Revealing a secret of teen ‘Life’

“The Secret Life of the American Teenager,” pilot, “Falling in Love,” ABC Family, July 1

The premise: Amy Juergens (Shailene Woodley) is a 15-year-old French horn player in her high school band. During a band camp weekend, she has sex for the first time. Weeks later, when she begins to feel weak and tired, she takes a home pregnancy test and discovers she may be pregnant. Her best friends aren’t sure they believe the results, so they smuggle a “professional” urine pregnancy test kit from their pediatrician’s office. This test also is positive, but Amy’s friends suggest that it could still be a false result because of a strange virus. They urge her to see her own pediatrician, but she is reluctant to go, concerned that using her family’s health insurance coverage would alert her parents to her condition. She is afraid to tell her mother, Anne (Molly Ringwald), and, by the end of the episode, she still hasn’t done so. In a monologue, however, she tells viewers that there should be open lines of communication between parents and teens.

The medical questions: Is it realistic to suspect pregnancy after one missed menstrual period and symptoms of fatigue and nausea? How accurate are home pregnancy tests compared with those found in doctors’ offices? How often are “false positives” on these tests caused by other diseases? How important is an early visit to the pediatrician or gynecologist? Can a minor keep a pregnancy secret after a visit to a doctor? Does good communication between parent and child help prevent teen pregnancy?

The reality: The symptoms of pregnancy, which also include cramping and breast tenderness, are universal. On the other hand, many teens who become pregnant remain in denial of their pregnancy for months. Among young women going to an emergency room complaining of unexplained nausea and vomiting, pregnancy is the most likely diagnosis.

The show is misleading about pregnancy tests -- home urine tests are just as effective as the urine tests available in the doctor’s office, with a greater than 95% accuracy rate when used properly after a missed menstrual period. The blood tests available in the doctor’s office can often detect pregnancy two weeks earlier. In both cases the hormone being tested is HCG (human chorionic gonadotropin), made by the placenta. False positives on home pregnancy tests are generally not caused by strange diseases, as Amy’s friends suggest, but rather by hormone-containing medications such as fertility treatments, which very few high school students are taking.

“The earlier you see a doctor the better,” says pediatrician Dr. Perri Klass, medical director of Reach Out and Read, which promotes early literacy. Decisions about terminating the pregnancy or continuing it with proper prenatal care are crucial early in the first trimester. A delayed termination requires a more extensive procedure.

Though she is underage, Amy would be considered capable of consenting to medical treatment on her own and entitled to confidentiality because she is pregnant. Nevertheless, Amy’s concern that information could leak to her parents through their insurance coverage is legitimate.

Studies do suggest that communication between parent and child can delay the onset of sexual activity and help prevent unwanted pregnancies. But “that communication has to start long before sexual activity and the risk of pregnancy,” Klass says. “The parent should want the child to feel able to ask for help and advice. You don’t want shame and embarrassment to keep a teen from asking for adult help.”

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.”