Abortion and its effect on risk of preeclampsia and transient hypertension

We examined the effect of abortion type, number, and gestational age on the risk of preeclampsia and transient hypertension among women who received prenatal care from 13 obstetric practices in southern Connecticut between April 1988 and December 1991 (N = 2,739). Subjects were interviewed before 16 weeks' gestation regarding reproductive history and pregnancy-related risk factors. We estimated the risk of preeclampsia (N = 44) and transient hypertension (N = 172) among nulliparous women who had had one or more abortions, with nulliparous women with no abortion as the referent group. Similar effects were seen for one spontaneous or induced abortion, when analyzed separately. A single prior abortion was associated with a decreased risk of preeclampsia [odds ratio (OR) = 0.35; 95% exact confidence interval (CI) = 0.09-1.01]. One abortion had only a small association with risk of transient hypertension (OR = 1.09, 95% exact CI = 0.68-1.72); however, a history of two or more abortions was associated with a decreased risk (OR = 0.42, 95% exact CI = 0.16-0.94). Among nulliparous women with a history of one abortion, a decreased risk of both hypertensive disorders was observed among women whose aborted pregnancy ended at > or =3 months gestation. These findings suggest that a history of abortion in nulliparous women is a protective factor against the risk of preeclampsia in the subsequent pregnancy.     

Changing paternity and the risk of preeclampsia/eclampsia in the subsequent pregnancy

To determine whether changing paternity affects the risk of preeclampsia or eclampsia in the subsequent pregnancy and whether the effect depends on a woman's history of preeclampsia/eclampsia with her previous partner, a cohort study was conducted based on 140,147 women with two consecutive births during 1989-1991 identified through linking of annual California birth certificate data. Among women without preeclampsia/eclampsia in the first birth, changing partners resulted in a 30% increase in the risk of preeclampsia/eclampsia in the subsequent pregnancy compared with those who did not change partners (95% confidence interval: 1.1, 1.6). On the other hand, among women with preeclampsia/eclampsia in the first birth, changing partners resulted in a 30% reduction in the risk of preeclampsia/eclampsia in the subsequent pregnancy (95% confidence interval: 0.4, 1.2). The difference of the effect of changing paternity on the risk of preeclampsia/eclampsia between women with and those without a history of this condition was significant (p < 0.05 for the interaction term). The above estimates were adjusted for potential confounders. These findings suggest that the effect of changing paternity depends on the history of preeclampsia/eclampsia with the previous partner and support the hypothesis that parental human leukocyte antigen sharing may play a role in the etiology of preeclampsia/eclampsia.     

Induced abortion and the risk of subsequent ectopic pregnancy.

This study assessed the effect of legal induced abortion on ectopic pregnancy risk by using a comparison group of reproductive-age women who were at risk of becoming pregnant during the same time period the women with ectopic pregnancy conceived. Cases were members of Group Health Cooperative of Puget Sound who were hospitalized for ectopic pregnancy from October 1981 through September 1986 (N = 211). Controls were randomly selected members matched to cases on age and county of residence (N = 457). All subjects in this analysis had had one or more prior pregnancies. Eighty-eight cases (41.7 per cent) and 177 controls (38.7 per cent) had a history of one or more induced abortions. The relative risk of ectopic pregnancy associated with one abortion was 0.9 (95 per cent confidence interval 0.6, 1.3), adjusted for age, county, reference date, religion, gravidity, age at first pregnancy, lifetime number of sexual partners, and miscarriage history. Among women with two or more prior pregnancies, the risk associated with two or more abortions was 1.2 (0.6, 2.4). Controlling for pelvic inflammatory disease and use of intrauterine devices did not alter these risks. We conclude that legal abortion as performed in the US since 1970 has little or no influence on a woman's risk of ectopic pregnancy in subsequent pregnancies.     

