The BMJ Today: Teenage pregnancy and sleepless nights

Teenage pregnancy (within the ages of 13-19) is a major public health concern. About 16 million females aged 15-19 and about 1 million girls aged less than 15 give birth. Complications during pregnancy and childbirth are the second cause of death in 15-19 year old females globally.

A clinical review by McCarthy and colleagues looks at the issues around teenage pregnancy and how to approach them. It discusses how common it is, who is most likely to become a teenage mother, and what can be done to prevent it. The medical and social impacts of teenage pregnancy on mothers and their children are neatly represented in an online infographic.

Not surprisingly, optimal antenatal care is associated with better pregnancy outcomes. The authors stress that the key factors in the management of teenage pregnancy are diet, lifestyle, sexually transmitted infections, and the involvement of the family.

The review concludes with a patient’s perspective from Kelly, who was 18 when she had her son and 16 when she had an abortion. She describes her struggle with postnatal depression and how she locked herself away in her room until she was put on medication, and eventually recovered. Her advice to teenage mums is: “Go to your GP earlier than I did. He put me in the right direction. Tell someone sooner than I did.”

Pregnant mums and mothers of young children will know all too well about the effects of having little or no sleep. But as Krishna Chinthapalli highlights, sleep is essential not only for making us feel more human in the mornings, but also for maintaining essential psychological and physiological functions. Sleep consolidates memories, clears metabolic waste from the brain, and optimises cognitive and motor performance. Without it, the consequences are dire.

Lack of sleep in its most extreme form can be fatal, known as “fatal familial insomnia,” a hereditary condition that is thankfully rare. Lesser degrees of sleep deprivation affect us all at some point, but what about the effects specifically on doctors’ performance? US data show that doctors sleeping for less than four hours a night are five times more likely to have a serious incident or malpractice suit. And after a night shift doctors are more likely to have sharps injuries, road traffic accidents, and worse clinical outcomes.

Despite the discipline of sleep medicine being around for decades, doctors are not confident in diagnosing sleep disorders (on average there is a 15 year delay in the diagnosis of narcolepsy). Why? “More UK medical schools teach complementary medicine than sleep medicine, and those that do include sleep in the curriculum spend an average of two hours on it,” says Chinthapalli.

Read the articles and send us your thoughts and experiences. Rapid responses can be submitted for every article in The BMJ; some are published as formal letters to the editor.

Giselle Jones is specialist reviews editor, The BMJ.