ACOG Guideline Aids Transition From Pediatric to Adult Care

Marcia Frellick

February 23, 2015

New guidelines from the American College of Obstetricians and Gynecologists (ACOG) are designed to help clinicians transition young women aged 18 to 26 years from pediatric to adult care and to addresses these patients' preventive care needs.

The recommendations were published in the March issue of Obstetrics & Gynecology.

Among the areas the recommendations highlight are:

  • Sexual health: The healthcare provider should discuss the patient's sexual health, orientation, behaviors, partners, satisfaction, and function. Discussion of contraceptive needs should include emergency contraception, nonemergency contraception, and prevention of sexually transmitted diseases.

  • Sleep disorders: Clinicians should educate patients that lack of sleep can lead to increased risk for diabetes, weight gain, heart disease, depression, and driving accidents.

  • Appearance, nutrition: Providers should ask the patient whether she has concerns about her weight or whether she has used diet pills, laxatives, fasting, or vomiting to lose weight.

  • Safety and violence: Providers should ask about abuse, neglect, physical or sexual violence, and reproductive coercion (sabotage of contraceptive methods, pregnancy coercion or pressure). Clinicians should counsel patients on risk for sexual assault and responsible and safe Internet use.

  • Breast and pelvic exams: The guidelines recommend clinical breast exams every 1 to 3 years beginning at age 20 years, and that clinicians educate patients about breast self-exams. Whether to perform a complete pelvic examination during periodic health checks for an asymptomatic patient should be a shared decision between the patient and her healthcare provider. Cervical cancer screening should begin at age 21 years and continue every 3 years through age 29 years. Additional options are available for women aged 30 years and older.

  • Substance abuse: Providers should ask about use of tobacco, alcohol, and other drugs, including designer and performance-enhancing drugs and stimulants prescribed for disorders such as attention-deficit/hyperactivity disorder.

  • Herbal supplements: Healthcare providers should assess use because some supplements can interfere with prescription medications (eg, St. John's wort interferes with the efficacy of oral contraceptives).

  • Mental health: Screening tools are available, but these two questions can help determine whether further help is needed: "Over the past 2 weeks, have you ever felt down, depressed, or hopeless? And have you felt little interest or pleasure in doing things?"

ACOG also publishes a more extensive review of well-woman care.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;125:752-754. Full text

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