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Using a Checklist to Assess Pregnancy in Teenagers and Young Women

Whiteman, Maura K. PhD; Tepper, Naomi K. MD, MPH; Kottke, Melissa MD, MPH, MBA; Curtis, Kathryn M. PhD; Goedken, Peggy MPH; Mandel, Michele G.; Marchbanks, Polly A. PhD

doi: 10.1097/AOG.0000000000000179
Contents: Original Research

OBJECTIVE: Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women.

METHODS: Study participants were a convenience sample of sexually active black females aged 14–19 years seeking care in an urban family planning clinic. Each participant provided a urine sample for pregnancy testing and was then administered the checklist in two formats, audio computer-assisted self-interview and in-person interview. We estimated measures of the checklist performance compared with urine pregnancy test as the reference standard, including negative predictive value, sensitivity, specificity, and positive predictive value.

RESULTS: Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted self-interview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results.

CONCLUSION: The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population.


A checklist based on criteria recommended in family planning guidance may be a useful tool to assess pregnancy among teenagers and young women.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia.

Corresponding author: Maura K. Whiteman, PhD, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Atlanta, GA 30341-3724; e-mail:

Supported by Cooperative Agreement Number U48DP001909-01 from the Centers for Disease Control and Prevention.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.