PDF herunterladen
Am 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. Makhlouf
1   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Rebecca G. Clifton
2   The George Washington University Biostatistics Center, Washington, DC
,
James M. Roberts
3   Department of Obstetrics and Gynecology University of Pittsburgh, Pittsburgh, Pennsylvania
,
Leslie Myatt
4   Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
,
John C. Hauth
5   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Kenneth J. Leveno
6   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Michael W. Varner
7   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
John M. Thorp Jr.
8   Department of Obstetrics and Gynecology University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Brian M. Mercer
9   Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
,
Alan M. Peaceman
10   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Susan M. Ramin
11   Department of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas
,
Jay D. Iams
12   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Anthony Sciscione
13   Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
,
Jorge E. Tolosa
14   Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
Yoram Sorokin
15   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network › Institutsangaben
Weitere Informationen

Publikationsverlauf

05. September 2013

19. September 2013

Publikationsdatum:
17. Dezember 2013 (online)

   Lizenzen und Reprints

Abstract

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.

Keywords

spontaneous abortion - induced abortion - maternal outcomes - neonatal outcomes

Note

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.


 

  • References

  • 1 Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M ; ANDERSEN A-MN. Maternal age and fetal loss: population based register linkage study. BMJ 2000; 320 (7251) 1708-1712
    CrossrefPubMedGoogle Scholar
  • 2 Wilcox AJ, Weinberg CR, O'Connor JF , et al. Incidence of early loss of pregnancy. N Engl J Med 1988; 319 (4) 189-194
    CrossrefPubMedGoogle Scholar
  • 3 Jones RK, Kost K, Singh S, Henshaw SK, Finer LB. Trends in abortion in the United States. Clin Obstet Gynecol 2009; 52 (2) 119-129
    CrossrefPubMedGoogle Scholar
  • 4 Atrash HK, Hogue CJ. The effect of pregnancy termination on future reproduction. Baillieres Clin Obstet Gynaecol 1990; 4 (2) 391-405
    CrossrefPubMedGoogle Scholar
  • 5 Bhattacharya S, Bhattacharya S. Effect of miscarriage on future pregnancies. Womens Health (Lond Engl) 2009; 5 (1) 5-8
    PubMedGoogle Scholar
  • 6 Bhattacharya S, Townend J, Shetty A, Campbell D, Bhattacharya S. Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy?. BJOG 2008; 115 (13) 1623-1629
    CrossrefPubMedGoogle Scholar
  • 7 Conde-Agudelo A, Belizán JM, Breman R, Brockman SC, Rosas-Bermudez A. Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. Int J Gynaecol Obstet 2005; 89 (Suppl. 01) S34-S40
    CrossrefPubMedGoogle Scholar
  • 8 Martius JA, Steck T, Oehler MK, Wulf KH. Risk factors associated with preterm (<37+0 weeks) and early preterm birth (<32+0 weeks): univariate and multivariate analysis of 106 345 singleton births from the 1994 statewide perinatal survey of Bavaria. Eur J Obstet Gynecol Reprod Biol 1998; 80 (2) 183-189
    CrossrefPubMedGoogle Scholar
  • 9 Moreau C, Kaminski M, Ancel PY , et al; EPIPAGE Group. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG 2005; 112 (4) 430-437
    CrossrefPubMedGoogle Scholar
  • 10 Swingle HM, Colaizy TT, Zimmerman MB, Morriss Jr FH. Abortion and the risk of subsequent preterm birth: a systematic review with meta-analyses. J Reprod Med 2009; 54 (2) 95-108
    PubMedGoogle Scholar
  • 11 Bhattacharya S, Smith N. Pregnancy following miscarriage: what is the optimum interpregnancy interval?. Womens Health (Lond Engl) 2011; 7 (2) 139-141
    PubMedGoogle Scholar
  • 12 Goldstein RR, Croughan MS, Robertson PA. Neonatal outcomes in immediate versus delayed conceptions after spontaneous abortion: a retrospective case series. Am J Obstet Gynecol 2002; 186 (6) 1230-1234 , discussion 1234–1236
    CrossrefPubMedGoogle Scholar
