most relevant variables for retention, thereby preserving the parsimony of the original versions. Results: Overall, 80.3% of participants were classified as not at risk, while the remainder were classified as at risk by one or both instruments. The results suggest that variables such as who the adolescent lives with, the age at which the adolescent had their first complete sexual intercourse, and how the adolescent would respond to an unplanned pregnancy are factors associated with the instrument-based risk classification. Subsequently, dimensionality reduction and logistic regression analyses identified a small subset of variables that can be used to reproduce the instrument-based classification of adolescent pregnancy risk. Conclusions: The reduced set of variables reproduced the instrument-based risk classification with high internal accuracy. Because the predictors and the outcome derive from the same instruments, these findings reflect internal reproduction of the instrument classification rather than prediction of an observed pregnancy, and they require external validation. Overall, the reduced and optimized set of variables from the IRENE and REND instruments offers a parsimonious approach that reproduces the instrument-based risk classification and that may support rapid screening once validated in independent adolescent samples. The main limitations are the use of a single institution, the non-probabilistic convenience sample, and the absence of an observed pregnancy outcome. Full article

Background: Maternal nutrition during pregnancy is increasingly recognized as an important determinant of offspring neurodevelopment. The Mediterranean diet has been associated with favorable cognitive and behavioral outcomes in children; however, evidence regarding autism-related traits remains limited, particularly during late childhood and adolescence. Objective: To investigate the association between maternal adherence to the Mediterranean diet during pregnancy and autism-related traits in preadolescent offspring in the KLOTHO birth cohort. Methods: This exploratory analysis included 96 adolescents (49 boys and 47 girls) from the KLOTHO birth cohort. Maternal adherence to the Mediterranean diet during pregnancy was assessed using a Mediterranean Diet Score derived from a food frequency questionnaire administered during gestation. Autism-related traits were evaluated during preadolescence using a parent-completed questionnaire that assessed social and emotional abilities, communication skills, cognitive characteristics, special interests, and motor skills. Associations were examined using Spearman’s correlation analyses and sex-stratified linear regression models adjusted for offspring body mass index, sleep duration, and physical activity, all assessed during the preadolescent follow-up examination. Results: Boys exhibited higher communication (3.92 ± 3.90 vs. 1.70 ± 2.89, p = 0.026), cognitive (5.76 ± 3.80 vs. 3.33 ± 2.99, p = 0.014), special-interest (2.64 ± 3.29 vs. 1.04 ± 2.16, p = 0.046), and overall autism-related trait scores (19.08 ± 13.92 vs. 10.15 ± 8.57, p = 0.009) compared with girls. In the overall cohort, maternal Mediterranean Diet Score was not associated with autism-related traits. Among boys, higher maternal Mediterranean Diet Scores were associated with lower communication-related trait scores (ρ = −0.442, p = 0.027). In multivariable analyses, the inverse association remained consistent in direction but did not retain statistical significance after adjustment for body mass index, sleep duration, and physical activity. Sensitivity analyses incorporating offspring KIDMED scores yielded similar findings. Conclusions: Higher maternal adherence to the Mediterranean diet during pregnancy was associated with lower communication-related trait scores in male offspring. These findings should be considered exploratory and require confirmation in larger prospective cohorts. Full article

