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CONTEXT: Women with multiple pregnancies in adolescence may experience medical, psychological and social complications. Improved understanding of the individual-, dyad-, family-, peer/community- and social system-level risk factors for repeat pregnancy may lead to the development of more effective prevention strategies for adolescent mothers in a variety of settings.

METHODS: Between 1993 and 1996, white, black and Mexican American adolescent mothers at a labor and delivery unit in Texas were interviewed after delivery and completed written surveys prospectively for up to 48 months. Logistic regression analyses were used to determine predictors of repeat pregnancy within 24 months, using social ecological theory as a guide.

RESULTS: Forty-two percent of adolescent mothers experienced a repeat pregnancy within 24 months; 73% of these delivered a second child. Individual-level predictors were planning to have another baby within five years (odds ratio, 1.6) and not using long-acting contraceptives within three months of delivery (2.4). Dyad-level predictors were not being in a relationship with the father of the first child three months after delivery (2.0), being more than three years younger than the first child’s father (1.6) and experiencing intimate partner violence within three months after delivery (1.9). Peer/community-level predictors were not being in school three months postpartum (1.8) and having many friends who were adolescent parents (1.5).

CONCLUSION: Adolescent mothers are at high risk for a rapid subsequent pregnancy. Interventions that address the complex and multifaceted aspects of the lives of adolescent mothers are needed to prevent repeat pregnancy.