The effect of partners' characteristics on teenage pregnancy and its resolution

CONTEXT: Although the determinants of whether a teenage woman has a nonmarital pregnancy and how such a pregnancy is resolved have been widely investigated, little is known about the effect of her partner's characteristics or the joint influence of the two partners' characteristics on nonmarital teenage pregnancy. METHODS: Data from the 1995 National Survey of Family Growth are used to examine whether the characteristics of teenage women and their partners affect the likelihood of a nonmarital pregnancy and how the pregnancy is resolved. The data are corrected for underreporting of abortions. RESULTS: More than 17% of teenage women are estimated to have become pregnant during their first nonmarital teenage sexual relationship. About 44% of these pregnancies result in a nonmarital birth and about 18% in a marital birth, while 37% end in an abortion. The likelihood of nonmarital pregnancy declines as age at first intercourse rises, but age does not affect how such a pregnancy is resolved. Women who are older than their first partner are more likely to become pregnant than those who are the same age, and their pregnancies are less likely to end in abortion than in a marital birth. Women who are younger than their first partner are no more likely to become pregnant than other women after the effects of other characteristics are taken into account. The male partner's education is negatively associated with the likelihood of nonmarital pregnancy but is positively associated with the likelihood of abortion if a pregnancy occurs. Differences between partners in race or ethnicity do not affect the likelihood of a nonmarital pregnancy but do increase the likelihood that such a pregnancy will end in abortion or a nonmarital birth rather than in a marital birth. CONCLUSIONS: The characteristics of teenage women and their partners appear to play a role in nonmarital teenage pregnancy and its outcome. However, the estimated relationships between one partner's characteristics and the probability of a nonmarital pregnancy and its resolution are generally little affected by whether the other partner's characteristics are also taken into account.     

Relations of gestational length and timing and type of incomplete pregnancy to ovarian cancer risk

While the protective nature of parity with respect to ovarian cancer has been well documented, whether a history of incomplete pregnancy affects ovarian cancer risk is uncertain. Data collected from 739 epithelial ovarian cancer cases and 1,313 community controls in the Delaware Valley from 1994 to 1998 were used to evaluate the relation between gestational length and timing of first induced or spontaneous abortion and ovarian cancer risk. Incomplete pregnancy was not associated with ovarian cancer among nulliparous women or among ever-pregnant women either before or after adjustment for relevant confounders (for nulliparous women, odds ratio (OR) = 1.12, 95% confidence interval (CI): 0.66, 1.89; for ever-pregnant women, OR = 0.95, 95% CI: 0.76, 1.18). Among unigravid women, one full-term pregnancy was more protective than an incomplete pregnancy (adjusted OR = 0.29, 95% CI: 0.15, 0.57). These results were independent of the type of pregnancy loss. Among ever-pregnant women, a spontaneous abortion before a first birth provided significant protection (adjusted OR = 0.47, 95% CI: 0.30, 0.75), while no significant effect was found for an induced abortion prior to a first birth (adjusted OR = 0.80, 95% CI: 0.44, 1.47). These data do not support an independent association between incomplete pregnancies, either spontaneous or induced, and ovarian cancer risk.     

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.     

The Role of Intimate Partners in Women's Reasons for Seeking Abortion

PurposeThe literature on partners and abortion focuses on intimate partner violence (IPV) and risk for abortion, and partners' control of women's abortion decisions. This paper examines how partners figure in women's abortion decisions, and identifies factors associated with identifying partner as a reason (PAR) for abortion.MethodsBaseline data were used from the Turnaway Study, a longitudinal study among women (n = 954) seeking abortion at 30 U.S. facilities between 2008 and 2010. Mixed methods were used. Data were analyzed using thematic coding and logistic regression.FindingsNearly one third of women reported PAR for abortion. Three most common partner-related reasons were poor relationships, partners unable/unwilling to support a baby, and partner characteristics that made them undesirable to have a baby with. Eight percent who mentioned PAR identified having abusive partners as a reason for abortion. One woman in this subgroup reported being pressured by her partner to seek abortion, whereas others in this subgroup sought abortion to end abusive relationships or to avoid bringing children into abusive relationships. Factors associated with identifying PAR for seeking abortion included race, education, partner's pregnancy intentions, relationship with man involved in the pregnancy, and experience of IPV.ConclusionWomen make decisions to terminate pregnancies considering the quality of the relationship with and potential support they will receive from the man involved. Even women who report IPV, who may be vulnerable to coercion, report their motivation for the abortion is to end an abusive relationship, rather than coercion into abortion.     

