Ability of the Higgins Nutrition Intervention Program to improve adolescent pregnancy outcome.

OBJECTIVES: To determine the extent to which birth weight can be increased and the risk for adverse pregnancy outcome decreased when pregnant adolescents participated in the Higgins Nutrition Intervention Program; and to describe the dietary components of the program, including their variation as a function of diagnosed risk for adverse pregnancy outcome. DESIGN: Retrospective cohort study involving review of medical charts. SUBJECTS/SETTING: Developed as an adjunct to routine prenatal care, the Higgins Nutrition Intervention Program consists of an assessment of each pregnant adolescent's risk profile for adverse pregnancy outcomes and an individualized nutritional rehabilitation program based on that profile. The intervention group for this evaluation consisted of 1,203 pregnant adolescents who participated in the Higgins program at the Montreal Diet Dispensary between 1981 and 1991. The nonintervention group consisted of a randomly selected group of 1,203 pregnant adolescents known not to have participated in the program. OUTCOMES MEASURED: Birth weight; rates of low birth weight, very low birth weight, preterm delivery, fetal growth retardation, perinatal morbidity and mortality; and maternal morbidity. STATISTICAL ANALYSIS: Means and proportions were used to describe risk profiles and pregnancy outcomes in the two groups. Analysis of covariance and logistic regression were used to compare pregnancy outcomes while controlling for the effect of key confounding variables. RESULTS: Results from multivariable analyses showed that infants in the intervention group weighed an average of 55 g more (P < .05) than infants in the nonintervention group; their low-birth-weight rate was 39% lower (P < .001) and their very-low-birth-weight rate was 56% lower (P < .01). Individually determined dietary prescriptions for the adolescents in the intervention group recommended increases in daily consumption averaging approximately 900 kcal energy and 52 g protein. The lowest daily increases (approximately 150 kcal energy and 2 g protein) were recommended to the group with no diagnosed risks; the greatest increases (approximately 1,300 kcal energy and 76 g protein) were recommended to the group with multiple risk conditions. Although none of the risk/intervention groups achieved their prescribed increases during intervention, increases in actual intake generally followed the pattern of the prescribed increases; that is, the greater the prescribed increase, the greater the actual increase. CONCLUSIONS: These results suggest that the Higgins Nutrition Intervention Program, in which nutrition intervention is individualized as a function of diagnosed risk, significantly improves the outcome of adolescent pregnancy.

La contraception de l'adolescente: Stratégies pour une observance optimale.

Approximately one-half of all female adolescents are sexually active. Family physicians whose patients include female adolescents must be able to provide them with information and advice about contraception. In this article, adolescent contraception is examined in detail and a number of strategies for achieving optimum compliance are presented.

Obstructing malformations of the uterus and vagina.

Sixteen cases of obstructing malformations of the uterus and vagina treated at The Children's Hospital between 1970 and 1983 are discussed. These patients typically present with pain within 2 years of their menarche and a pelvic mass. Unilateral renal agenesis is the most common associated nongynecologic defect encountered (53%). The key to early diagnosis is a high index of suspicion when significant gynecologic symptoms develop in perimenarchal patients. A complete investigation should be carried out before the undertaking of corrective surgery, because a thorough understanding of the patient's anatomy is necessary for the determination of the type of operation that will optimally preserve reproductive and sexual function. The specific abnormalities encountered in this series are divided into three groups on the basis of the site(s) of obstruction. Recommendations for surgical treatment of each group are presented.