Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.

OBJECTIVES: The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. METHODS: Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression. RESULTS: The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. CONCLUSIONS: No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.     

Young women's education and behavioural risk trajectories: clarifying their association with unintended-pregnancy resolution

In the USA, most pregnancies occurring to teenage women are unplanned, making both the decisions regarding their resolution and the consequences of those decisions important topics of inquiry. Substantial debate surrounds the potential consequences for young women of either carrying an unintended pregnancy to term or voluntarily terminating it. The present study utilises data from The US National Longitudinal Study of Adolescent Health prospectively to examine the predictors of pregnancy resolution decisions in terms of young women's educational goals and their engagement in risk behaviours. Additionally, the long-term consequences of these decisions for education and risk-taking behaviours are identified. Results indicate that young women with strong educational goals have a greater likelihood of terminating an unintended pregnancy than those with low aspirations, and that pregnancy termination predicts higher educational attainment compared to motherhood. Risk behaviours did not predict pregnancy-resolution decisions, but young women who became mothers reported lower rates of subsequent substance use and fewer sexual partners post-pregnancy than those who terminated the pregnancy or who had never been pregnant. Motherhood appears to be a catalyst for lifestyle change among young women, limiting substance use and sexual partnering, in contrast to abortion, which appears to allow adolescents to continue risk-taking trajectories.     

Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling

PURPOSE: Low birth weight (LBW), preterm births, abnormal placentation, and miscarriages have been associated with prior induced abortions. An incidence-related effect has been suggested. The objective of this study is to assess the effects of prior induced abortions on obstetric risk factors and pregnancy outcome in conditions of free high-standard maternity care used by almost the entire pregnant population in Finland. METHODS: We analyzed a population-based database including 26,976 singleton pregnancies from 1989 to 2001, of which 2364 were among women with one prior induced abortion and 355 women had had at least two prior induced abortions. Data included maternal risk factors, pregnancy characteristics, and obstetric outcome measures and were based on results of a self-administered questionnaire at 20 weeks of pregnancy and clinical records. Odds ratios (ORs) concerning pregnancy outcomes were calculated in multiple logistic regression analysis. RESULTS: Induced abortions were associated with several known pregnancy risk factors; specifically, maternal age older than 35 years, unemployment, unmarried status, low educational level, smoking, alcohol consumption, overweight condition, and chronic illnesses. Preterm birth (OR, 1.19; 95% confidence interval, 1.01-1.41) in women with one prior abortion (7.3% versus 6.2%) and LBW (OR, 1.54; 95% confidence interval, 1.02-2.32) in women with two or more prior abortions (7.0% versus 4.7%) appeared to be more common, but after logistic regression analysis, we found no evidence of adverse pregnancy outcomes. CONCLUSIONS: Induced abortion is not an independent risk factor for adverse obstetric outcome. Marked health behavioral pregnancy risks are associated with prior induced abortions. Health counseling of these women is a challenge, but this objective has not yet been achieved.     

Unintended pregnancy among American women

This research note presents new estimates of the proportion of American women of reproductive age who experience unintended pregnancies, unintended births and abortions. The data are based on tabulations from the 1982 National Survey of Family Growth (NSFG) and the Alan Guttmacher Institute's 1981-1982 national survey of abortion providers. Of 6.1 million women who became pregnant in 1982, 3.7 million gave birth, 1.6 million had abortions and 0.9 million experienced miscarriages. An estimated 37% of all births in the 5 years preceding the 1982 NSFG were unintended. Applying that proportion to 1982 births results in an estimate of 1.3 million unintended births. It can be assumed that all 1.6 million abortions were terminations of unintended pregnancies. Respondents in the 1982 NSFG reported that 40% of the births they had ever had were unintended. 33% of NSFG respondents said that they had had at least 1 unintended birth during their life. Abortions were seriously underreported in the NSFG, as they have been in most other surveys. Only 47% of the abortions that occurred during the period 1977-1981 were reported. The real proportion of women of reproductive age who have ever had an abortion appears to be 21%. 65% of all women aged 40-44 in 1982 had had at least 1 unintended pregnancy, and more than 1/3 of them had had at least 1 abortion. It is probably inappropriate to view these levels as representative of the proportions of today's young women who will ever experience an unintended pregnancy or abortion. Estimates of the proportion of women who will have had abortions by age 45 indicate that 18% of women will have had a 1st abortion by age 20; 41% will have had one by age 30; and 46%, by age 45.     

Social and Emotional Adjustment Following Early Pregnancy in Young Australian Women: A Comparison of Those Who Terminate,Miscarry, or Complete Pregnancy

PurposeTo compare social and emotional adjustment including educational attainment and substance use in women who had a child, pregnancy termination, or miscarriage by young adulthood.MethodsData were from a population-based longitudinal study of the health and well-being of 1,943 young Australians (Victorian Adolescent Health Cohort Study) followed from 15 to 24 years of age. The sample was restricted to female participants and based on pregnancies reported by age 24 years. Analyses were adjusted for early teenage depressive symptoms, cigarette smoking, alcohol use, cannabis use, and parent socioeconomic context.ResultsA total of 208 pregnancies (in 170 women) were reported from a sample of 824 young women by 24 years of age. Compared with those who had never been pregnant, those who had a child had lower tertiary education completion and a higher risk of nicotine dependence; those who terminated a pregnancy were more commonly single and had a higher risk of smoking and alcohol use as well as nicotine and alcohol dependence; and those who had a miscarriage had a higher risk of depressive symptomatology and binge drinking as well as nicotine and cannabis dependence.ConclusionsYoung women who have been pregnant by their mid-twenties report a range of difficulties in social and emotional adjustment that vary across the different pregnancy outcomes. Broad-based psychosocial health care is essential not only for young women whose pregnancies proceed to live birth, but also for those whose pregnancies end with miscarriage or induced abortion.     

Exploring the link between substance abuse and abortion: the roles of unconventionality and unplanned pregnancy

CONTEXT: Several studies have found a relationship between abortion and prior substance use, suggesting that a reduction in substance use might help decrease abortion rates. However, such a conclusion requires a greater understanding of the processes linking abortion and prior substance use. METHOD: Path analysis of longitudinal data from 1,224 women was used to simultaneously test two pathways from adolescent substance use to abortion by age 29, one mediated by higher rates of unplanned pregnancy and the other independent of unplanned pregnancy rates. The model was then expanded to examine how these pathways change when unconventional attitudes and behaviors (such as rebelliousness and low religiosity) are taken into consideration. RESULTS: In the analysis that did not control for unconventionality, women who reported smoking cigarettes or using marijuana or hard drugs at age 18 had an increased likelihood of subsequent unplanned pregnancy and, as a result, higher rates of abortion. In addition, women who had used marijuana had an increased likelihood of abortion independent of unplanned pregnancy rates. In the final model, unconventionality strongly predicted both abortion and unplanned pregnancy. Moreover, it explained the associations between the use of hard drugs or marijuana and abortion that were due to higher unplanned pregnancy rates. CONCLUSIONS: Unconventionality mediates certain associations between substance use and abortion, perhaps because unconventional women are more likely both to use substances and to engage in behaviors that increase their risk of unplanned pregnancy. Hence, it seems unlikely that reducing substance use will result in substantially fewer abortions.     

Ectopic pregnancy and prior induced abortion.

We compared the prior pregnancy histories of 85 multigravid women with an ectopic pregnancy and 498 multigravid delivery comparison subjects. We found a relationship between the number of prior induced abortions and the risk of ectopic pregnancy: the crude relative risk of ectopic pregnancy was 1.6 for women with one prior induced abortion and 4.0 for women with two or more prior induced abortions; however, use of multivariate techniques to control confounding factors reduced the relative risks to 1.3 (95 per cent confidence interval, 0.6-2.7) and 2.6 (95 per cent confidence interval, 0.9-7.4), respectively. The analysis suggests that induced abortion may be one of several risk factors for ectopic pregnancy, particularly for women who have had abortions plus pelvic inflammatory disease or multiple abortions.     

When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy

A group of 360 black teenage women of similar socioeconomic background who sought pregnancy tests from two Baltimore family planning providers was followed for two years to determine if those who obtained abortions were adversely affected by their abortion experience. After two years, the young women who had terminated their pregnancies were far more likely to have graduated from high school or to still be in school and at the appropriate grade level than were those who had decided to carry their pregnancy to term or those whose pregnancy test had been negative. Those who had obtained an abortion were also better off economically than were those in the other two groups after two years. An analysis of psychological stress showed that those who terminated their pregnancy had experience no greater levels of stress or anxiety than had the other teenagers at the time of the pregnancy test, and they were no more likely to have psychological problems two years later. The teenagers who had obtained abortions were also less likely than the other two groups to experience a subsequent pregnancy during the following two years and were slightly more likely to practice contraception. Thus, two years after their abortions, the young women who had chosen to terminate an unwanted pregnancy were doing as well as (and usually better than) those who had had a baby or who had not been pregnant.     

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.     

Abortion, contraceptive use, and adolescent pregnancy among first-year medical students at a major public university in Mexico City.

OBJECTIVE: If properly trained, medical students could become future opinion leaders in health policy and could help the public to understand the consequences of unwanted pregnancies and of abortions. The objective of this study was to analyze the frequency of unwanted pregnancies and induced abortions that had occurred among women who were first-year medical students at a major public university in Mexico City and to compare the experiences of those women with the experiences of the general population of Mexican females aged 15 to 24. METHODS: In 1998 we administered a cross-sectional survey to all the first-year medical students at the National Autonomous University of Mexico, which is the largest university in Latin America. For this study we analyzed 549 surveys completed by female students. RESULTS: Out of the 549 women, 120 of them (22%) had been sexually active at some point. Among those 120 sexually active students, 100 of them (83%) had used a contraceptive method at some time, and 19 of the 120 (16%) had been pregnant. Of those 19 women who had been pregnant, 10 of them had had an illegal induced abortion (in Mexico, abortions are illegal except under a small number of extenuating circumstances). The reported abortion rate among the female medical students, 2%, was very low in comparison with the 11% rate for women of similar ages in the Mexican general population. CONCLUSIONS: The lower incidence of abortion among the female medical students indicates that when young Mexican women have access to medical information and are highly motivated to avoid unintended pregnancy and abortion, they can do so.     

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.     

‘You just have to learn to keep moving on’: young women’s experiences with unplanned pregnancy in the Cook Islands

The Cook Islands is one of several countries in the Pacific region that has high rates of teenage pregnancy and birth. While the social determinants of pregnancy and early motherhood are well established in the global context, little is known about how Cook Islands young women who become pregnant before age 20 make sense of their experiences. Drawing on individual interviews with a purposive sample of 10 young mothers, this paper examines the phenomenology of early pregnancy from their perspectives. Structural, cultural and individual factors emerged as salient themes in participants’ accounts. Qualitative analysis revealed that nearly all the pregnancies were unplanned and every participant reacted negatively when she learned she was pregnant. While some participants wanted to terminate their pregnancies, lack of access to safe, legal and affordable abortion care limited their options. Ultimately, while nearly all participants wished they had been able to delay motherhood, they expressed happiness and pride about their new-found status as mothers. These findings allow for a fuller understanding of factors shaping young women’s experiences of pregnancy in the Cook Islands, which have policy implications for reproductive health and rights.     

Factors related to induced abortion among young women in Edo State, Nigeria

Sub-Saharan Africa has the highest death rate from induced abortion in the world, and young women in southern Nigeria are particularly likely to terminate their pregnancies. This study assesses the prevalence of and factors associated with induced abortion among 602 young women aged 15-24 who were surveyed in Edo State, Nigeria, in 2002. We find that 41 percent of all pregnancies reported by the young women surveyed were terminated, and we estimate the age-specific abortion rate for 15-19-year-olds in Edo State at 49 abortions per 1,000 women, which is slightly higher than previous local estimates and nearly double the countrywide estimate for women aged 15-49. We construct explanatory multivariate models to predict the likelihood that a young woman has experienced sexual intercourse, has become pregnant, and has undergone an induced abortion, controlling for important demographic and risk-behavior factors. Young women unmarried at the time of the interview are found to be significantly more likely than married women to have had an abortion. Young women who have experienced transactional or forced sex are also significantly more likely to report ever having had an abortion, as are young women who have experienced more than one pregnancy. We conclude with suggestions for modifying the content and target populations of behavioral change messages and programs in the area.     

陕西省咸阳地区贫困农村育龄妇女自然流产状况调查

目的了解陕西省贫困农村育龄妇女自然流产状况及其相关因素。方法于2002—2005年间对陕西省长武县、彬县的农村怀孕妇女进行入户访问获得孕产妇的既往生育史,并对孕妇进行随访,直至获得本次妊娠结局。结果共随访5844例孕产妇,总妊娠次数为9638次,其中1153次为自然流产。孕产妇自然流产妊娠比为12.0%,自然流产率为13.6%,发生自然流产的比例为16.4%。随着妇女年龄的增加、妊娠次数的增加等,育龄妇女发生自然流产的危险性也在增加。结论加强计划生育,减少妊娠次数,延长生育间隔,防止高龄怀孕将有助于降低陕西省贫困农村育龄妇女自然流产的发生水平。     

Repeat abortion: is it a problem?

As the number of Canadian women who have had induced abortions increases with each succeeding year, the number at risk--and the actual incidence--of repeat abortion also increases. Some researchers have argued that women who have more than one induced abortion are less well adjusted, others that they are less willing to use contraceptives, perhaps because of anxiety about sexuality. Still others have suggested that repeat abortion is unrelated to the psychology or attitudes of individual women, but rather is an inevitable result of imperfect contraceptives, imperfect contraceptive practice and the availability of legal abortion for the termination of unwanted pregnancies. A group of 580 women seeking abortions were interviewed at the Montreal General Hospital and given a number of psychological tests. About one in five of these women were having repeat abortions. The women having repeat abortions were older, less likely to be married and more tolerant of legal abortion than were women having their first abortions. They also had intercourse more frequently than the first-abortion patients. Women obtaining a repeat abortion were slightly more likely to have been using contraceptives at the time they became pregnant, but they did not differ from first-abortion patients in the types of methods that they used. On no other social or demographic characteristics, measures of psychological adjustment or attitudes about sexuality were there any important differences between the groups. A more complex statistical analysis reveals that the two most important factors differentiating first-abortion and repeat-abortion patients are age and coital frequency--both of which are variables that reflect added exposure to the risk of unintended pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)     

The place of abortion in the pregnancy decision‐making process in young adult women in Catalonia,Spain

Induced abortion is one option to control fertility in Spain. Young adult women (25–34 years old) show a different abortion pattern compared to women in other age groups, being less likely to seek abortions than younger women and having one of the lowest proportions of unintended pregnancies. We aimed to analyse the factors involved in the pregnancy decision‐making process to better understand why young adult women seek abortions in Catalonia, Spain. In‐depth semi‐structured interviews with 25 nulliparous pregnant young adult women and one focus group discussion with healthcare providers were conducted in 2008/2010. We found that inconsistent contraceptive use prior to an unintended pregnancy was due to ambivalence and weighing of priorities during sex. The quality of the relationship was paramount to the abortion decision whereas other reasons (financial/employment status, fulfilling aspirations, support networks) were less important. We conclude that the motivations for the abortion decision are interrelated and based on the current life stage of women and that there is pressure on young adult women in Spain to become mothers. Induced abortion is perceived as the last resort to postpone motherhood. Our findings reinforce the unequal societal burden placed on women to take responsibility for prevention of unintended pregnancy.     