The influence of significant others on Australian teenagers' decisions about pregnancy resolution

CONTEXT: Teenagers' decisions about how to resolve a pregnancy are made in the context of a society, a family and a relationship with a partner. Little is known about how such decisions are made, however, particularly in Australia. METHODS: The association between the influence--both direct and indirect--of significant others and adolescent women's decisions to terminate or continue a pregnancy is examined here using data from a case-control study on 1,324 pregnant teenagers in Australia. Bivariate analyses were used to explore the association between pregnancy resolution and direct or indirect influence toward abortion or birth. Multivariate logistic regression analyses were used to model the association between significant others' influence and teenagers'pregnancy resolution decisions while controlling for adolescent women's background characteristics. RESULTS: Teenagers who reported that their partner influenced them toward abortion had significantly increased odds of choosing abortion (10.4), and those whose partner influenced them toward motherhood had significantly reduced odds of choosing abortion (0.5). Direct influence from parents toward either abortion or motherhood was not significantly associated with teenagers' decisions. Mothers are an important source of indirect influence, however: Teenagers whose mother had become a mother as a teenager had reduced odds of choosing abortion (0.4), and those whose mother had ever had an abortion had increased odds of choosing abortion (2. 1). Teenagers who had a sister who had ever had an abortion had significantly increased odds of choosing abortion (2.4). CONCLUSION: While most young women report they were not directly influenced by a significant other in their decision to continue or terminate a pregnancy, pregnancy resolution decisions are affected by families and partners, often indirectly. These findings have important implications for the manner in which services are delivered to these young women.     

Characteristics of women with recurrent spontaneous abortions and women with favorable reproductive histories.

Women with a history of recurrent spontaneous abortions (repeaters) are compared with women who have had live births and no spontaneous abortions (multiparae) and women who have had live births and only one spontaneous abortion (sporadics) to identify characteristics of the women and their abortuses that might predict subsequent fetal loss. A number of risk factors for recurrent spontaneous abortion have been identified: the loss of a chromosomally normal conception, loss after the first trimester of pregnancy, a delay in conceiving prior to the study pregnancy, a diagnosis of cervical incompetence, and a history of very low birthweight deliveries. The odds ratios associated with being a repeater vary from 1.4 to 5.6 depending on the number of characteristics present.     

Factors associated with violence by a current partner in a nationally representative sample of German women

Partner violence is a serious human rights violation and public health issue. Although its pervasiveness is well documented, more research is needed on risk and protective factors to inform interventions. This study is based on a secondary analysis of the first national survey on violence against women in Germany. Women who reported partner violence by their current partner were compared to women who never reported partner violence. The prevalence of physical or sexual violence, or both, by current partners was 17 per cent. Women who experienced violence during their childhood had higher odds of experiencing partner violence. Partner violence was associated with women's drug use in the last 5 years, physical disability or debilitating illness, having more than three children, experiencing violence by a non-partner and feeling socially excluded. The odds of violence also increased if both partners were unemployed or lacked vocational training or if only the woman had vocational skills. Relationships shorter than 5 years or where the man or both partners drank heavily were likewise associated with higher odds of violence. Partner violence interventions should focus on reducing children's exposure to violence and preparing women and men for the job market as well as including interventions that tackle social isolation and substance use.     

Partner Violence and Abortion Characteristics

We conducted a retrospective cohort study using randomly selected medical charts of women reporting a history of partner violence and women with no history of partner violence at the time of a family planning or abortion appointment (n = 6,564 per group). We analyzed lifetime history of partner violence for odds of lifetime history of abortion and miscarriage number, and birth control problems. To more closely match timing, we analyzed a subsample of 2,186 women reporting current violence versus not at the time of an abortion appointment for differences in gestational age, medical versus surgical method choice, and return for follow-up visit. After adjusting for years at risk and demographic characteristics, women with a past history of partner violence were not more likely to have ever had one abortion, but they were more likely to have had problems with birth control, repeat abortions, and miscarriages than women with no history of violence. Women with current partner violence were also more likely to be receiving an abortion at a later gestational age. We found no differences between the groups in return for abortion follow-up visit or choice of surgical versus medication abortion. Findings support screening for the influence of partner violence on reproductive health and related safety planning.     

