Using a Checklist to Assess Pregnancy in Teenagers and Young Women

• Type of Material: Article
• Authors: Maura K. Whiteman, Centers for Disease Control and Prevention; Naomi Tepper, Emory University; Melissa Kottke, Emory University; Kathryn M. Curtis, Centers for Disease Control and Prevention; Peggy Goedken, Emory University; Michele G. Mandel, Centers for Disease Control and Prevention; Polly A. Marchbanks, Centers for Disease Control and Prevention
• Language: English
• Date: 2014-04-01
• Publisher: Lippincott, Williams & Wilkins: No Hybrid Open Access
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 by The American College of Obstetricians and Gynecologists.
• Final Published Version (URL): http://dx.doi.org/10.1097/AOG.0000000000000179
• Title of Journal or Parent Work: Obstetrics and Gynecology
• ISSN: 0029-7844
• Volume: 123
• Issue: 4
• Start Page: 777
• End Page: 784
• Grant/Funding Information: Supported by Cooperative Agreement Number U48DP001909-01 from the Centers for Disease Control and Prevention.
• Keywords: Obstetrics & Gynecology; FAMILY-PLANNING CLIENTS; Science & Technology; Life Sciences & Biomedicine; STEROID-CONTRACEPTIVES; INUTERO EXPOSURE; RULE
• Research Categories: Health Sciences, Obstetrics and Gynecology

Abstract

OBJECTIVE: Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women. METHODS: Study participants were a convenience sample of sexually active black females aged 14-19 years seeking care in an urban family planning clinic. Each participant provided a urine sample for pregnancy testing and was then administered the checklist in two formats, audio computer-assisted self-interview and in-person interview. We estimated measures of the checklist performance compared with urine pregnancy test as the reference standard, including negative predictive value, sensitivity, specificity, and positive predictive value. RESULTS: Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted selfinterview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results. CONCLUSION: The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population