Teen childbirth poses big risks for baby and mom : Shots

The United States has one of the highest teen birth rates among developed nations, even after three decades of improvement. And Arkansas has the highest teen birth rate in the U.S., roughly tied with Mississippi.

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Maryanna’s eyes widened as the waitress delivered dessert, a plate-sized chocolate chip cookie topped with hot fudge and ice cream.

Sitting in a booth at a Cheddar’s in Little Rock, Ark., Maryanna, 16, wasn’t sure of the last time she’d been to a sit-down restaurant. With two children — a daughter she birthed at 14 and a 4-month-old son — and sharing rent with her mother and sister for a cramped apartment with a dwindling number of working lights, Maryanna rarely got out, let alone to devour a Cheddar’s Legendary Monster Cookie.

On this muggy September evening, though, she was having dinner with her “sister friend” Zenobia Harris, who runs the Arkansas Birthing Project, an organization working to reduce the odds that Arkansas women and girls die from pregnancy and childbirth. In a highchair next to her, Maryanna’s daughter, Bry’anna, spiraled sideways and backward, her arms outstretched, flying. Her eyes would settle on her grilled cheese, and she’d swoop her small hand down to pick up the sandwich.

Maryanna suffered mightily during Bry’anna’s birth. (NPR has agreed not to use the family’s last name to protect Maryanna’s privacy.) She remembers telling her mother, “I don’t want to do none of this.” Nurses routinely checked to see how far she had dilated, a painful prodding of the cervix typically done before pain medications are administered.

“Nobody talks about that. I would not open my legs wide enough for them,” she said, cringing at the memory. “There were seven nurses up in there, and I was like, ‘No! Why ya’ll doing this?’”

Hours later, a doctor used vacuum suction to pull the baby through Maryanna’s 14-year-old vaginal canal, ripping apart the skin and muscle of her perineum.

Conservative states have the highest teen birth rates
The U.S. has one of the highest teen birth rates among developed nations, even after three decades of improvement. And Arkansas, roughly tied with Mississippi, has the highest teen birth rate in the country.

A U.S. map of teen birth rates from 2020, the latest data available, looks eerily like the results of the Joe Biden-Donald Trump match-up and, not coincidentally, a post-Roe v. Wade guide to legal and illegal abortion. Liberal-leaning states largely have the lowest teen birth rates per 1,000 females: Massachusetts (6.1), New Hampshire (6.6), Vermont (7), Connecticut (7.6), Minnesota (9.1), New Jersey (9.2), Rhode Island (9.4), New York (10), Oregon (10.1), Maine (10.6), Utah (10.8), California (11).

And conservative states largely have the highest rates: Arkansas (27.8), Mississippi (27.9), Louisiana (25.7), Oklahoma (25), Alabama (24.8), Kentucky (23.8), Tennessee (23.3), West Virginia (22.5), Texas (22.4), New Mexico (21.9).

Teenagers in Arkansas do not have significantly more sex than teens elsewhere, according to a 2019 risk behavior survey by the Centers for Disease Control and Prevention, but they are far less likely to use birth control. Sex education is not required in Arkansas schools and, by law, any school-based curriculum must stress abstinence.

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In 2017, Gov. Asa Hutchinson, a Republican, successfully jettisoned Planned Parenthood clinics from the state’s Medicaid program. Since then, girls and women who receive medical care at the organization’s clinics cannot use Medicaid coverage to obtain contraception.

Arkansas’ trigger ban outlawing abortion went into effect the day the Dobbs v. Jackson Women’s Health Organization decision came down in June. A woman can receive an abortion only if her death is imminent. For teenagers seeking medical care to end a pregnancy, the nearest clinic where abortion is accessible is in Illinois — 400 miles northeast of Little Rock and a six-hour drive.

“If you’re from a small town in Arkansas, the idea of going to Chicago or Colorado, it may as well be on the moon,” said Gordon Low, a nurse practitioner at Planned Parenthood in Little Rock. Faced with finding a car and gas money, or dealing with a school absence, teenagers “may throw their hands up and continue with the pregnancy, even if they don’t want to.”

For Maryanna, abortion did not really seem an option even before the Dobbs decision. Like many adolescent girls in Arkansas, her extended family is filled with moms who gave birth as teens and whose children grew up to do the same. It’s the life she knows, and, at least at first, the notion of having a baby seemed a respite from the chaos of her family life.

Bry’anna’s father, who Maryanna believes is 19, is not in the picture. She was in eighth grade when her mother, battling her own stresses, took off — temporarily, it turned out — and left Maryanna and her siblings with her “brother’s baby mother’s family.” Into that stew of terrifying uncertainty, the texts from an older boy felt comforting.

