Ju n e 1 5 , 2 0 0 7 • w w w. f a m i l y p r a c t i c e n ew s . c o m Women’s Health 31

vical biopsies, and to determine whetherthe lesions would have gone undetected ifthe recommended screening guidelineshad been strictly followed.

The investigators reviewed the charts of275 adolescent girls for demographic in-formation, including age, race, gravidityand parity, history of prior sexually trans-mitted diseases, age at first vaginal inter-course, and age at first abnormal Papsmear. They then compiled these dataalong with the Pap smear, colposcopy, andbiopsy results, said Dr. Vichnin. “Recordsthat did not have age at first intercoursewere considered incomplete and were notincluded in the final analysis,” she said.

Of the 275 patient charts included in theinitial review, only 195 had complete in-formation for analysis. Of these, 96% ofthe patients were African American, 88%had at least one pregnancy, and 73% hadgiven birth to at least one child, Dr. Vich-nin reported. The average age at first in-tercourse was 14.9 years, and the averageage at first abnormal Pap smear was 18years. Prior history of sexually transmitteddiseases was confirmed in 62% of the pa-tients, she said.

The final data analysis showed that 34 ofthe 195 young women had biopsy-provencervical intraepithelial neoplasia grade 2 or

3 (CIN2, CIN3) disease. Of these 34 pa-tients, 9 developed high-grade disease in lessthan 3 years from initiation of intercourseand 4 developed high-grade disease at 3years, said Dr. Vichnin. “This is a significantnumber of patients with biopsy-confirmedhigh-grade disease,” said Dr. Vichnin.

Of the girls diagnosed with CIN2 orCIN3 disease, “nearly half [49%] were ei-ther lost to follow-up or noncompliantwith treatment recommendations,” saidDr. Vichnin. “This leaves a large numberof girls who are vulnerable to progressionto cervical cancer untreated.”

The findings show “a small but signifi-cant rate of progression to high-grade dis-ease within 3 years of initiation of inter-course among these urban adolescentfemales and a high rate of failure to followup on treatment recommendations,” saidDr. Vichnin.

“We’re concerned that the 3-year wait-ing period for these high-risk adolescentsis potentially dangerous, and so we areadvocating for closer scrutiny in this pop-ulation to guard against the develop-ment of invasive lesions,” Additionally,she said, “further studies are needed toconfirm our findings and to appropri-ately amend current guidelines for thisunique population.” ■

High-Grade Dysplasia Slips ByPap Test from page 1

Repeat Pregnancies Occur inTeens, Despite Access to ECPs

B Y D I A N A M A H O N E Y

Ne w England Bureau

A T L A N T A — Advanced provision ofemergency contraceptive pills did not sig-nificantly decrease the rapid repeat preg-nancy rate in a racially and ethnically di-verse group of adolescents enrolled in aColorado study “because many of theyoung women failed to use them,”Jeanelle Sheeder reported at the annualmeeting of the North American Societyfor Pediatric and Adolescent Gynecology.

To better understand why emergencycontraceptive pills (ECPs) have not had theanticipated impact on teen pregnancy, Ms.Sheeder and colleagues in the departmentof pediatrics at the University of ColoradoHealth Sciences Center in Denver assessedthe sexual and contraceptive behavior of382 predominantly primiparous 14- to 21-year-old women in that institution’s ado-lescent maternity program. At the time ofenrollment, all of the young women ex-pressed a desire not to get pregnant againfor at least 2 years. Each participant re-ceived either a prescription for or a packetof ECPs, with no limit on refills.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpar-tum month, the study participants com-pleted a questionnaire that asked abouttheir interval sexual and contraceptive be-havior, Ms. Sheeder said.

Controlling for age, race/ethnicity, edu-cation level, reason for not using contra-ception before conception, future familyplans, and postpartum month, the investi-

gators also analyzed the use of ECPs in re-lation to unprotected intercourse.

During the course of the study, 44% ofthe young mothers had episodes of un-protected intercourse, said Ms. Sheeder,noting that “of these women, 15% re-ported one episode of unprotected inter-course, 24% had two to four episodes, and5% had more than four episodes.”

While more than half (54%) of thewomen reporting unprotected intercourseused ECPs, only 28% used them appro-priately, Ms. Sheeder noted. “They wereunderutilized by 65% of the women and7% engaged in augmented use,” she said.

A total of 19 pregnancies occurred dur-ing the study period. “Teens who experi-enced unwanted pregnancies did not en-gage in more unprotected intercourse orECP underuse than those who did not,”Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in youngwomen who reported using some contra-ceptive method during the study periodbut their contraceptive use was inconsis-tent or incorrect. The remaining 10 preg-nancies were not attributable to unrecog-nized contraceptive or ECP failure.

The findings suggest a high prevalenceof unprotected intercourse during the first6 postpartum months among teen moth-ers who say they don’t want a rapid repeatpregnancy, said Ms. Sheeder. “Additional-ly, it appears that the reason ECPs have notsignificantly decreased the repeat teenpregnancy rate is because most teenmothers underutilize ECPs even whenthey have them on hand,” she said. ■