Pregnancy is a physiological period in a woman’s reproductive life that is characterized by physical, psychological and social changes in a short period of time. When a woman becomes pregnant and becomes a mother, she experiences moments of doubt, insecurity and fear. Adolescence, on the other hand, is a period between childhood and adulthood, with profound physical, psychological and social changes. In just a few years, a girl becomes a woman, requiring her to define her new identity, which generates questions, anxiety and emotional instability.

The two important evolutionary phases in a woman’s life are similar and have in common important transformations in a relatively short period of time. Combining the two phases at the same time in life leads to an exacerbation of this process, increasing the risk of changes that can be considered pathological.

Teenage pregnancy (TG) should be assessed broadly, covering prevention and care for the mother, the teenage father and their child.

Pregnancy in this age group, although it may be desired consciously or unconsciously, is generally unplanned and is related to intrinsic factors related to the age group and extrinsic factors, such as sociocultural and economic factors.

The prognosis of this pregnancy, as well as the psychological and emotional changes experienced by adolescent parents, is directly related to the level of medical and social assistance provided. Understanding the factors that led to pregnancy and demystifying the idea that all pregnancies are unwanted and have disastrous consequences for the future of adolescents, as well as the participation of male adolescents in prevention and assistance, are essential.

Not all teenage pregnancies are high obstetric risk. Classical literature usually associates teenage pregnancy with a higher incidence of hypertensive disease specific to pregnancy, prematurity and low birth weight, among other changes. We cannot forget that gestational risk is related to clinical, obstetric, cultural and socioeconomic aspects, and is multifactorial in nature. More recent studies aiming to analyze the age variable in isolation with the risk of pregnancy in adolescence have demonstrated that ages under 15 years, associated with a gynecological age of 2 years or less, i.e., adolescents still in the process of growth, may be related to a higher risk during pregnancy.

Late entry into prenatal care is frequently cited in the literature as being one of the main factors associated with maternal and perinatal prognosis (Setzer et al., 1992; Konse et al., 1992; Scholl, 1992).

In the care of pregnant adolescents, early diagnosis is essential for the assessment and permanent control of risk from the beginning of pregnancy.

Pregnant teenagers may come to health services with typical complaints, such as nausea, vomiting, drowsiness, and delayed menstruation. Others may present nonspecific symptoms, such as abdominal pain, irregular menstruation, urinary disorders, mood swings, leucorrhoea, itching, dyspareunia, or headache. Many report having normal menstruation or deny sexual activity.

The physiological changes in this age group, such as irregular menstrual cycles in the two years after menarche, and the lack of knowledge about how their own body works, make early diagnosis of pregnancy difficult.

It is up to the health professional to analyze the complaints and not rule out the possibility of pregnancy. In relation to teenagers, the differential diagnosis of pregnancy should be investigated, not only in cases of delayed menstruation, but also in situations in which no definitive diagnosis is reached in the first evaluation.

Confirmation of pregnancy is the first crisis that the teenager will face. Her world is falling apart, and she is faced with the great dilemma: to have or not to have, that is the question.

Health professionals must be prepared to help the woman at this critical moment, free from prejudice, guiding her to seek support from her family and highlighting the positive and negative aspects of each choice. The final decision must be made by the adolescent, because when forced to make a decision, a new pregnancy often occurs in a short space of time, or the child is rejected.

If the decision is to terminate the pregnancy, the professional will have an important role in guiding her regarding the negative aspects of the act and trying to minimize its consequences.

This situation becomes more serious when one considers the statistics on abortions in the second trimester of pregnancy. In addition to having serious ethical and emotional consequences, abortions performed at this stage increase the risk of maternal death, especially when performed in poor conditions. For economic reasons, and also for fear of being discovered, the adolescent ends up seeking unqualified people for the procedure, which is almost always performed without minimum asepsis conditions and with a high risk of death, especially from infection or hemorrhage. In the United States, in 1980, 25% of abortions performed on adolescents under 15 years of age occurred in the second trimester of pregnancy; in the age group 15 to 19 years, the proportion of these late abortions was 14%; and in the group of adult women, 70%. The figures clearly show the greater degree of exposure of adolescents, especially the very young (Stubblefield, 1985). This highlights the need to pay special attention to the group of younger adolescents, under 15 years of age, who, in addition to being exposed to greater risk, have shown increasing pregnancy rates.

Brazilian law considers induced abortion a crime, but it continues to be performed clandestinely in most cities in our country. The purpose of this chapter is not to discuss such a controversial subject, which involves ethical, moral and religious issues, but rather to draw attention to the need to provide adequate care to adolescents who, for some reason, have undergone the procedure. It must be impartial and free from prejudice.

In post-abortion follow-up, psychological support and contraceptive guidance are essential to prevent future pregnancies, depression, behavioral changes and sexual disorders.

