Article Title

Abnormal pap smears in teenage mothers and the association with domestic violence, homelessness, and chlamydia

Abstract

Objective. To assess the incidence of Pap smear abnormalities and cervical intraepithelial neoplasia (CIN) on cervical biopsy results in teenage mothers and to establish if there are associations with social disruption.

Patients and Methods. A prospective study of 498 pregnant teenagers was performed at three Australian hospitals. Enrolled patients had a Pap smear performed. Women with abnormal Pap smear results underwent colposcopy with directed biopsy of the cervix. Independently, women were interviewed to identify demographic and social variables. Variables associated with an abnormal Pap smear result were analyzed using a mixed model of analysis.

Results. Four hundred fifty-seven patients participated in the study (response rate, 92%). The prevalences of low- and high-grade squamous intraepithelial lesions on Pap smear were 37 in 1,000 and 13 in 1,000, respectively. The prevalence of CIN 1 was 35 in 1,000 and of CIN 2,3 was 15 in 1,000. In univariate analysis, teenagers with abnormal Pap smear results were significantly more likely to have a history of exposure to domestic violence (odds ration [OR], 7.10; 95% CI, 2.76-18.53), be homeless (OR, 6.82; 95% CI, 2.59-17.83), to have coexisting Chlamydia infection (OR, 5.44; 95% CI, 1.59-17.64), or be current users of illegal drugs or have a history of illegal drug use (current: OR, 3.06; 95% CI, 1.22-7.69; history: OR, 2.75; 95% CI, 1.04-7.53). Exposure to domestic violence, homelessness, and Chlamydia infection remained significant on multivariate analysis (p < .05).

Conclusions. The incidence of CIN in pregnant teenagers is high and is associated with domestic violence, homelessness, and Chlamydia infection.

Keywords

pap smear, teenage, domestic violence, pregnancy, homelessness