Skip to main content

Currently Skimming:

4 Long-Term Health Effects
Pages 129-158

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 129...
... This chapter reviews research on the long-term physical and mental health effects of having an abortion.1 The focus is on four putative areas of potential harm: • future childbearing and pregnancy outcomes (e.g., secondary infer tility; ectopic pregnancy; spontaneous abortion and stillbirth; com plications of pregnancy; and preterm birth, small for gestational age, and low birthweight) ; • risk of breast cancer; • mental health disorders; and • premature death.
From page 130...
... . Sources of Bias Observational studies of abortion's long-term health effects have two important sources of information bias: selective recall bias and selection bias.
From page 131...
... . Recall bias is best addressed by using registry or medical record data to document prior abortions and link the abortion histories with reliable records of subsequent patient outcomes.
From page 132...
... Much of the research on abortion's long-term effects has been conducted outside the United States, and a substantial volume of literature is based on abortion care in countries where such factors as socioeconomic conditions, culture, population health, health care resources, and/or the health care system are markedly different from those in the United States. In addition to the other selection criteria listed below, the committee determined the applicability of published research based on the likelihood that the abortion interventions examined reflected contemporary abortion care in the United States (e.g., in European countries)
From page 133...
... FUTURE CHILDBEARING AND PREGNANCY OUTCOMES Many women are likely to desire and experience a future pregnancy after having had an abortion. Abortion has been investigated for its potential effect on secondary infertility; ectopic pregnancy; spontaneous abortion and stillbirth; pregnancy complications that can lead to adverse maternal or fetal health; and preterm birth, low birthweight, and/or weight that is small for gestational age.
From page 134...
... Pregnancy Complications The committee identified three primary research studies4 that used documented records of receipt of an abortion to assess the effect of abortion 4The committee identified a fourth study that used Danish registry data to assess the effects of abortions performed from 1980 to 1982 on subsequent pregnancy complications. This study, by Zhou and colleagues (2001)
From page 135...
... Hypertension of pregnancy includes preeclampsia and chronic and gestational hypertension. It is associated with increased risk of both maternal complications, such as placental abruption and gestational diabetes, and poor birth outcomes, such as preterm birth, having a baby that is small for gestational age, and infant death (CDC, 2016)
From page 136...
... 136 THE SAFETY AND QUALITY OF ABORTION CARE IN THE UNITED STATES TABLE 4-1 Studies Assessing the Association Between Abortion and Subsequent Pregnancy Complications Using Record-Linkage Methods Location Author (year) (time period)
From page 137...
... Cesarean sectionj 0.94 (0.66–1.35) n/a n/a n/a Odds ratios not reported; outcomes reported as percentages (abortion versus control)
From page 138...
... . However, unlike the other outcomes the researchers investigated (e.g., see the above review of hypertensive disorders and preterm birth)
From page 139...
... See Table 4-2 for further details on study designs and results. Do Early-Gestation Aspiration or Medication Abortions Increase the Risk of Preterm Birth?
From page 140...
... , and Small for Gestational Age (SGA) Using Record-Linkage Methods Adjusted Odds Ratios (Confidence Intervals)
From page 141...
... for maternal age, marital status, maternal smoking, maternal residence of municipality, and birth year 0.99 (0.94–1.05) n/a SGA of child.
From page 142...
... previous abortion abortions n = 264,190 n = 36,442
From page 143...
... maternal age at delivery, smoking, and social class.
From page 144...
... , and that controls were lacking for important variables, including race, socioeconomic status, smoking, and prior uterine surgery (including dilation and curettage) (Jackson et al., 2007, Table 1)
From page 145...
... LONG-TERM HEALTH EFFECTS 145 Adjusted Odds Ratios (Confidence Intervals) All PTB Spontaneous <37 Weeks PTB <37 Weeks LBW or SGA Notes n/a n/a n/a Odds ratios not reported; outcomes reported as percentages (abortion versus control)
From page 146...
... . Controlling for maternal age, multiparity, prior preterm birth, first-trimester dilation and curettage, firsttrimester spontaneous delivery, and prior cervical surgery, the researchers found no significant difference in the risk of a later spontaneous preterm birth between the groups of women with a prior D&E abortion and no prior abortion.
From page 147...
... The researchers found a dose-response relationship between the number of prior abortions before a first birth and an increased risk of very preterm birth (<28 weeks' gestation) 6 after two abortions (aOR = 1.69; 95% CI = 1.14, 2.51)
From page 148...
... However, much of this literature, including systematic reviews, meta-analyses, and primary research, is flawed by recall bias and lack of controls for such clinically important confounding factors as age at first live birth. The risk of hormone receptor-positive breast cancer increases with a woman's age at first full-term pregnancy (NCI, 2016)
From page 149...
... The committee identified a wide array of research on mental health outcomes, including systematic reviews (Bellieni and Buonocore, 2013; Charles et al., 2008; Coleman, 2011; Fergusson et al., 2013; Major et al., 2008, 2009; NCCMH, 2011) , prospective cohort studies (Biggs et al., 2015, 2016, 2017; Foster et al., 2015; Munk-Olsen et al., 2011)
From page 150...
... . The committee identified several more recent studies that met its selection criteria but were published after the NCCMH and other systematic reviews (Biggs et al., 2015, 2016, 2017; Foster et al., 2015; Leppalahti et 9The committee did not examine the literature on the mental health consequences of terminations of pregnancies due to fetal abnormalities.
From page 151...
... . Four recent articles draw on the Turnaway study, a prospective longitudinal cohort study designed to address many of the limitations of other studies (Biggs et al., 2015, 2016, 2017; Foster et al., 2015)
From page 152...
... As a result of the inability to control for the many ways in which women who have unwanted pregnancies differ from those who do not, no clear conclusions regarding the association between abortion and long-term mortality can be drawn from these studies. SUMMARY This chapter has reviewed the epidemiological evidence on abortion's long-term effects on future childbearing and pregnancy outcomes, risk of breast cancer, mental health disorders, and premature death.
From page 153...
... in a woman's first birth was found to be associated with having two or more prior aspiration abortions compared with first births among women with no abortion history; the risk appears to be associated with the number of prior abortions. Preterm birth is associated with pregnancy spacing after an abortion: it is more likely if the interval between abortion and conception is less than 6 months (the same is also true of pregnancy spacing in general)
From page 154...
... Findings from a prospective longitudinal cohort study. British Medical Journal Open 6(2)
From page 155...
... 2017. Increased risk of premature death following teenage abortion and childbirth: A longitudinal cohort study.
From page 156...
... 2012. Adolescent depressive symptoms and subsequent pregnancy, pregnancy completion and pregnancy termination in young adulthood: Findings from the Victorian Adolescent Health Cohort Study.
From page 157...
... 2016. Interpregnancy interval after live birth or pregnancy termination and estimated risk of preterm birth: A retrospective cohort study.
From page 158...
... 2016. Risk factors associated with preterm birth after a prior term delivery.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.