Agricultural commodity markets remain central to household survival across many developing economies, yet their volatility is rarely framed as an adolescent sexual and reproductive health problem. This mini review uses a structured narrative approach anchored in a screened evidence map of 1065 records, from which 50 papers were retained and 16 studies were prioritized for full synthesis. We define adolescent reproductive health holistically, including sexual agency, contraceptive information and use, pregnancy intention, antenatal and obstetric care, protection from coercion, and maternal and neonatal outcomes. The review provides a concrete answer to the primary question: agricultural commodity price volatility is a distal, context-conditioned determinant of adolescent reproductive health, not a uniform direct cause. Its effects operate mainly through food security, household income, labor allocation, school continuity, gendered bargaining power, and service access. Negative shocks more consistently erode nutrition, schooling, transport to care, and access to adolescent-friendly services, especially among rural girls in households with weak shock buffers. Positive shocks may increase births or union formation when income effects dominate, but they may also harm health when higher labor demand raises the opportunity cost of caregiving and service use. Direct adolescent-specific causal evidence remains limited; therefore, adjacent evidence on fertility, child health, schooling, and maternal or neonatal outcomes is interpreted through an explicit evidence hierarchy rather than treated as equivalent to direct adolescent evidence. Policy priorities include shock-responsive social protection, school retention, contraceptive supply continuity, adolescent-friendly care, and early warning systems that trigger health and education responses during commodity instability. Full article

Background/Objectives: Automated insulin delivery (AID) systems have improved the management of type 1 diabetes (T1D), but exercise and nutrition remain challenging because they rapidly alter glucose flux, substrate oxidation, hepatic glucose output, insulin requirements, and fuel availability. This narrative review aimed to synthesize current evidence on the interaction between AID systems, physical activity, and nutritional strategies from a metabolism-oriented perspective. Methods: A narrative bibliographic approach was used to integrate evidence from clinical trials, observational studies, technical studies, consensus statements, and reviews involving people with T1D across different life stages, including pediatric, adolescent, adult, and pregnancy-related contexts, when available. The review focused on AID systems, exercise physiology, nutritional strategies, meal announcement, bolus adjustment, dual-hormone systems, metabolic biomarkers, and emerging metabolomic approaches. Results: AID systems generally improve time in range and reduce hypoglycemia across several user groups, although most exercise- and nutrition-specific evidence comes from adult and pediatric/adolescent cohorts rather than pregnancy-specific exercise studies. Exercise-related glucose responses remain highly dependent on user input, exercise modality, insulin on board, meal timing, and metabolic state. Planned exercise announcement, prandial bolus reduction before postprandial activity, and individualized carbohydrate intake remain key strategies. Biomarkers such as lactate, ketone bodies, non-esterified fatty acids, and counter-regulatory hormones may help explain interindividual variability and support future personalization. Conclusions: Nutrition and exercise management in AID users should be interpreted as a dynamic metabolic interface among exogenous insulin, endogenous counter-regulation, substrate availability, and algorithmic control. Emerging approaches, including activity sensors, adaptive algorithms, dual-hormone systems, digital twins, and metabolomics-informed personalization, may improve safety and reduce user burden, but several remain exploratory and require further validation in diverse free-living conditions. Full article

Background: Adolescent pregnancy is associated with increased maternal and neonatal morbidity, particularly in the context of inadequate prenatal care. Understanding the distribution of maternal and obstetrical complications in this population is important for improving clinical management and pregnancy outcomes. Methods: This retrospective observational study included primiparous adolescent patients (≤18 years) and focused on the assessment of maternal and obstetrical complications. The analysis compared the frequency of these complications between adolescents with adequate prenatal care and those without adequate prenatal follow-up, aiming to identify the most common complications and their distribution according to antenatal care status. Results: Significant differences were identified between groups. Maternal infections were more frequent among patients without adequate prenatal care (24.1% vs. 9.3%, p = 0.039). Hemorrhage was significantly more frequent among patients with adequate prenatal care (59.3% vs. 35.2%, p = 0.012). Among obstetrical complications, cephalopelvic disproportion showed a significant association with prenatal care status (p = 0.034), occurring more frequently in patients without antenatal follow-up. Hypertensive disorders, including gestational hypertension and preeclampsia, were identified only among patients without adequate prenatal care; however, no statistically significant association was observed (p = 0.118). Placenta previa (p = 0.057) and placental abruption (p = 0.495) were also observed only among patients without adequate prenatal care. Conclusions: Primiparous adolescent patients without adequate prenatal care showed a higher frequency of maternal and obstetrical complications, particularly infections and delivery-related disorders. Prenatal monitoring was associated with earlier identification and management of maternal and obstetrical risk factors. These findings highlight the importance of improving access to antenatal care among adolescent populations. Full article