Risks for abuse against pregnant Hispanic women: Morelos, Mexico and Los Angeles County, California

BACKGROUND: Although violence against women is gaining international attention as a prevention priority, little is known about how risks differ across countries. METHODS: A comparative study of violence against pregnant Mexican women in Morelos, Mexico, and Latina women in Los Angeles County, California, United States. In 1998 and 1999, women in prenatal clinics were interviewed about psychological abuse and sexual and physical violence by their partner, during and the 1 year prior to the index pregnancy. The overall response rate for Morelos was 99%, with a sample size of 914; Los Angeles County had a response rate of 96.9%, with a sample size of 219. RESULTS: Women in Morelos reported a higher prevalence of violence compared to women in the California (14.8% v 11.9%, respectively). A partner aged <20 years was associated with increased violence in both countries, but the association of violence with other socioeconomic factors differed by country. For example, employed women had higher odds of violence in California but lower odds in Morelos. Women who experienced violence during both the year prior to pregnancy and as a child were more than 25 times more likely to be abused during pregnancy than women not reporting this type of abuse. CONCLUSION: The identification of factors associated with violence against women, especially as they differ by culture and ethnicity, will help clinicians to better identify victims and to design and implement culturally appropriate prevention programs.     

Male reproductive control of women who have experienced intimate partner violence in the United States

Women who have experienced intimate partner violence (IPV) are consistently found to have poor sexual and reproductive health when compared to non-abused women, but the mechanisms through which such associations occur are inadequately defined. Through face-to-face, semi-structured in-depth interviews, we gathered full reproductive histories of 71 women aged 18–49 with a history of IPV recruited from a family planning clinic, an abortion clinic and a domestic violence shelter in the United States. A phenomenon which emerged among 53 respondents (74%) was male reproductive control which encompasses pregnancy-promoting behaviors as well as control and abuse during pregnancy in an attempt to influence the pregnancy outcome. Pregnancy promotion involves male partner attempts to impregnate a woman including verbal threats about getting her pregnant, unprotected forced sex, and contraceptive sabotage. Once pregnant, male partners resort to behaviors that threaten a woman if she does not do what he desires with the pregnancy. Reproductive control was present in violent as well as non-violent relationships. By assessing for male reproductive control among women seeking reproductive health services, including antenatal care, health care providers may be able to provide education, care, and counseling to help women protect their reproductive health and physical safety.     

Partner effects on a woman's intention to conceive: 'not with this partner'

CONTEXT: Current definitions of pregnancy intention that are useful at aggregate levels are weak at the individual level. This is especially true in social contexts where childbearing and pregnancy often occur within casual or transient relationships. METHODS: Extensive data on lifetime partnerships and sexual behaviors, including pregnancies and births, from 250 low-income women who had experienced a total of 839 pregnancies are used to explore correlates of intention to conceive, as well as the extent to which women attribute their intentions to a current partnership. RESULTS: Some 57% of reported pregnancies were unintended. Overall, 21% of the women had not wished to conceive at least one of their pregnancies with the partner who impregnated them; that proportion rose to 33% among women who had had only unintended pregnancies. Even among women who had had no unintended pregnancies, 18% had had at least one conception that they had not wanted with their partner at the time of conception. Women were less likely to say they had not wanted to conceive with a particular partner if they were living with that partner than if they were not. The likelihood of not having wanted a pregnancy with a given partner rose with the lifetime number of serious partners. Pregnancies that were not wanted with a particular partner were more than twice as likely to end in abortion as were those that were (33% vs. 14%). CONCLUSIONS: Among these women, the desire to avoid childbearing relates more to the couple involved in the conception than to abstract notions of completed family size. It would therefore be useful to include items pertaining to partner relationships in future studies of pregnancy intention.     

Factors associated with effective contraceptive use among a sample of Latina women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.     

Experiences of unmarried young abortion-seekers in Bihar and Jharkhand,India

While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15–24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it. Once recognised, most confided in the partner and, for the most part, partners were supportive; a significant minority, including those who had experienced forced sex, did not have partner support and delayed the abortion until the second trimester of pregnancy. Family support was absent in most cases; where provided, it was largely to protect the family reputation. Finally, unsuccessful attempts to terminate the pregnancy were made by several young women, often with the help of partners or family member. Findings call for programmes for young women and men, their potential partners, parents and families and the health system that will collectively enable unmarried young women to obtain safe abortions in a supportive environment.     

Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis.

