PREGNANCY PRETERM BIRTH
Cost Consequences of Induced Abortion as an Attributable Risk for Preterm Birth and Impact on Informed Consent
J Reprod Med. 2007 Oct;52(10):929-37.Links
Calhoun BC, Shadigian E, Rooney B.
Department of Obstetrics, West Virginia University, Charleston 25302, USA. [email protected]
OBJECTIVE: To investigate the human and monetary cost consequences of preterm delivery as related to induced abortion (IA), with its impact on informed consent and medical malpractice.
STUDY DESIGN: A review of the literature in English was performed to assess the effect of IA on preterm delivery rates from 24 to 31 6/7 weeks to assess the risk for preterm birth attributable to IA. After calculating preterm birth risk, the increased initial neonatal hospital costs and cerebral palsy (CP) risks related to IA were calculated.
RESULTS: IA increased the early preterm delivery rate by 31.5%, with a yearly increase in initial neonatal hospital costs related to IA of > $1.2 billion. The yearly human cost includes 22,917 excess early preterm births (EPB) (< 32 weeks) and 1096 excess CP cases in very-low-birth-weight newborns, <1500 g.
CONCLUSION: IA contributes to significantly increased neonatal health costs by causing 31.5% of EPB. Providers of obstetric care and abortion should be aware of the risk of preterm birth attributable to induced abortion, with its significant increase in initial neonatal hospital costs and CP cases.
PMID: 17977168 [PubMed – indexed for MEDLINE]
Termination of Pregnancy Among Very Preterm Births and its Impact on Very Preterm Mortality: Results from Ten European Population-Based Cohorts in the MOSAIC Study
BJOG. 2008 Feb;115(3):361-8.
Papiernik E, Zeitlin J, Delmas D, Draper ES, Gadzinowski J, Künzel W, Cuttini M, Di Lallo D, Weber T, Kollée L, Bekaert A, Bréart G; MOSAIC Research Group.
Université Paris V Réné Descartes et Maternité de Port-Royal, Assistance-Publique Hôpitaux, Paris, France.
OBJECTIVE: To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe.
DESIGN: European prospective population-based cohort study.
SETTING: Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination.
POPULATION OR SAMPLE: Births 22-31 weeks gestational age. METHODS: The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions.
MAIN OUTCOME MEASURES: Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003.
RESULTS: Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies.
CONCLUSION: Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ.
PMID: 18190373 [PubMed – indexed for MEDLINE]
* Survival of very preterm infants: Epipage, a population based cohort study. [Arch Dis Child Fetal Neonatal Ed. 2004]
* Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. [JAMA. 2002]
* Analysis of birthweight and gestational age in antepartum stillbirths. [Br J Obstet Gynaecol. 1998]
* Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort. [Pediatrics. 2008]
* The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study. [BJOG. 2000]
Impact of Induced Abortions on Subsequent Pregnancy Outcome: the 1995 French National Perinatal Survey
BJOG. 2001 Oct;108(10):1036-42.
Henriet L, Kaminski M.
INSERM, Epidemiological Research in Perinatal and Women's Health, Paris, France.
OBJECTIVE: To study the impact of previous induced abortions on preterm delivery, small for gestational age and low birthweight in subsequent pregnancies. DESIGN: Survey of a national sample of births in France in 1995.
SETTING: All public and private maternity hospitals in France.
POPULATION: 12,432 women who had a singleton live birth during one week.
METHODS: Data were collected during the women's postpartum stay in hospital, partly obtained by interview and partly abstracted from hospital medical records. Rates of preterm delivery, small for gestational age and low birthweight were compared according to existence and number of previous induced abortions. Maternal age, parity, history of previous adverse pregnancy outcome, maternal weight before pregnancy, marital status, educational level, maternal employment status during pregnancy, nationality, smoking during the third trimester of pregnancy and antenatal care were controlled for using multiple logistic regression and polytomous logistic regression.
