Reproductive outcomes following induced abortion: a national register-based cohort study in Scotland

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Abstract

Objective: To investigate reproductive outcomes in
women following induced abortion (IA).
Design: Retrospective cohort study.
Setting: Hospital admissions between 1981 and 2007
in Scotland.
Participants: Data were extracted on all women who
had an IA, a miscarriage or a live birth from the
Scottish Morbidity Records. A total of 120 033,
457 477 and 47 355 women with a documented
second pregnancy following an IA, live birth and
miscarriage, respectively, were identi¿ed.
Outcomes: Obstetric and perinatal outcomes, especially
preterm delivery in a second ongoing pregnancy
following an IA, were compared with those in
primigravidae, as well as those who had a miscarriage
or live birth in their ¿rst pregnancy. Outcomes after
surgical and medical termination as well as after one or
more consecutive IAs were compared.
Results: IA in a ¿rst pregnancy increased the risk of
spontaneous preterm birth compared with that in
primigravidae (adjusted RR (adj. RR) 1.37, 95%
CI 1.32 to 1.42) or women with an initial live birth
(adj. RR 1.66, 95% CI 1.58 to 1.74) but not in
comparison with women with a previous miscarriage
(adj. RR 0.85, 95% CI 0.79 to 0.91). Surgical abortion
increased the risk of spontaneous preterm birth
compared with medical abortion (adj. RR 1.25, 95% CI
1.07 to 1.45). The adjusted RRs (95% CI) for
spontaneous preterm delivery following two, three and
four consecutive IAs were 0.94 (0.81 to 1.10), 1.06
(0.76 to 1.47) and 0.92 (0.53 to 1.61), respectively.
Conclusions: The risk of preterm birth after IA is
lower than that after miscarriage but higher than that in
a ¿rst pregnancy or after a previous live birth. This risk
is not increased further in women who undergo two or
more consecutive IAs. Surgical abortion appears to be
associated with an increased risk of spontaneous
preterm birth in comparison with medical termination
of pregnancy. Medical termination was not associated
with an increased risk of preterm delivery compared to
primigravidae.
Original languageEnglish
Article numbere000911
JournalBMJ Open
Volume2
DOIs
Publication statusPublished - 2012

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