title: High postpartum rates of sexually transmitted infections among teens: pregnancy as a window of opportunity for prevention.
abstract: OBJECTIVE
  To identify incidence and predictors of Chlamydia trachomatis and Neisseria gonorrhoeae among postpartum adolescents. These estimates are compared to similar estimates among a cohort of non-pregnant, sexually active teens.
  
  
  METHODS
  203 pregnant and 208 non-pregnant adolescents aged 14-19 years were recruited from 10 community based health clinics in Connecticut, United States. Structured interviews and sexually transmitted infection (STI) testing using ligase chain reaction (LCR) were conducted at a baseline visit (during the third trimester for the pregnant adolescents), and at 6 and 12 month follow up visits (3 and 9 months post partum, for those pregnant at baseline).
  
  
  RESULTS
  Among pregnant teens, new infections of C trachomatis and N gonorrhoeae increased from 7.1% at the 6 month follow up interview to 14.3% at the 12 month follow up interview; among non-pregnant teens, new infections remained relatively stable over the 6 and 12 month follow up interviews (9.0% to 8.3%) (group by time interaction, p = 0.005). C trachomatis and N gonorrhoeae prevalence was 1.9 times higher (95% CI: 0.97 to 3.89, p = 0.06) among teens in the late postpartum follow up compared to the non-pregnant teens, controlling for baseline STIs. Predictors of postpartum STIs included having a new partner and number of partners per year of sexual activity.
  
  
  CONCLUSIONS
  Postpartum adolescents are vulnerable to STIs. Routine prenatal and postpartum care provide unique opportunities to promote condom use and other risk reduction interventions among adolescents. If sustained post partum, long term reproductive health can be promoted.
authors.affiliation: Yale University, Department of Epidemiology and Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT 06510, USA. Jeanette.Ickovics@yale.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Ickovics
authors.forename: L M
authors.initials: LM
authors.lastname: Niccolai
authors.forename: J B
authors.initials: JB
authors.lastname: Lewis
authors.forename: T S
authors.initials: TS
authors.lastname: Kershaw
authors.forename: K A
authors.initials: KA
authors.lastname: Ethier
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000517:prevention & control; D002692:Chlamydia trachomatis; D017280:Condoms / Q000706:statistics & numerical data; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D009344:Neisseria gonorrhoeae; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D015995:Prevalence; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000517:prevention & control; D012044:Regression Analysis; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners