Risk of spontaneous abortion in Italy, 1978-1995, and the effect of maternal age, gravidity, marital status, and education

This paper describes the trend in the risk of spontaneous abortion in Italy from 1974 to 1995. There was a dramatic decline in the risk after the law that legalized induced abortion was passed in 1978, which implies that probably many induced abortions performed before 1978 were registered as spontaneous abortions. Data for 1991 have been extracted from the Italian national registers of births and abortions and analyzed to investigate the effects of maternal age, gravidity, marital status, and education on the risk of spontaneous abortion. In comparison with women under age 20 years, the risk is found to be increased for women aged 35-39 (odds ratio = 1.45) and women over age 40 (odds ratio = 3.10). The odds ratio is almost 2 for women who have been pregnant two or more times previously. Unmarried women have an increased risk (odds ratio = 1.33), but no important effect of education was observed. There is an important interaction between maternal age and gravidity. The risk of spontaneous abortion is excessively high for young women with high gravidity. It is hypothesized that this could be due to the effect of short intervals between pregnancies.     

Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes

CONTEXT: Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result. METHODS: Population, birth and fetal death data, as well as pregnancy termination reports, obtained from Washington State were used to calculate abortion rates and ratios and birthrates for Washington residents in 1983-1984 and in 1993-1994. Residence of abortion patients was classified by county only, and location of providers was recorded as large urban county, small urban county, large rural county or small rural county. Distances that women traveled to obtain an abortion were calculated. Chi-square tests were used to compare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods. RESULTS: Birthrates and abortion rates decreased for both rural and urban Washington women between 1983-1984 and 1993-1994, but the magnitude of the decrease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1,000, while the urban rate dropped 17%, from 21.8 to 18.2 per 1,000. The decline in the abortion rate was larger for adolescents than it was for other age-groups. In rural areas, the abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 1983-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,000 to 16.9 per 1,000 in urban areas. From the earlier to the later time period, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county decreased from 25% to 3%. In the earlier time period, 62% of rural women traveled 50 miles or more to obtain an abortion, compared with 73% in 1993-1994. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state for an abortion increased from 8% to 14%. The proportion of rural women terminating their pregnancy after the first trimester increased from 8% in 1983-1984 to 15% in 1993-1994. CONCLUSION: Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining their abortions at a later gestational age, which is associated with a decade-long decline in the number of abortion providers.     

Abortion-related maternal mortality in the Russian Federation

This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.     

Seasonal variation in spontaneous abortions.

Using a national sample of hospital discharges, we found identical seasonal patterns for spontaneous abortions and conceptions but no significant seasonal variation in the rate of spontaneous abortions per 1,000 conceptions. The differences between our findings and those of previous investigators of spontaneous abortion may reflect our more comprehensive definition of spontaneous abortion, our more complete estimate of the monthly number of conceptions, and our more rigorous statistical analysis. The periodic regression analysis (PRA) reported in our study may be useful in other studies that monitor short-term trends.     

浙江省嘉兴地区初孕妇女自然流产状况研究

目的 了解浙江省嘉兴地区初孕妇女自然流产状况及分布特征.方法 资料来源于北京大学生育健康研究所嘉兴地区围产保健监测及自然流产数据.研究对象为嘉兴地区1993-1995年登记的准备结婚及生育并最终怀孕(不包括人工流产、宫外孕及葡萄胎)的初孕妇女14769名.结果 嘉兴地区初孕妇女自然流产率为9.8%(1454/14769,95%CI:9.3～10.3),平均妊娠诊断孕周为(7.6±2.1)周,平均流产孕周为(10.1±3.1)周.早期(≤12周)自然流产率为7.3%(95%CI:6.8～7.7),占总流产的73.7%.流产集中发生在8～13周,占37.7%.经多因素Cox回归分析,生育年龄≥30岁、农民、文化程度高者自然流产率较高.结论 嘉兴地区初孕妇女自然流产率高于国内其他地区;自然流产主要发生在8～13孕周.     

Health conditions of immigrant women in Italy

The number of immigrant women in Italy has increased from 260,000 in 1991 to at least 750,000 in 2003. This article describes the health situation of these women, in particular it deals with reproductive health. Immigrant women are generally young, in good health and they go to the health services mainly for pregnancy, delivery, spontaneous and induced abortion. Forty-eight per cent of acute hospital admissions and 56 per cent of day hospital admissions in 2002 were related to reproduction. Among foreign citizens, the induced abortion rate is three times higher than that reported among Italians, while the risk of spontaneous abortion is similar (97 per thousand and 101 per thousand, respectively). In general, the data show that immigrant women in Italy live in deprived social conditions, which can influence their reproductive choices and their access to health services. In order to take account of their particular needs, it is necessary to modify the health services and plan public health interventions especially for the prevention of induced abortion.     

A portrait of American women who obtain abortions

In 1981, as in 1980, most abortions in the United States were obtained by young women, unmarried women and white women, and were performed in the first eight weeks following the last menstrual period (approximately six weeks after conception). The proportion of abortions obtained by unmarried women has increased slightly, and the fraction obtained by teenagers has decreased, mainly because of shifts in the distribution of these groups in the population. The percentage of abortions that are repeat procedures has increased, representing more than one-third of all abortions. The increase is due largely to the rise in the number of women who have had a first abortion, and who are, therefore, exposed to the risk of having a second procedure. Eighty-five percent of all abortions are performed by vacuum aspiration. Dilatation and evacuation is the method used in two-thirds of abortions performed more than 12 weeks past the last menstrual period, and in nine out of 10 abortions that are performed between the 13th and the 15th week. About three percent of women aged 15-44 obtained abortions in 1981, and 26 percent of pregnancies were terminated by abortion--the same fractions as in 1980. About six percent of 18-19-year-olds had abortions--the highest rate of any age-group. The abortion rate (the number of abortions per 1,000 women aged 15-44) and ratio (the number of abortions per 100 live births and abortions) are much higher for unmarried than for married women.(ABSTRACT TRUNCATED AT 250 WORDS)     

Abortion incidence and services in the United States in 2000

CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996.
METHODS: In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys.
RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15–44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nation's 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000.
CONCLUSIONS: Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.     

Abortion in the United States: incidence and access to services, 2005

CONTEXT: Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. METHODS: All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. RESULTS: An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. CONCLUSION: The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services.     

Risk of spontaneous abortion in workers exposed to toluene.

Rates of spontaneous abortions were determined using a reproductive questionnaire administered by personal interview to 55 married women with 105 pregnancies. They were employed in an audio speaker factory and were exposed to high concentrations of toluene (mean 88, range 50-150 ppm). These rates of spontaneous abortion were compared with those among 31 women (68 pregnancies) who worked in other departments in the same factory and had little or no exposure to toluene (0-25 ppm), as well as with a community control group of women who underwent routine antenatal and postnatal care at public maternal health clinics (190 women with 444 pregnancies). Significantly higher rates for spontaneous abortions were noted in the group with high exposure to toluene (12.4 per 100 pregnancies) compared with those in the internal control group (2.9 per 100 pregnancies) and in the external control group (4.5 per 100 pregnancies). Among the exposed women, significant differences were also noted in the rates of spontaneous abortion before employment (2.9 per 100 pregnancies) and after employment in the factory (12.6 per 100 pregnancies). Almost all the women were nonsmokers and did not drink; other known risk factors such as maternal age at pregnancy, order of gravidity, and race were not likely to explain the results. Thus, specific exposure to toluene seems to be associated with a risk of foetal loss.     

Risk of spontaneous abortion in workers exposed to toluene.

Rates of spontaneous abortions were determined using a reproductive questionnaire administered by personal interview to 55 married women with 105 pregnancies. They were employed in an audio speaker factory and were exposed to high concentrations of toluene (mean 88, range 50-150 ppm). These rates of spontaneous abortion were compared with those among 31 women (68 pregnancies) who worked in other departments in the same factory and had little or no exposure to toluene (0-25 ppm), as well as with a community control group of women who underwent routine antenatal and postnatal care at public maternal health clinics (190 women with 444 pregnancies). Significantly higher rates for spontaneous abortions were noted in the group with high exposure to toluene (12.4 per 100 pregnancies) compared with those in the internal control group (2.9 per 100 pregnancies) and in the external control group (4.5 per 100 pregnancies). Among the exposed women, significant differences were also noted in the rates of spontaneous abortion before employment (2.9 per 100 pregnancies) and after employment in the factory (12.6 per 100 pregnancies). Almost all the women were nonsmokers and did not drink; other known risk factors such as maternal age at pregnancy, order of gravidity, and race were not likely to explain the results. Thus, specific exposure to toluene seems to be associated with a risk of foetal loss.     

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.     

Abortion trends in Japan, 1975-95

In this study, recent trends in the incidence of induced abortion are analyzed in order to identify the target population and its requirements for family planning policy in Japan. Abortion statistics from 1975 to 1995 from the Ministry of Health and Welfare are reviewed. The abortion rate (the number of cases of induced abortion per 1,000 women per year) for women younger than 20 increased during the study period. The abortion ratio (number of cases per 1,000 live births) remained the highest among women aged 40-44. An increase in the abortion ratio was seen in the two youngest groups (younger than 20 and 20-24), especially among those who were born after 1955. The proportion of abortions experienced by women younger than 25 increased from 18 percent between 1976 and 1980 to 30 percent between 1991 and 1995, and a slight increase was also observed among women aged 40-44. The proportion of abortions performed after eight weeks of a pregnancy for the two youngest groups remained higher than that for older age groups during 1975-95. The analysis demonstrates that women younger than 25 should be the principal concern of family planning policy in Japan. Further investigations on unintended pregnancy are recommended.     

Spontaneous abortions in an industrialized community in Finland

Spontaneous abortions were analyzed in an industrialized Finnish community according to the occupation and workplace of both the women and their husbands. Information about spontaneous abortions and births was obtained from the hospital discharge register, and data about the women and their families were collected from census files. When compared with all women employed outside the home, women who worked at a textile plant (factory A, a clothing manufacturer) had an increased rate of spontaneous abortion (16.7 per cent vs 11.4 per cent). The rate of spontaneous abortions among women employed at factory A differed according to the husband's workplace. The odds ratio for women employed at factor A whose husbands worked at a large metallurgical factory was 3.8, whereas the odds ratio for women whose husbands worked elsewhere was 1.2. Between 1973 and 1976, the rate of spontaneous abortions in this town was consistently lower for the summer period. (May-August) than for the other periods of the year.     

Adverse reproductive outcomes among female veterinarians

Because female veterinarians are exposed to several known reproductive hazards, the authors conducted a reproductive survey of all female graduates of a US veterinary school (n = 537) and law school (comparison group, n = 794). Analysis was confined to pregnancies completed after the second year of professional school and from 1966 to 1986. Based on one randomly chosen eligible pregnancy per woman (veterinarians, n = 176; lawyers, n = 229), spontaneous abortion rates, adjusted for elective abortions, were 13.3% for the veterinarians and 15.1% for the lawyers; these did not differ significantly. A Cox life table regression model controlling for age, smoking, alcohol use, and prior spontaneous abortion also showed no significant difference in spontaneous abortion rates between the two populations. Using all pregnancies, veterinarians who reported performing five or more radiographic examinations per week had a marginally elevated risk of spontaneous abortion, but the statistical significance disappeared when analysis was limited to one random pregnancy per woman. For one random eligible birth per woman, the mean birth weight did not differ significantly between the veterinarians and lawyers, even after controlling for possible confounders in regression analyses. A higher rate of reportable birth defects was observed among the veterinarians than among the lawyers (relative risk = 4.2, 95% confidence interval 1.2-15.1), but this unexpected result must be considered hypothesis-generating. The authors did not find an overall increased risk for spontaneous abortion or low birth weight infants among veterinarians compared with lawyers, but veterinarians who reported performing five or more radiographic examinations per week may have been at increased risk for spontaneous abortion.     

Subfertility and risk of spontaneous abortion

OBJECTIVES: The purpose of this study was to assess the association between subfertility and spontaneous abortion. METHODS: A total of 1572 women in New York and Vermont reported 3269 pregnancies between 1980 and 1990 and were able to provide an estimate of the waiting time to conception for 2967. Subfertility was defined as a delay of 1 year or more before a recognized conception was achieved. Rates of spontaneous abortion were determined among women with and without subfertility, and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated via multiple logistic regression. RESULTS: Spontaneous abortion rates were 23.0% in pregnancies preceded by subfertility and 14.0% in pregnancies without impaired fertility (adjusted OR = 1.71, 95% CI = 1.26, 2.94). The attributable risk of spontaneous abortion associated with subfertility was 6.2%. CONCLUSIONS: Subfertile women evidence an increased number of spontaneous abortions.     