Pregnancies,Abortions, and Births among Women with and without Borderline Personality Disorder

BackgroundThe purpose of this study was to examine history of pregnancies among women with and without borderline personality disorder (BPD), to determine whether BPD symptoms are associated with teenage pregnancies, unplanned pregnancies, elective and spontaneous abortions, and live births.MethodsThree hundred seventy-nine women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses, Structured Interview for DSM-IV Personality for Axis II diagnoses, and a reproductive health interview. African-American (AA) women were oversampled, because little is known about BPD in AA women and they are at greater risk of teenage pregnancy, unplanned pregnancies, and spontaneous abortions.ResultsBPD symptom severity was associated with a teenage pregnancy, even after controlling for race and socioeconomic status. Symptom severity was also associated with unplanned pregnancies and live births, but only for women without a history of a substance use disorder. BPD symptom severity was not associated with abortion.ConclusionWomen with BPD become pregnant and have children, often during the period when BPD symptoms emerge and intensify. They are at increased risk of teenage pregnancies and unintended pregnancies compared with women with Axis I disorders. Treatment planning for this population should include attention to their reproductive health and better integration of physical and mental health services.     

Contraceptive behavior of Jerusalem women seeking pregnancy counseling, 1980-1989.

BACKGROUND: Inconsistencies between intent and action in the area of birth control are often attributed, in both theory and medical practice, to female ignorance and lack of contraceptive skills. In the light of prevailing theories, this survey examines the contraceptive behavior of 1,425 Jerusalem clients of the Pregnancy Counseling and Follow-up Service. METHODS: The majority of clients were "in crisis" due to unplanned pregnancies and had turned to the counseling service for help in crisis resolution. The data are based on intake questionnaires and clinical records filled in by counselors. Recorded information included age, education, marital status, religious observance, previous pregnancies and abortions, contraceptives ever used and methods used prior to pregnancy, age of fetus, initial attitude, treatment process, and outcome. RESULTS: The results suggest that the women in the sample became pregnant not because they lacked the skills to avoid it, but because they failed to use those skills effectively. Younger, unmarried, and less educated women and those with many children were especially prone to risk-taking. They also waited longer than others before turning to counseling.     

Safety and immunogenicity of HepB-CpG in women with documented pregnancies post-vaccination: A retrospective chart review

BackgroundThere are currently no published data on the use of HepB-CpG (HEPLISAV-B®) during pregnancy or in women with documented pregnancies in the post-vaccination period. We aimed to evaluate data from the clinical development program of HepB-CpG in women who became pregnant during study participation and follow up.MethodsWe identified all study participants in the HepB-CpG pivotal pre-licensure clinical trials that had documented pregnancies during study follow up. We measured immunogenicity among study participants in the HepB-CpG (Heplisav-B®) arm compared to the HepB-alum (Engerix-B®) arm of the studies by comparing seroprotection rates (SPRs; anti-HBs ≥ 10 mIU/mL) and geometric mean concentrations (GMCs) of anti-HBs, obtained with FDA approved anti-HBsAg antibody assays at prespecified time points up to 28 weeks of follow up. Pregnancy outcomes were ascertained by chart review of extracted medical records of study participants.ResultsWe identified 40 documented pregnancies in the HepB-CpG arm and 19 documented pregnancies in the HepB-alum arm. Among subjects with documentation of seroprotection rates, 97.2% (95% CI 85.5–99.9) were seroprotected in the HepB-CpG arm and 66.7% (95% CI 41.0–86.7) were seroprotected in the HepB-alum arm. In the HepB-CpG arm, thirty-six study participants from the pivotal trials had reported pregnancy outcomes, the majority, 21/36 (58%) had a healthy term delivery, with 3/36 (8%) with spontaneous abortions, 1/36 (3%) congenital anomaly, and 2/36 (6%) had preterm birth. In the HepB-alum arm, 10/17 (59%) had healthy term deliveries, with 2/17 (12%) had spontaneous abortions and 1/17 (6%) had congenital anomaly.ConclusionsThese limited data suggest that HepB-CpG is immunogenic in women who become pregnant after vaccination, and pregnancy outcomes appear to be similar to women who received HepB-alum prior to pregnancy. These results need to be further verified with larger prospective studies with HBV vaccine administration during pregnancy.