They’d been texting each other for a month, with the boy “acting like he could relate to me,” she said. “He was, like, ‘Your momma gone, so you might as well do this or that.’ I just fell for it.” She remembers thinking, “Yeah, she is gone. She told me to save my virginity, but who listens to her anymore? I was just upset.”

Girls’ menstrual cycles can take years to settle into a predictable routine, and Maryanna initially made nothing of the fact that it had been months since she last bled. By then, her mother had returned and the family was living, periodically, in a motel. She considered adding water to her pee to outsmart the pregnancy test, but, she said, “Something was telling me, ‘No, you want to know the truth.’”

A few months after Bry’anna’s birth, Maryanna had sex with an older teenager who only pretended to put a condom on, she said. She gave birth to her son, Tai’lyn, in April.

The young man’s name is listed on Tai’lyn’s birth certificate, but like Bry’anna’s father, he has never paid child support.

Laws underplay the risks for the teen mom and the baby
Traditionally, teen motherhood is viewed as a symptom of poverty, invoking puzzled head-shaking by wizened adults and calls from many conservative lawmakers for young, unmarried people to stop having sex. But it is also a dangerous undertaking for a teen mother and baby.

Infant mortality rates in Arkansas are highest for babies born to women younger than 20, and the large number of teen births fuels the state’s third-highest infant mortality rate in the country. Arkansas women have the highest rate of pregnancy-related deaths in the U.S., according to data from the CDC, about double the national average.

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For young women who continue their pregnancies, the emotional and physical challenges can be daunting. The age at which girls in the U.S. begin menstruating has dropped in recent decades, in part due to widespread obesity, but the physiological changes necessary to birth and feed a newborn require additional years of development.

“When she has her first menstruation, she is capable of becoming pregnant, but that doesn’t mean she is capable of having a child,” said Dr. Dilys Walker, director of global health research for the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Walker explained that during adolescent development, the beginning of menarche signals the start of a growth spurt that can take up to four years to complete. During that time, a girl’s uterus and bony structures, including her pelvis, remain narrow, developing slowly as she ages.

It’s a precarious moment to give birth. It’s not uncommon for girls to face obstructed labor “because their pelvis is not developed enough to accommodate a vaginal delivery,” said Dr. Sarah Prager, an obstetrics and gynecology professor at the University of Washington School of Medicine.

Going through with a vaginal birth could cause lasting damage to a teen’s pelvic area and rectum. So, teenage childbirth often ends in cesarean section, causing uterine scarring that almost guarantees she will need to give birth via cesarean section if she has more children.

“Adolescents are at increased risk for low-birth-weight babies, high blood pressure in pregnancy, preeclampsia, higher complications from sexually transmitted diseases, and increased rate of infant death,” said Dr. Anne Waldrop, a maternal-fetal medicine fellow at Stanford University.

Abortion opponents have argued in recent months that girls are duty-bound to give birth no matter how old they are. In the high-profile case of a 10-year-old rape victim from Ohio who traveled to Indiana for an abortion, James Bopp, chief counsel for the National Right to Life Committee, said, “She would have had the baby, and as many women who have had babies as a result of rape, we would hope that she would understand the reason and ultimately the benefit of having the child.”

A judge in Florida recently ruled that a 16-year-old girl “had not established by clear and convincing evidence that she was sufficiently mature to decide whether to terminate her pregnancy.”

Researchers Are Closer to Preventing and Treating Long COVID

Three years into the COVID-19 pandemic, with millions of people around the world suffering from long-term complications of the virus, there is still no proven way to treat or prevent Long COVID—besides not getting infected in the first place.

Recently, however, there’s been reason for cautious optimism. Researchers have found promising (though preliminary) signs that certain drugs may reduce the risk of developing Long COVID, and possibly even ease symptoms among people who are already sick.

The latest hopeful news relates to metformin, an accessible and affordable drug that’s been U.S. Food and Drug Administration (FDA)-approved to treat Type 2 diabetes since the 1990s. Metformin, which belongs to a class of drugs called biguanides, is taken as a liquid or pill and works by controlling the amount of sugar in the blood. It also decreases inflammation in the body.

In a study that was posted online in March but has not yet been peer-reviewed, researchers tracked a group of 564 overweight or obese U.S. adults who started a two-week course of metformin when they had acute COVID-19. People who took metformin had a 42% lower chance of being diagnosed with Long COVID over the following 10 months, compared to those who took a placebo when they first got sick with COVID-19. (The study also tracked the effects of drugs ivermectin and fluvoxamine, but neither showed a benefit against Long COVID.)