Background: Adolescence is a critical developmental period for emotional health, and anxiety disorders are a major public health concern. Adherence to the Mediterranean diet has been associated with improved mental health outcomes in adults; however, evidence in adolescents remains limited. Methods: We analyzed data from 86 adolescents participating in the KLOTHO birth cohort. Dietary quality was assessed using the KIDMED index, whereas maternal adherence to the Mediterranean diet during pregnancy was evaluated using a Mediterranean diet score. Psychological outcomes included behavioral difficulties (Strengths and Difficulties Questionnaire), anxiety symptoms (Spence Children’s Anxiety Scale), and mood-related outcomes (Mood and Feelings Questionnaire). Associations were examined using Spearman’s correlation analyses and multivariate linear regression models adjusted for sex, body mass index (BMI), sleep duration, and physical activity. Results: Higher adherence to the Mediterranean diet in adolescents was inversely associated with anxiety levels in correlation analyses (ρ = −0.294, p = 0.029). However, after adjustment for sex, body mass index, sleep duration, and physical activity, the association with total anxiety score was attenuated and no longer statistically significant associated with lower anxiety levels in correlation analyses (ρ = −0.294, p = 0.029). In adjusted models, the KIDMED score was not associated with total anxiety score but was independently associated with lower scores in specific anxiety domains, including social phobia and separation anxiety. Maternal adherence to the Mediterranean diet was associated with lower overall anxiety in offspring but not with specific anxiety subdomains. Conclusions: Adherence to the Mediterranean diet during adolescence is modestly associated with lower levels of specific anxiety symptoms, suggesting a modest domain-specific association between dietary patterns and emotional health. Full article

Background/Objectives: Adolescent pregnancy, defined as pregnancy occurring between ages 10 and 19, remains a pressing global health concern with significant disparities in prevalence and outcomes across countries. Early and systematic diagnostic screening may allow timely risk stratification and adequate management. Methods: We conducted this retrospective cohort study at a tertiary referral center from January 2015 through December 2024, including all women who delivered live fetuses at our facility, analyzing adolescent pregnancy outcomes in our region and comparing them with adult pregnancy outcomes. Results: Younger adolescents have higher rates of vaginal infections (45.3% vs. 38.1%), chorioamnionitis, urinary tract infections (6% vs. 4.9%), preterm birth, higher cesarean section rates, SGA and FGR fetuses, with more frequent NICU admissions than older adolescents. Adolescent pregnancies more often resulted in vaginal births compared to adult pregnancies but also showed higher rates of operative vaginal delivery, episiotomy, perineal tears, vaginal tears, and cervical lacerations. Gestational diabetes and excessive gestational weight gain were overall less common in adolescents, but pre-pregnancy maternal obesity was significantly more prevalent in the older adolescent group than in the younger ones. Gestational hypertension was about twice as frequent in adult pregnancies, while HELLP syndrome was approximately six times more common in adults than in adolescents. Conclusions: In summary, adolescent pregnancy presents both potential biological advantages and notable disadvantages, with outcomes resulting from the complex interplay of biological immaturity and socioeconomic factors. These results highlight the critical importance of implementing comprehensive early diagnostic screening protocols and structured antenatal care to facilitate earlier identification and mitigation of modifiable risk factors to improve both maternal and fetal outcomes. Full article

