Missed opportunities for pregnancy prevention among insured adolescents.

IMPORTANCE: Birth to a teenaged mother is associated with adverse health and social outcomes. Adolescents at risk for pregnancy may not receive needed reproductive health services at primary care visits.

OBJECTIVE: To review services provided at outpatient visits in the year prior to pregnancy among adolescents in a US Midwestern integrated health care delivery system.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of continuously insured adolescents aged 15 to 19 years experiencing pregnancy in a nonprofit Minnesota health care organization.

MAIN OUTCOMES AND MEASURES: Primary care visits in the year prior to pregnancy.

RESULTS: Adolescents experiencing a pregnancy with stable insurance coverage had an estimated average of 2.7 primary care visits in the 12 months prior to becoming pregnant. Medical record review revealed that 57% did not have documentation of sexual activity and 47% did not have documentation of reproductive health counseling. These rates varied by health care professional type and visit type. Only 35% had contraception prescribed within 12 months of becoming pregnant and only 1 had a long-acting contraceptive prescribed.

CONCLUSIONS AND RELEVANCE: Our data highlight the need for primary care professionals to review health behaviors and pregnancy risk at all adolescent encounters.