The aim of care for pregnant adolescents is to ensure that the pregnancy proceeds without complications and to prepare them for childbirth and motherhood. The ideal model consists of continued monitoring of adolescents by multidisciplinary teams, involving doctors, nurses, social workers, psychologists and nutritionists, in the form of individual and group care.

Prenatal care is often the first contact that adolescents have with health services. It is important to take advantage of this situation of assiduity to provide broader guidance not only regarding pregnancy, childbirth and newborn care, but also regarding contraception, sexually transmitted diseases (STDs), drugs, sexuality, work and hygiene.

It is important to emphasize that, since pregnancy has already occurred, the use of condoms is practically eliminated, resulting in a greater risk of STDs.

Nutrition plays a very important role in prenatal care for adolescents, and guidance should be adjusted to each adolescent. The greater demand for calcium, iron and folic acid during pregnancy should be considered, as well as the specific needs of adolescence, when developing the nutritional program for pregnant women.

Preparation for breastfeeding is essential during prenatal care. We must guide adolescents regarding the importance of breastfeeding for their health and that of their newborns and demystify certain taboos, such as the idea that small breasts do not produce milk or that it affects the appearance of the breast (the main factors that affect the appearance of the breast are heredity, age and, lastly, pregnancy). The claim that adolescents do not breastfeed their children is not true. In our experience, encouragement and education during prenatal care have had a positive influence on the success of breastfeeding.

During pregnancy, it is ideal for adolescents to have a specific space for care that includes group dynamics, an ideal way to discuss fears, anxieties, fantasies and myths about pregnancy and childbirth, and to clarify doubts and teach basic notions of childcare. During adolescence, groups play an important role. Through interaction with others, adolescents form their identity and begin to define their role and space. When they become pregnant, they end up distancing themselves from their group of friends and begin to feel somewhat lost and without a place. Thus, when they find the possibility of a new group space, where they can share their situation with their peers, they usually respond positively, with excellent results.

The situation of lack of protection that younger mothers find themselves in during pregnancy is aggravated by childbirth, a time when they must confront reality. If there is no preparation for this situation during prenatal care, the consequences can be serious for both mother and child, in terms of emotional aspects, with a serious risk of compromising the mental health of both.

In our experience, when adolescents feel supported and receive adequate preparation, they rarely have problems, but when this does not happen, they easily lose control right at the beginning of labor. Ideally, they should be accompanied during the pre-delivery period by a family member, their partner, their mother, godmother or any other person they trust, preferably someone who has received guidance.

Each stage of labor requires support from the health team and, if possible, from a companion. With good support, it is unlikely that the mother will lose control. Our experience with pregnant women at Pedro Ernesto University Hospital shows that the attitude of adolescents who have been prepared for childbirth is very good, often better than that of adult women.

Most programs for pregnant adolescents focus their attention exclusively on the periods of pregnancy and immediate postpartum, forgetting that after giving birth they become adolescent mothers, experiencing a double crisis situation: adolescence and motherhood. The postpartum period introduces women to the reality of motherhood. Regardless of the reasons that led to pregnancy, there is satisfaction in proving fertility and the ability to have a child. The need to care for a child on a daily basis leads to the awareness of the change in perspective on life.

During pregnancy, the adolescent is the center of attention, and by taking care of herself, she is also taking care of the baby. After giving birth, suddenly, the importance shifts to the child, who demands attention and care day and night. The adolescent suddenly becomes unimportant, and many are afraid that they will not be capable or prepared to take on the responsibility of taking care of another life. This fear can cause depression.

For these reasons, prenatal programs should provide assistance to adolescents until the baby’s first year of life. During this period, the psychological, social and educational aspects take on even greater importance, which should reinforce all prenatal guidance.

In our experience, the vast majority of adolescents return for postnatal follow-up, maintaining a bond with the team, which becomes a point of reference; 60% of the adolescents breastfed until the third month; 30%, until the sixth month; and only 10% had hospitalized children. It is important to emphasize that by stimulating self-esteem and strengthening the mother/baby bond, providing medical, psychological and social assistance, it is possible to obtain highly effective results, not only in terms of breastfeeding, but also in terms of the physical, psychological and social well-being of the adolescent mother and her child.

In the last decade, we have seen the implementation of a series of prenatal programs for adolescents in Brazil and we have participated in the training of professionals interested in providing care to pregnant adolescents, which demonstrates that health professionals recognize the importance of this subject.

Current studies have already proven that prenatal care can minimize the obstetric risks of teenage pregnancy, but unfortunately, adolescents’ access to prenatal services remains insufficient. It is important that prenatal programs implement strategies aimed at early identification and appropriate and timely care for Brazilian adolescents, and that they develop services aimed at preventing teenage pregnancy and providing care to the mother and father of adolescents and their children.