RESULTS: Twelve percent of women reported one previous induced abortion, and 3% two or more. Previous induced abortion was associated with an increased risk of preterm birth (OR 1.4; 95% CI 1.1-1.8); the risk of preterm delivery increased with the number of previous induced abortions (OR 1.3; 95% CI 1.0-1.7 for one previous abortion and OR 1.9; 95% CI 1.2-2.8 for two or more). The relationship was the same for very preterm and moderately preterm deliveries and for spontaneous and indicated preterm deliveries. After controlling for potential confounders, the association between previous induced abortions and small for gestational age and low birthweight infants was no longer significant.
CONCLUSION: This study suggests that a history of induced abortion increases the risk of preterm delivery, particularly for women who have ha
d repeated abortions. The respective role of the surgical and medical techniques used for induced abortions needs to be explored.
PMID: 11702834 [PubMed – indexed for MEDLINE]
Obstetric Outcomes After Surgical Abortion at > or = 20 Weeks' Gestation.
Am J Obstet Gynecol. 2005 Sep;193(3 Pt 2):1161-4.
Chasen ST, Kalish RB, Gupta M, Kaufman J, Chervenak FA.
Division of Maternal-Fetal Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA. [email protected]
OBJECTIVE: The purpose of this study was to describe obstetric outcomes after surgical abortion at > or = 20 weeks, and to identify risk factors for subsequent spontaneous preterm birth.
STUDY DESIGN: Patients who had surgical abortion at > or = 20 weeks' gestation from 1996 to 2003 and received subsequent prenatal care at The New York Weill Cornell Medical Center were identified. Indication for abortion, operative technique, and subsequent pregnancy outcomes were reviewed. Student t test, Fisher exact test, and Mann-Whitney U were used where appropriate.
RESULTS: One hundred and twenty pregnancies in 89 women were identified. Thirteen (10.8%) ended with early miscarriage, and 5 were electively terminated. Of the remaining 102 pregnancies, 7 ended with spontaneous preterm birth. Those who experienced preterm birth were more likely to have undergone abortion due to cervical dilation and/or preterm premature rupture of membranes (PPROM) (27.3% vs 4.4%; P = .03). Those with a multifetal pregnancy in the subsequent pregnancy were more likely to have preterm birth (75.0% vs 4.3%; P < .001). In patients who underwent dilation and evacuation (D&E) for reasons other than cervical dilation and/or PPROM, rates of spontaneous preterm birth were identical between those who had intact dilation and extraction (D&X) and D&E using forceps (4.2% vs 4.5%; P = 1.0).
CONCLUSION: In those who have undergone D&E at > or = 20 weeks, only a history of midtrimester cervical dilation and/or PPROM or a current multifetal pregnancy were associated with spontaneous preterm birth.
PMID: 16157130 [PubMed – indexed for MEDLINE]
Reproductive Outcomes in Adolescents Who had a Previous Birth or an Induced Abortion Compared to Adolescents' First Pregnancies.
BMC Pregnancy Childbirth. 2008 Jan 31;8:4.
Reime B, Schücking BA, Wenzlaff P.
Faculty of Nursing and Healthcare, University of Applied Sciences of the Saarland, Goebenstr, 40, 66117 Saarbrücken, Germany. [email protected]
BACKGROUND: Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth.
METHODS: In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990-1999 (participation rate 87-98% of all hospitals) in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women <19 years remained. Of these 8857 women, 7845 were nulliparous, 801 had one previous birth, and 211 had one previous induced abortion.
The outcomes were stillbirths, neonatal mortality, perinatal mortality, preterm births, and very low birthweight. Bivariate and multivariable logistic regression models were conducted.
RESULTS: In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58].
After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers.
CONCLUSION: The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion and the follow-up care. Also, health care workers should attempt to improve the pregnancy outcomes of subsequent teenage pregnancies by addressing modifiable risk factors, for example, supporting smoking cessation and utilization of prenatal care.
PMID: 18237387 [PubMed – indexed for MEDLINE]