STUDY OBJECTIVE: To ascertain, from the published reports to date, whether or not a significantly increased risk of breast cancer is specifically attributable to a history of induced abortion, independent of spontaneous abortion and age at first full term pregnancy (or first live birth); to establish the relative magnitude of such risk increase as may be found, and to ascertain and quantify such risk increases as may pertain to particular subpopulations of women exposed to induced abortion; in particular, nulliparous women and parous women exposed before compared with after the first full term pregnancy. INCLUDED STUDIES: The meta-analysis includes all 28 published reports which include specific data on induced abortion and breast cancer incidence. Since some study data are presented in more than one report, the 28 reports were determined to constitute 23 independent studies. Overall induced abortion odds ratios and odds ratios for the different subpopulations were calculated using an average weighted according to the inverse of the variance. An overall unweighted average was also computed for comparison. No quality criteria were imposed, but a narrative review of all included studies is presented for the reader's use in assessing the quality of individual studies. EXCLUDED STUDIES: All 33 published reports including data on abortion and breast cancer incidence but either pertaining only to spontaneous abortion or to abortion without specification as to whether it was induced or spontaneous. These studies are listed for the reader's information. RESULTS: The overall odds ratio (for any induced abortion exposure; n = 21 studies) was 1.3 (95% confidence interval of 1.2, 1.4). For comparison, the unweighted overall odds ratio was 1.4 (1.3,1.6). The odds ratio for nulliparous women was 1.3 (1.0,1.6), that for abortion before the first term pregnancy in parous women was 1.5 (1.2,1.8), and that for abortion after the first term pregnancy was 1.3 (1.1,1.5). CONCLUSIONS: The results support the inclusion of induced abortion among significant independent risk factors for breast cancer, regardless of parity or timing of abortion relative to the first term pregnancy. Although the increase in risk was relatively low, the high incidence of both breast cancer and induced abortion suggest a substantial impact of thousands of excess cases per year currently, and a potentially much greater impact in the next century, as the first cohort of women exposed to legal induced abortion continues to age.     

Experiences of unmarried young abortion-seekers in Bihar and Jharkhand, India

While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15-24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it. Once recognised, most confided in the partner and, for the most part, partners were supportive; a significant minority, including those who had experienced forced sex, did not have partner support and delayed the abortion until the second trimester of pregnancy. Family support was absent in most cases; where provided, it was largely to protect the family reputation. Finally, unsuccessful attempts to terminate the pregnancy were made by several young women, often with the help of partners or family member. Findings call for programmes for young women and men, their potential partners, parents and families and the health system that will collectively enable unmarried young women to obtain safe abortions in a supportive environment.     

A case-control study to investigate the role of recent spontaneous abortion in the aetiology of neural tube defects

Summary. Clarke et al.¹ suggested that women who have had a spontaneous abortion are at an increased risk in their next pregnancy of producing an offspring with a neural tube defect (NTD). A matched case-control study was carried out to test the related hypothesis that a spontaneous abortion occurring in the 6-month period prior to the conception of a pregnancy (recent spontaneous abortion) is a risk factor for the development of an NTD in that pregnancy. The cases were 177 singleton pregnancies to non-primigravida Leicestershire women, which were affected by non-syndromal NTDs between 1976 and 1989. Two control pregnancies were matched with each case on intended place of delivery and date of maternal last normal menstrual period (LNMP). After adjusting for potential confounders, recent spontaneous abortion was found to be associated with a decreased relative risk of neural tube defect, odds ratio 0.46, 95% confidence interval 0.20, 1.07. The result provided little evidence in favour of the hypothesis, suggesting instead that prior spontaneous abortion has a protective effect in relation to subsequent NTD development rather than being a major risk factor in the aetiology of NTDs.     

Sociodemographic and sexual health profile of users of emergency hormonal contraception: data from a British probability sample survey

OBJECTIVE: This study aimed to identify factors associated with the use of emergency hormonal contraception (EHC). METHODS: Data from a probability sample survey of 12,110 men and women aged 16-44 living in Britain were used for this study; 5916 women were selected as potential users of EHC, defined as women reporting at least one male partner in the year prior to the survey. RESULTS: Of the 5916 women, 2.3% reported EHC use in the previous year. EHC use was more common among younger, single women, those with more than one sexual partner in the past year and those using condoms for contraception. It was significantly associated with experience of abortion (odds ratio adjusted for age, marital status and number of male partners: 2.40) but not with sexually transmitted infection (STI) diagnosis. CONCLUSIONS: The use of EHC identifies a group of women at increased risk of unplanned pregnancy and condom use but not STI acquisition. Provision of information on more reliable contraceptive methods is needed to reduce the risk of unplanned pregnancy recurrence.