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PLoS Medicine 2013Numerous studies have demonstrated that therapeutic termination of pregnancy (abortion) is associated with an increased risk of subsequent preterm birth. However, the...
BACKGROUND
Numerous studies have demonstrated that therapeutic termination of pregnancy (abortion) is associated with an increased risk of subsequent preterm birth. However, the literature is inconsistent, and methods of abortion have changed dramatically over the last 30 years. We hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008.
METHODS AND FINDINGS
We studied linked Scottish national databases of births and perinatal deaths. We analysed the risk of preterm birth in relation to the number of previous abortions in 732,719 first births (≥24 wk), adjusting for maternal characteristics. The risk (adjusted odds ratio [95% CI]) of preterm birth was modelled using logistic regression, and associations were expressed for a one-unit increase in the number of previous abortions. Previous abortion was associated with an increased risk of preterm birth (1.12 [1.09-1.16]). When analysed by year of delivery, the association was strongest in 1980-1983 (1.32 [1.21-1.43]), progressively declined between 1984 and 1999, and was no longer apparent in 2000-2003 (0.98 [0.91-1.05]) or 2004-2008 (1.02 [0.95-1.09]). A statistical test for interaction between previous abortion and year was highly statistically significant (p<0.001). Analysis of data for abortions among nulliparous women in Scotland 1992-2008 demonstrated that the proportion that were surgical without use of cervical pre-treatment decreased from 31% to 0.4%, and that the proportion of medical abortions increased from 18% to 68%.
CONCLUSIONS
Previous abortion was a risk factor for spontaneous preterm birth in Scotland in the 1980s and 1990s, but the association progressively weakened and disappeared altogether by 2000. These changes were paralleled by increasing use of medical abortion and cervical pre-treatment prior to surgical abortion. Although it is plausible that the two trends were related, we could not test this directly as the data on the method of prior abortions were not linked to individuals in the cohort. However, we speculate that modernising abortion methods may be an effective long-term strategy to reduce global rates of preterm birth.
Topics: Abortion, Induced; Abortion, Therapeutic; Cohort Studies; Female; Humans; Logistic Models; Models, Theoretical; Odds Ratio; Pregnancy; Premature Birth; Risk Assessment; Scotland; Time Factors
PubMed: 23874161
DOI: 10.1371/journal.pmed.1001481 -
Canadian Medical Association Journal Oct 1974
Topics: Abortion, Legal; Abortion, Therapeutic; Adolescent; Canada; Female; Humans; Pregnancy
PubMed: 4414437
DOI: No ID Found -
Fertility and Sterility Jul 1979Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3...
Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.
Topics: Abortion, Therapeutic; Adult; Contraceptives, Oral; Female; Humans; Intrauterine Devices; Marriage; Pelvic Inflammatory Disease; Pregnancy; Time Factors
PubMed: 456627
DOI: 10.1016/s0015-0282(16)44110-5 -
Journal of Medical Ethics May 2006Reproductive autonomy is central to women's welfare both because childbearing takes place in women's bodies and because they are generally expected to take primary... (Review)
Review
Reproductive autonomy is central to women's welfare both because childbearing takes place in women's bodies and because they are generally expected to take primary responsibility for child rearing. In 2005, the factors that influence their autonomy most strongly are poverty and belief systems that devalue such autonomy. Unfortunately, such autonomy is a low priority for most societies, or is anathema to their belief systems altogether. This situation is doubly sad because women's reproductive autonomy is intrinsically valuable for women and also instrumentally valuable for the welfare of humankind. This paper takes for granted the moral and practical necessity of such autonomy and digs deeper into the question of what such a commitment might entail, focusing on the mid-level policy making that, at least in the US and Canada, plays a significant role in shaping women's options. This paper examines a large teaching hospital's policy on reduction of multifetal pregnancies. The policy permits reduction of triplets to twins, but not twins to a singleton. As there is no morally relevant difference between these two types of reduction, it is evident that inappropriate medicalisation can still limit women's autonomy in undesirable ways.
Topics: Abortion, Therapeutic; Attitude to Health; Culture; Female; Feminism; Health Policy; Humans; Morals; Personal Autonomy; Pregnancy; Pregnancy, Multiple; Reproduction; Reproductive Techniques, Assisted; Risk Factors; Women
PubMed: 16648280
DOI: 10.1136/jme.2004.013193 -
Canadian Family Physician Medecin de... Apr 2016
Topics: Abortion, Induced; Abortion, Therapeutic; Canada; Counseling; Family Planning Services; Family Practice; Female; Health Services Accessibility; Humans; Pregnancy; Pregnant Women; Prenatal Diagnosis
PubMed: 27076535
DOI: No ID Found -
California Medicine Jul 1953Pregnancy and parturition are not considered the basic causes of associated mental disorders, but as precipitating stresses. Pregnancy and parturition are thought to...
Pregnancy and parturition are not considered the basic causes of associated mental disorders, but as precipitating stresses. Pregnancy and parturition are thought to involve conflicts relating to dependency needs, homosexuality and hostility toward the child and husband. The incidence of psychoses related to pregnancy and childbirth appears to be declining. Therapeutic abortion and/or sterilization are indicated when continuance of pregnancy or future pregnancies would be likely to precipitate severe mental disease. Among the important factors to be weighed in considering a recommendation for abortion or sterilization are: the pattern of previous psychotic reactions (severity, duration, reversibility, relation to pregnancy), the physical constitution of the patient, the religious and other personal beliefs of the patient and her family, the desire for parenthood, and the number of living children.A physician would do well to consult the laws of his state with regard to abortion and to call upon suitable consultation in approved hospitals as safeguards against subsequent legal complications. The legal situation regarding sterilization appears to be less complex.
Topics: Abortion, Induced; Abortion, Therapeutic; Female; Humans; Mental Disorders; Motivation; Parturition; Pregnancy; Referral and Consultation; Sterilization; Sterilization, Reproductive
PubMed: 13059643
DOI: No ID Found -
British Medical Journal Nov 1969
Topics: Abortion, Therapeutic; Erythroblastosis, Fetal; Female; Fetomaternal Transfusion; Hemorrhage; Humans; Immunoglobulin G; Pregnancy; Rh-Hr Blood-Group System
PubMed: 4982188
DOI: 10.1136/bmj.4.5681.495-b -
Canadian Medical Association Journal Mar 1968
Topics: Abortion, Therapeutic; Contraception; Female; Humans; Legislation, Medical; United Kingdom
PubMed: 5645188
DOI: No ID Found -
Canadian Medical Association Journal May 1970
Topics: Abortion, Therapeutic; Female; Humans
PubMed: 5421000
DOI: No ID Found -
British Medical Journal Jan 1966
Topics: Abortion, Therapeutic; England; Female; Humans; Jurisprudence; Legislation, Medical; Pregnancy
PubMed: 5901582
DOI: No ID Found