Trends in induced abortion in England and Wales.

Analysis of routinely published abortion and fertility data for England and Wales between 1968 and 1980 shows that the age-specific abortion rates increased from 1968 until about 1973 when the rates peaked for all ages; rates then declined until 1977 but have subsequently returned to higher levels. Two factors are implicated: (1) the recent changes are related to parallel changes in the fertility rate; but (2) there is also a tendency for recent cohorts of women to resort to abortion more readily. These relationships are derived from analyses of fertility rates and abortion ratios, the proportion of conceptions that result in abortions. The results are discussed in terms of attitudes and practices related to birth control.     

Work schedule during pregnancy and spontaneous abortion

BACKGROUND: There is inconsistent evidence as to whether work schedule (including rotating shifts and night work) can affect reproductive outcomes. METHODS: We investigated the association between work schedule and risk of spontaneous abortion in U.S. nurses. The Nurses' Health Study II is a prospective cohort study established in 1989. In 2001, information about occupational activities and exposures during pregnancy was collected from female nurses for the most recent pregnancy since 1993. Of 11,178 eligible respondents, 9547 (85%) indicated willingness to participate in the occupational study, and 8461 of those (89%) returned the questionnaire, for an overall participation rate of 76%. Of these, 7688 women had pregnancies that were eligible for analysis. RESULTS: Participants reported 6902 live births and 786 (10%) spontaneous abortions. Compared with women who reported usually working "days only" during their first trimester, women who reported usually working "nights only" had a 60% increased risk of spontaneous abortion (RR = 1.6; 95% confidence interval [CI] = 1.3-1.9). A rotating schedule, with or without night shifts, was not associated with an increase in risk (RR = 1.2 [CI = 0.9-1.5] and 1.0 [CI = 0.8-1.2], respectively). Women who reported working more than 40 hours per week during the first trimester were also at increased risk of spontaneous abortion (1.5; 1.3-1.7) compared with women working 21-40 hours, even after adjustment for work schedule. CONCLUSIONS: Nightwork and long work hours may be associated with an increased risk of spontaneous abortion. Further studies are needed to determine whether hormonal disturbances attributed to night work affect pregnancy outcome.     

Deprivation and variations in teenage conceptions and abortions in England

There are substantial variations between local authorities in the conception rate of teenagers and the proportion of these that end in abortion. This study builds two deprivation models that explain part of the variation in conceptions and abortions. It then identifies outliers, local authorities with teenage conception and abortion rates that are above or below those predicted by the model. It is suggested that the local authorities with lower than expected conceptions are the ones to look to when seeking to discover how to prevent teenage conceptions and those with higher than expected abortion rates may have abortion services that are more accessible. In general, spatial comparisons of conceptions and abortion should take into account variations in deprivation.     

Deliveries, abortion and HIV-1 infection in Rome, 1989–1994

The prevalence of HIV-1 among women of reproductive age is currently estimated at the time they give birth. We assessed HIV-1 prevalence at the end of pregnancy, whether they delivered or had an induced or spontaneous abortion. Women admitted at the end of pregnancy to hospitals in the Lazio Region, Italy, were tested for antibodies to HIV-1. Consent for testing was granted by 97.1% of 218,357 subjects; women who did not consent were tested anonymously. The prevalences of infection were 0.34% in 1989, 0.38% in 1990, 0.28% in 1991, 0.23% in 1992, 0.28% in 1993, and 0.24% in 1994. Significantly higher prevalences of infection were associated with induced abortion (0.49%) than with delivery (0.18%; OR: 2.72; 95% CI: 2.29–3.22) and among women who refused (0.85%) than among those who consented to testing (0.27%; OR: 3.14; 95% CI: 2.35–4.19). A significant temporal reduction in prevalence was observed only among women who delivered (0.15% in 1993 and 1994; 0.26% in 1989 and 1990). The prevalence of HIV-1 infection is thus higher among women undergoing induced abortions than among those who deliver and higher among women who refuse testing than among those who consent. Studies confined to neonatal testing or to voluntary testing of pregnant women would thus underestimate the prevalence of HIV-1 among women of reproductive age.