Risk factors and protective factors in pregnant adolescents

Pregnancy and birth in adolescence involve certain risks for both mother and fetus. Psychologically, adolescent mothers have a higher risk of developing emotional disorders. This paper is a review based on information from the literature. The analysis was limited to articles in English published between January 1, 2000 and September 1, 2021 on PubMed, Scien-ceDirect and Google Scholar using the following keywords: pregnancy, adolescents, adolescence, risk factors, support factors, psychological interventions. In the context of pregnancy in this challenging stage of adolescence girls should be referred to pre- and postnatal counseling programs or support groups so that they develop healthy relationships and support networks.


INTRODUCTION
Adolescence is associated with significant psychological and physiological changes. This period is difficult because of the formation and adoption of new visions, new patterns of behavior and the initiation into a new life experience -the sexual one. A risky aspect of adolescent sexual behavior is an unwanted pregnancy, being an important and complex problem that is associated with multiple consequences on the emotional health of adolescents [1,2], such as stress, depression, anxiety [3,4] but also social problems, such as dropping out of school [5].
The issue of sexual behavior in adolescence, as well as that of reproductive health at this age, has been influenced in recent decades by a number of factors such as early puberty, rising of the age of marriage and new technologies of mass communication.
Our country is facing one of the highest incidences of teenage pregnancy in Europe. This corre-lates with patients from the rural environment, the precarious socio-economic and educational status, the low level of education and the disorganized family environment.
About half of unwanted pregnancies result in abortion [6], with voluntary termination of pregnancy being an old intervention that occurs globally regardless of whether it is legalized or not. However, regardless of the method used, the side effects can be multiple, in this sense even medical abortion is not a safe procedure and the body can develop a negative response to the treatment received. Also, if this procedure fails and the woman decides to keep the fetus may develop certain birth defects. This is why it is very important to be aware that abortion is not a method of pregnancy planning and to emphasize the importance of using modern methods of contraception.

MEDICAL AND PSYCHOLOGICAL RISKS OF ADOLESCENT PREGNANCY
In some cases, pregnancy and childbirth in adolescence have some implications for a woman's general and reproductive health. Pregnancy in adolescence comes with certain risks, including during birth, which can affect the health of the mother or child.
According to a 2015 review, pregnant adolescents are more likely to develop complications during pregnancy or childbirth [7]. One of the problems is that they do not seek specialized medical help during pregnancy. Moreover, adolescents are at risk of developing pregnancy-induced hypertension but also preeclampsia [8]. They can also give birth to a low birth weight baby or may be at risk of perinatal death. Common complications of pregnancy in adolescence are prematurity and intrauterine growth restriction. The risk factors associated with these complications are both biological and medical and refer to the incomplete development of the mother's stature, her poor nutrition, sexually transmitted infections, the absence or insufficiency of prenatal care and the consumption of tobacco, alcohol, drugs during pregnancy.
Psychologically, adolescent mothers have a higher risk of developing emotional disorders, such as anxiety, stress and depression during pregnancy but also postnatal depression. Moreover, isolation or abandonment by family, friends and even by the child's father can create mental problems for the mother and this can include feelings of fear, uncertainty, loneliness or even clinical symptoms.

PROTECTIVE FACTORS IN PREGNANT ADOLESCENTS
In a recent study [9], pregnant adolescents also diagnosed with emotional disorders reported less perceived social support in the affective-emotional domains (the ability to respond to individual needs in relation to emotional issues), tangible (access to practical resources and material help), informational (interaction with people who advise, inform and guide) and in terms of positive relationships with others (interaction with people which allow access to relaxation and well-being).
Social support, especially the one received from the family, is very important for maintaining mental health and increasing the individual's ability to cope with stressful situations. In the case of mothers, social support facilitates the expression of child-focused behavior [10].
Over time, different concepts have been used to define social support. Some authors define social support as a set of factors that include counseling, positive interactions, guidance, trust, belonging, information and assistance, while others define it as the support of people they trust [11]. Regardless of the differences, the authors emphasize the importance of social support for women's well-being during pregnancy, as it provides a sense of control over the situation and more life satisfaction and also contributes to low levels of depression and anxiety [12].
Prenatal interventions in pregnant adolescents, providing preparation in antenatal and postnatal care, as well as family support, are also important protective factors in maintaining or optimizing emotional health. Studies [13] show that in this COVID-19 pandemic period, even online interventions can be effective, having the potential to support adolescent mothers.

CONCLUSIONS
From a social perspective, expecting a baby can be a source of negative emotions and feelings for the adolescent who will become a mother, especially when unfavorable factors, uncertainty or emotional disturbances occur. Pregnancy in adolescents has medical and psychosocial risks, such as dropping out of school, stress, anxiety and depression. However, a significant protective factor is social support, with studies showing that it has beneficial effects on mental health. Studies show that emotional support programs are needed for pregnant adolescents to increase their resilience and emotional coping skills.