Pregnancy following induced abortion: maternal morbidity, congenital abnormalities and neonatal death. Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists Joint Study

Abstract

In a prospective cohort study of the long-term sequelae of induced abortion, a comparison is made between a group of 6418 women who had an induced abortion (cases) and a control group of 8059 women recruited with an unplanned pregnancy which was not terminated with an induced abortion (controls). The present paper reports on 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no material effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. There was, however, a significant difference in two specific conditions. In the post-index pregnancy in the cases there was an increased relative risk (RR 2.26) of the occurrence of urinary tract infection and a decreased risk (RR 0.25) of pregnancy-related anaemia.

PIP: The long-term sequelae of induced abortion were investigated in a prospective cohort study involving 6418 women who had an induced abortion and 8059 controls recruited with an unplanned pregnancy that was not termined through abortion. This article reports on the 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no significant effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. However, in cases there was an increased risk of urinary tract infection (relative risk, 2.26) and a decreased risk of anemia (relative risk, 0.25). The prospective design of the present studyminimized the problems of unreliable recall of previous induced abortion and the under-reporting of early pregnancy complications. Although 11% of cases had a post-index pregnancy at the time of data analysis compared with 22% of controls, there is no reason to believe that this difference should affect any complication rates of the post-index pregnancy, especially since the rates were adjusted for variables such as age, smoking, parity, and previous mental illness. To determine whether induced abortion reduces the complication rate in the next pregnancy to the same extent as a full-term pregnancy, a further comparison was carried out in which the induced abortion of cases was counted as a full-term pregnancy. The significantly increased relative risk of 1.62 in the cases suggests that induced abortion does not offer the protection of a full-term pregnancy.