Background and Objectives: Adolescent pregnancy is traditionally associated with increased obstetric risk, particularly among very young adolescents. Romania continues to report one of the highest adolescent birth rates in the European Union, yet age-stratified clinical data on obstetric outcomes among minors remain limited. This study aimed to evaluate maternal and intrapartum outcomes among underage mothers (<18 years), stratified by age (<15, 15–16, and 17 years), and to identify predictors of adverse obstetric outcomes. Materials and Methods: We conducted a retrospective cohort study of all live births and stillbirths among mothers aged 12–17 years recorded between 2020 and 2024 at a secondary maternity hospital in Romania. Data were extracted from standardized obstetric and neonatal records. Primary outcomes included preterm birth (<37 weeks), cesarean delivery, and intrapartum complications. Group comparisons were performed using non-parametric tests and the χ² test. Multivariable logistic regression models were used to assess independent associations between maternal age and obstetric outcomes. Results: The cohort comprised 763 adolescent mothers aged 12–17 years. No significant differences were observed across age groups in gestational age at birth, preterm birth rate, fetal presentation, or mode of delivery. In multivariable analyses, younger maternal age was not independently associated with preterm birth (adjusted odds ratios [aORs] 0.87–1.21) or cesarean delivery (aORs 0.74–1.08). Obstetric factors, such as non-cephalic presentation and characteristics of membrane rupture, were the main predictors of adverse outcomes. Temporal analyses demonstrated stable outcome patterns across the study period, with no significant interaction between maternal age and year of delivery. Conclusions: In this tertiary-care cohort, very young maternal age (<15 years) was not associated with poorer obstetric outcomes compared with older adolescents. These findings suggest that standardized antenatal surveillance and intrapartum management may mitigate age-related obstetric risk among underage mothers. Further population-based studies are warranted to contextualize these results within broader healthcare access and social determinants of adolescent pregnancy. Cesarean section rates were high across all groups (~50%), with no significant differences by maternal age. Full article

This study aimed to evaluate the effectiveness of counseling and educational interventions delivered during pregnancy and early motherhood in promoting maternal health knowledge, self-care behaviors, and related health outcomes among adolescent and young women. A systematic review of randomized controlled trials and quasi-experimental studies published in English or Spanish was conducted using Medline, Web of Science, Scopus, Cinahl, and the Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and risk of bias was evaluated using the Risk-of-Bias 2 and ROBINS-I tools. Data were synthesized narratively and in tables. When comparable outcomes were reported, preliminary meta-analyses were performed using standardized mean differences with random-effects models. The certainty of evidence was assessed using the GRADE approach. Seven studies (n = 7) involving 776 participants were included. Interventions consisted of counseling or educational programs delivered through face-to-face sessions, group activities, or digital resources. Overall, the interventions were associated with improvements in pregnancy-related knowledge, self-care behaviors, psychological outcomes, and maternal health practices and attitudes; however, the certainty of evidence was low to very low and a high risk of bias was identified across studies. Meta-analysis suggested a possible beneficial effect favoring the intervention for pregnancy-related health knowledge (SMD = 1.90; 95% CI: −0.02 to 3.83) and self-care behaviors (SMD = 2.39; 95% CI: 0.29 to 4.49), although substantial heterogeneity was observed. Counseling and educational interventions during pregnancy may contribute to improvements in pregnancy-related health knowledge and self-care among pregnant adolescents and young women; however, the current evidence is limited and of low certainty. Further well-designed studies conducted in diverse settings are needed to confirm these findings and strengthen the evidence base. Full article

Adolescents are prone to unwanted pregnancies and sexually transmitted infections. It is key that they receive reproductive sexual education during secondary education, which can be important for the prevention of these events. This study aims to compare knowledge of reproductive health between adolescents with and without STI history. A cross-sectional study was carried out on 164 schoolchildren from a national school in Lima (Peru). The AA-20 short questionnaire and the t-test were used to demonstrate differences between students with and without a history of sexually transmitted infections (STIs). Twenty-six (15.9%) students had STIs (mean age 16.6 ± 2.3 years). The average knowledge in students with and without STIs was 15.4 ± 3.7 points and 14.7 ± 3.9 points, respectively (p = 0.417). Among students with and without a previous STI, it was found that the majority used some form of contraception (61.5% vs. 31.9%, p = 0.004) and had received talks on the topic (92.3% vs. 72.5%, p = 0.031). Condom use was the most commonly used method to prevent STIs in both groups. In conclusion, students with a previous STI had slightly better knowledge about pregnancy and infections than students without a history. Full article

