Amer J Perinatol 2014; 31(09): 765-772
DOI: 10.1055/s-0033-1358771
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Adverse Pregnancy Outcomes among Women with Prior Spontaneous or Induced Abortions

Michel A. Makhlouf1, Rebecca G. Clifton2, James M. Roberts3, Leslie Myatt4, John C. Hauth5, Kenneth J. Leveno6, Michael W. Varner7, John M. Thorp Jr.8, Brian M. Mercer9, Alan M. Peaceman10, Susan M. Ramin11, Jay D. Iams12, Anthony Sciscione13, Jorge E. Tolosa14, Yoram Sorokin15, for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network
  • 1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
  • 2The George Washington University Biostatistics Center, Washington, DC
  • 3Department of Obstetrics and Gynecology University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
  • 5Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
  • 6Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
  • 7Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
  • 8Department of Obstetrics and Gynecology University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • 9Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
  • 10Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
  • 11Department of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas
  • 12Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
  • 13Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
  • 14Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
  • 15Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
Further Information

Publication History

05 September 2013

19 September 2013

Publication Date:
17 December 2013 (eFirst)


Objective The aim of the article is to determine whether prior spontaneous abortion (SAB) or induced abortion (IAB), or the interpregnancy interval are associated with subsequent adverse pregnancy outcomes in nulliparous women.

Methods We performed a secondary analysis of data collected from nulliparous women enrolled in a completed trial of vitamins C and E or placebo for preeclampsia prevention. Adjusted odds ratios (ORs) for maternal and fetal outcomes were determined for nulliparous women with prior SABs and IABs as compared with primigravid participants.

Results Compared with primigravidas, women with one prior SAB were at increased risk for perinatal death (adj. OR, 1.5; 95% CI, 1.1–2.3) in subsequent pregnancies. Two or more SABs were associated with an increased risk for spontaneous preterm birth (PTB) (adj. OR, 2.6, 95% CI, 1.7–4.0), preterm premature rupture of membranes (PROM) (adj. OR, 2.9; 95% CI, 1.6–5.3), and perinatal death (adj. OR, 2.8; 95% CI, 1.5–5.3). Women with one previous IAB had higher rates of spontaneous PTB (adj. OR, 1.4; 95% CI, 1.0–1.9) and preterm PROM (OR, 2.0; 95% CI, 1.4–3.0). An interpregnancy interval less than 6 months after SAB was not associated with adverse outcomes.

Conclusion Nulliparous women with a history of SAB or IAB, especially multiple SABs, are at increased risk for adverse pregnancy outcomes.


The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD34208, HD27869, HD40485, HD40560, HD40544, HD34116, HD40512, HD21410, HD40545, HD40500, HD27915, HD34136, HD27860, HD53118, HD53097, HD27917, and HD36801); the National Heart, Lung, and Blood Institute; and the National Center for Research Resources (M01 RR00080, UL1 RR024153, UL1 RR024989) and its contents do not necessarily represent the official view of NICHD, NHLBI, NCRR, or NIH.