This annual report - Taranaki District Health Board

to commissioning and delivering maternity services for young parents” provides theevidence base for the guidelines [254]. It provides a review of evidence linking teenagepregnancy with poorer health outcomes for mothers and their babies, social exclusion, andhigher levels of risk factors such as smoking in pregnancy, poor diet and reduced rates ofbreastfeeding compared to older mothers. Access to maternity care is reviewed, includingdelayed booking and missed appointments, and the benefits of high quality care andinvolving fathers in maternity care. The report summarises UK government policy andguidance. Evidence-based guidelines on designing high quality maternity services forteenage mothers and young fathers include: ensuring early and sustained access toservices, providing sessions specifically tailored to young parents, a multi-agencyapproach ensuring clear referral pathways between agencies, prevention of repeatunplanned conception, smoking cessation and addressing alcohol and other drug use,encouragement and support for breastfeeding and addressing mental health. A variety ofemerging models of care are reviewed. A framework for reviewing, planning and deliveringlocal services is provided.Antenatal care for young pregnant womenThe NICE guidance on pregnancy and complex social factors includes a systematic reviewaddressing service provision for young women under the age of 20 [139]. The reportemphasises that young women are a diverse group, for example the needs of 14 year oldsmay differ from those of 19 year olds. The review examined access to antenatal services,barriers to care, maintaining contact, additional supports and information requirement foryoung women. Nine retrospective studies assessed the effectiveness of interventions toimprove access to antenatal services. Interventions included targeted hospital basedservices, school based services and home visiting. The small number of studies, whichwere mainly based in the US, made it difficult to generalise the findings and themultifaceted nature of the interventions made it difficult to identify which components werecritical in improving care, although continuity of care was supported. School-baseantenatal care was not supported by the evidence. Ten qualitative studies, based in theUS and UK, examined barriers to care. Key barriers to care included staff attitudes, notwanting to recognise a pregnancy or tell parents, feeling embarrassed, having other socialproblems, transport difficulties and age discrepancies between young women and otherservice users. Twenty-one, mainly American studies examined interventions aimed atimproving contact with antenatal services throughout the pregnancy. Age-appropriatedantenatal classes were associated with increased uptake of antenatal care.Although some studies of home-visiting found it to be effective, some of the effects wereonly achieved during the pilot stage and not replicated when the programme was adoptedon a wider scale. Studies assessing the effectiveness of additional consultations andsupport (mainly assessing comprehensive, multidisciplinary support including: antenatalcare; benefits advice; health, nutrition and childcare education; counselling; home visiting;a one-to-one relationship with a key worker; a case manager to coordinate input from arange of agencies; opportunity to form friendships; opportunity to continue with education;transport to appointments; and material or financial incentives to attend) providedinconclusive evidence. None of the studies were longitudinal so the long term effects onmaternal and child health are unknown. The review concludes with recommendations forhealthcare providers and service organisations including: offering age-appropriate servicesand help with other social problems, transport to and from appointments, providingopportunities for the father to be involved, working in partnership with other agencies,providing antenatal care in a variety of settings, offering antenatal education in peer groupsat the same time and location as clinic appointments.In another review, Allen et al. sought to identify whether the way maternity care is providedaffects maternal and neonatal outcomes for young women [176]. Nine studies wereidentified in this systematic review including one RCT, three prospective cohort studies,two comparative studies with concurrent controls, two comparative studies with historicalcontrols, and one case series (3,971 young women). Three models of care were identified:Midwifery Group Practice (MGP), Group Antenatal Care, and Young Women’s Clinic. MGP(one study) refers to a group of two to three midwives providing continuity of carerIn-Depth Topic: Adversity in Pregnancy - 295