Background: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a standard procedure with recognized long-term complications that may emerge years after surgery. Informed consent requires disclosure of material risks, but it is unclear whether these long-term sequelae are consistently communicated. This study systematically reviewed publicly available consent materials to assess disclosure of evidence-based long-term complications of PSF for AIS. Methods: Official websites of spine, orthopedic, and neurosurgical societies, along with major hospitals across North America, South America, Europe, and Australia, were searched for publicly available informed consent forms and patient information leaflets related to PSF for AIS. Documents were assessed for explicit mention of predefined long-term complications: chronic pain/health-related quality of life, pseudoarthrosis, adjacent segment degeneration, future surgery, pulmonary function impact, late infection, local tissue reaction to metal debris, and pregnancy-related issues. Disclosure frequencies were calculated. Results: Thirty-one documents from ten countries were included. Immediate perioperative risks were almost universally reported, whereas long-term complications were inconsistently disclosed. Reporting frequencies were: pseudoarthrosis, 80.6% (n = 25); future surgery, 67.7% (n = 21); adjacent segment degeneration, 51.6% (n = 16); chronic pain, 48.4% (n = 15); local tissue reaction to metal debris, 38.7% (n = 12); late infection, 25.8% (n = 8); pregnancy-related issues, 22.6% (n = 7); and pulmonary impact, 9.7% (n = 3). Conclusions: Publicly available consent materials for AIS surgery incompletely disclose long-term complications compared with the published evidence. However, written information sheets and consent forms represent only one component of the consent process. Consistently with the patient-centered standard articulated in Montgomery v Lanarkshire Health Board, informed consent should include discussion of material risks, benefits, reasonable alternative treatments including standard care, and the option of no treatment, with disclosure tailored to what matters to the patient and family. Updating written materials to better reflect lifelong risks may strengthen one important component of informed consent and shared decision-making for patients and families. Full article

Background: Prenatal vitamin D exposure has been proposed as a potential determinant of immune development and subsequent allergic disease risk in offspring; however, long-term cohort data remain inconsistent. Methods: We analyzed data from the KLOTHO birth cohort, including 98 adolescents with available allergic outcome assessment. A maternal–neonatal sub-cohort of mother–child pairs with available maternal and neonatal serum total 25-hydroxyvitamin D₃ [25(OH)D] measurements at delivery was used for vitamin D analyses. Allergic outcomes included asthma, allergic rhinitis, and eczema in offspring. Associations were evaluated using descriptive statistics, Spearman correlation analyses, and logistic regression models. Results: Maternal 25(OH)D concentrations were not significantly associated with asthma (ρ = 0.075, p = 0.652), allergic rhinitis (ρ = 0.100, p = 0.556), or eczema (ρ = 0.131, p = 0.426). In crude logistic regression models, vitamin D concentrations were not associated with asthma (odds ratio (OR) per 10 nmol/L: 1.07, 95% confidence interval (CI): 0.78–1.48, p = 0.67), allergic rhinitis (OR: 1.05, 95% CI: 0.76–1.45, p = 0.77), or eczema (OR: 1.17, 95% CI: 0.86–1.60, p = 0.31). Adjusted models including maternal age, pre-pregnancy body mass index (BMI), season of delivery, and ultraviolet exposure yielded similar non-significant findings, although analyses were limited by a reduced complete-case sample size. Conclusions: In this prospective cohort with follow-up into early adolescence, vitamin D status at delivery was not associated with asthma, allergic rhinitis, or eczema in offspring. These findings support a lack of statistically significant association; however, potential non-linear relationships should be interpreted cautiously, given the modest sample size. Full article