Human Reproduction - Journals · Human Reproduction is the leading European journal in the field,...

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Human Reproduction is the leading European journal in the field, and is the official journal of ESHRE, the European Society of Human Reproduction and Embryology.

It features full-length peer-reviewed papers reporting original research, clinical case histories, short communications, and articles on social and ethical reproductive issues.

No other journal can offer such wide coverage of European specialists in the field of human reproduction and embryology.

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Impact Factor: 4.475Ranking: 3/79 Si: Obstetrics & Gynecology 2/28 Si: Reproductive Biology Journal Citation Reports® (Science Citation Index, ISI)

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human reproductionVolume 27, number 8 August 2012 www.humrep.oxfordjournals.org

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ORIGINAL ARTICLE Reproductive epidemiology

Birth outcomes after induced abortion:a nationwide register-based studyof first births in FinlandR. Klemetti1, M. Gissler1,2, M. Niinimaki3, and E. Hemminki11National Institute for Health and Welfare (THL), PO Box 30, 00271 Helsinki, Finland 2NHV, Nordic School of Public Health, 12133 SE-40242 Gothenburg, Sweden 3Department of Obstetrics and Gynaecology, University Hospital of Oulu, Kajaanintie 50, 90230 Oulu, Finland

*Correspondence address. Tel: +358-29-524-7265; Fax: +358-20-610-7227; E-mail: [email protected]

Submitted on May 21, 2012; resubmitted on June 26, 2012; accepted on July 9, 2012

study question: Is the perinatal health of first-born children affected by the mother’s previous induced abortion(s) (IAs)?

summary answer: Prior IAs, particularly repeat IAs, are correlated with an increased risk of some health problems at first birth; evenin a country with good health care quality.

what is known already: A positive association between IA and risk of preterm birth or a dose–response effect has been foundin some previous studies. Limited information and conflicting results on other infant outcomes are available.

study design, size and duration: Nationwide register-based study including 300 858 first-time mothers during 1996–2008 inFinland.

participants/materials, setting and methods: All the first-time mothers with a singleton birth (obtained from theMedical Birth Register) in the period 1996–2008 (n ¼ 300 858) were linked to the Abortion Register for the period 1983–2008.

main results and the role of chance: Of the first-time mothers, 10.3% (n ¼ 31 083) had one, 1.5% had two and 0.3%had three or more IAs. Most IAs were surgical (88%) performed before 12 weeks (91%) and carried out for social reasons (97%). Afteradjustment, perinatal deaths and very preterm birth (,28 gestational week) suggested worse outcomes after IA. Increased odds for verypreterm birth were seen in all the subgroups and exhibited a dose–response relationship: 1.19 [95% confidence interval (CI) 0.98–1.44]after one IA, 1.69 (1.14–2.51) after two and 2.78 (1.48–5.24) after three IAs. Increased odds for preterm birth (,37 weeks) and lowbirthweight (,2500 g and ,1500 g) were seen only among mothers with three or more IAs: 1.35 (1.07–1.71), 1.43 (1.12–1.84) and2.25 (1.43–3.52), respectively.

limitations, reasons for caution: Observational studies like ours, however large and well-controlled, will not provecausality.

wider implications of the findings: In terms of public health and practical implications, health education should containinformation of the potential health hazards of repeat IAs, including very preterm birth and low birthweight in subsequent pregnancies.Health care professionals should be informed about the potential risks of repeat IAs on infant outcomes in subsequent pregnancy.

study funding/competing interest(s): National Institute for Health and Welfare and the Academy of Finland. Nocompeting interests.

Key words: induced abortion / termination of pregnancy / birth outcomes / prematurity / low birthweight / register study

IntroductionInduced abortion (IA) is one of the most common gynecologicalprocedures performed on women but the impact of IAs onwomen’s subsequent childbearing has not yet been properly studied(van Oppenraaij et al., 2009; Lowit et al., 2010).

Many previous studies (Henriet and Kaminski, 2001; Ancel et al.,2004; Ngyen et al., 2004; Moreau et al., 2005; Freak-Poli et al.,2009; Voigt et al., 2009) and reviews (van Oppenraaij et al., 2009;Shah and Zao, 2009; Swingle et al., 2009; Lowit et al., 2010) havefound a positive association between IA and risk of preterm birth ora dose–response effect (i.e. the risk of preterm birth increased with

& The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.For Permissions, please email: [email protected]

Human Reproduction, Vol.0, No.0 pp. 1–6, 2012

doi:10.1093/humrep/des294

Hum. Reprod. Advance Access published August 29, 2012

at OU

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Human Reproduction - Journals · Human Reproduction is the leading European journal in the field,...

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