Metformin appeared to be even more effective when used early. Among people who took it within four days of developing symptoms, the risk of Long COVID dropped by more than 60%. In total, about 6% of people who took metformin went on to be diagnosed with Long COVID, compared to more than 10% of the people who took a placebo.

Other studies have shown that metformin can stop the SARS-CoV-2 virus from replicating, which may help prevent both severe disease and long-term complications, explains study co-author Dr. Carolyn Bramante, an assistant professor at the University of Minnesota Medical School. Metformin seems to work against the virus by blocking a protein in human cells that the virus uses to copy itself, and by disrupting the inflammatory response caused by the virus, she says.

Bramante says she was pleasantly surprised by how well metformin seemed to prevent Long COVID, especially when taken right away, although more research is required to confirm the findings. “It’s probably in every pharmacy in the world,” Bramante says. Someone could likely “get metformin within a day of knowing they have COVID.”

In the future, Bramante says, researchers should also study whether metformin can treat existing Long COVID symptoms. Some experts believe Long COVID is caused by remnants of the virus lingering in the body. If that’s true, Bramante says, metformin’s antiviral properties might help clear it from the body.

Other recent studies have also suggested that Paxlovid, an antiviral drug used to prevent severe COVID-19 among high-risk patients, may help prevent Long COVID in a similar way. One study, which was posted online in late 2022 but had not been peer-reviewed, found that people who took Paxlovid within five days of testing positive for COVID-19 had a 26% lower risk of developing Long COVID, compared to an untreated control group. (Ensitrelvir, another antiviral drug that is authorized in Japan but not the U.S., may also reduce the risk of developing Long COVID when taken shortly after testing positive, its manufacturer announced in February.)

Some researchers are also studying whether Paxlovid can treat Long COVID symptoms—an important question, since there is still no proven cure for Long COVID.

Read More: People Are Far Less Likely to Get Long COVID After Omicron, Study Finds

Long COVID is difficult to treat, at least in part because the disease takes many forms. One person might have debilitating fatigue and brain fog while another could have gastrointestinal issues or nervous-system dysfunction. Instead of trying to find a single drug that can treat all of Long COVID’s 200-plus potential symptoms, some research teams are zeroing in on specific symptoms, or groups of them, in hopes of finding targeted therapies.

Some tools used to treat people with myalgic encephalomyelitis/chronic fatigue syndrome, a post-viral condition that shares key symptoms with Long COVID (including extreme fatigue and crashes after exertion), may also be effective for people with post-COVID complications, according to an article published in Nature Reviews Microbiology in January. These tools include an energy-rationing strategy known as pacing, the anti-inflammatory drug low-dose naltrexone, and beta blockers to slow heart rate and lower blood pressure. Antihistamines have also been shown in small studies to reduce some Long COVID symptoms, including fatigue, brain fog, and an inability to exercise, as have blood-thinning drugs.

Dr. Eric Topol, founder of the Scripps Research Translational Institute and co-author of the recent review, says he’s also encouraged by preliminary data on stimulation of the vagus nerve, which helps control unconscious actions like breathing and heart rate, to ease certain symptoms.

Multiple research teams are also studying transcranial direct current stimulation (tDCS) as a potential treatment. Researchers have already studied whether tDCS devices—which administer low-intensity electrical currents to the scalp to stimulate the brain—can improve cognition, mental health, and chronic pain. Consumers can buy a variety of tDCS devices to use at home, though many have not been cleared by the FDA.

In one small study that was posted online in September 2022 but had not been peer-reviewed, researchers found that, after eight tDCS sessions, people with Long COVID reported reductions in physical fatigue and depression, though mental fatigue and overall quality of life scores didn’t improve.

Clinical neurologist and study co-author Dr. Jordi Matias-Guiu says he’s planning a longer follow-up study, with patients receiving treatments for three weeks, to see if that leads to better results. “This should be confirmed in other clinical trials, but the findings are encouraging,” he says. “This is a technique that could be administered at home, and this is a non-invasive technique with minimal [side effects].”

The list of potential treatments is growing, but the field needs larger, more coordinated research projects, Topol says; at the moment, most findings are coming from small studies that need to be peer-reviewed, expanded, and duplicated. RECOVER, the U.S. National Institutes of Health’s $1 billion Long COVID research project, has begun designing trials of potential treatments, but they haven’t turned into therapies yet.

The lack of proven treatments is disappointing, Topol says, but he considers the recent findings about metformin’s potential to prevent Long COVID “very good news.”

Topol agrees that more studies on metformin are needed—but he says he believes that the early findings are promising enough, and the drug is safe and cheap enough, that he would personally take it now if he got sick with COVID-19. “I don’t want to get Long COVID,” Topol says.