  • 13 Wyss P, Biedermann K, Huch A. Relevance of the miscarriage-new pregnancy interval. J Perinat Med 1994; 22 (3) 235-241
    CrossrefPubMedGoogle Scholar
  • 14 Basso O, Olsen J, Christensen K. Risk of preterm delivery, low birthweight and growth retardation following spontaneous abortion: a registry-based study in Denmark. Int J Epidemiol 1998; 27 (4) 642-646
    CrossrefPubMedGoogle Scholar
  • 15 Love ER, Bhattacharya S, Smith NC, Bhattacharya S. Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. BMJ 2010; 341: c3967
    CrossrefPubMedGoogle Scholar
  • 16 Roberts JM, Myatt L, Spong CY , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med 2010; 362 (14) 1282-1291
    CrossrefPubMedGoogle Scholar
  • 17 Alexander GR, Kogan MD, Himes JH. 1994-1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Matern Child Health J 1999; 3 (4) 225-231
    CrossrefPubMedGoogle Scholar
  • 18 Hammoud AO, Merhi ZO, Diamond M, Baumann P. Recurrent pregnancy loss and obstetric outcome. Int J Gynaecol Obstet 2007; 96 (1) 28-29
    CrossrefPubMedGoogle Scholar
  • 19 Jivraj S, Anstie B, Cheong YC, Fairlie FM, Laird SM, Li TC. Obstetric and neonatal outcome in women with a history of recurrent miscarriage: a cohort study. Hum Reprod 2001; 16 (1) 102-106
    CrossrefPubMedGoogle Scholar
  • 20 Reginald PW, Beard RW, Chapple J , et al. Outcome of pregnancies progressing beyond 28 weeks gestation in women with a history of recurrent miscarriage. Br J Obstet Gynaecol 1987; 94 (7) 643-648
    CrossrefPubMedGoogle Scholar
  • 21 Ancel P-Y, Lelong N, Papiernik E, Saurel-Cubizolles M-J, Kaminski M ; EUROPOP. History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey. Hum Reprod 2004; 19 (3) 734-740
    CrossrefPubMedGoogle Scholar
  • 22 Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of pre-term birth: a population study. J Matern Fetal Neonatal Med 2009; 22 (1) 1-7
    PubMedGoogle Scholar
  • 23 Lowit A, Bhattacharya S, Bhattacharya S. Obstetric performance following an induced abortion. Best Pract Res Clin Obstet Gynaecol 2010; 24 (5) 667-682
    CrossrefPubMedGoogle Scholar
  • 24 Voigt M, Henrich W, Zygmunt M, Friese K, Straube S, Briese V. Is induced abortion a risk factor in subsequent pregnancy?. J Perinat Med 2009; 37 (2) 144-149
    CrossrefPubMedGoogle Scholar
  • 25 Chen A, Yuan W, Meirik O , et al. Mifepristone-induced early abortion and outcome of subsequent wanted pregnancy. Am J Epidemiol 2004; 160 (2) 110-117
    CrossrefPubMedGoogle Scholar
  • 26 Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004; 103 (3) 551-563
    CrossrefPubMedGoogle Scholar
  • 27 Beck I. Incidence of pre-eclampsia in first full-term pregnancies preceded by abortion. J Obstet Gynaecol (Lahore) 1985; 6 (2) 82-84
    CrossrefPubMedGoogle Scholar
  • 28 Eskenazi B, Fenster L, Sidney S. A multivariate analysis of risk factors for preeclampsia. JAMA 1991; 266 (2) 237-241
    CrossrefPubMedGoogle Scholar
  • 29 Koifman A, Levy A, Zaulan Y , et al. The clinical significance of bleeding during the second trimester of pregnancy. Arch Gynecol Obstet 2008; 278 (1) 47-51
    CrossrefPubMedGoogle Scholar
  • 30 Seidman DS, Ever-Hadani P, Stevenson DK, Gale R. The effect of abortion on the incidence of pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 1989; 33 (2) 109-114
    CrossrefPubMedGoogle Scholar
  • 31 Zhu Q-X, Gao E-S, Chen A-M, Luo L, Cheng Y-M, Yuan W. Mifepristone-induced abortion and placental complications in subsequent pregnancy. Hum Reprod 2009; 24 (2) 315-319
    CrossrefPubMedGoogle Scholar
  • 32 Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL. Risk factors for severe preeclampsia. Obstet Gynecol 1994; 83 (3) 357-361
    PubMedGoogle Scholar
  • 33 Campbell DM, MacGillivray I, Carr-Hill R. Pre-eclampsia in second pregnancy. Br J Obstet Gynaecol 1985; 92 (2) 131-140
    CrossrefPubMedGoogle Scholar
  • 34 Shah PS ; Knowledge Synthesis Group on Determinants of LBW/PT births. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand 2010; 89 (7) 862-875
    CrossrefPubMedGoogle Scholar
  • 35 Fu H, Darroch JE, Henshaw SK, Kolb E ; FU H. Measuring the extent of abortion underreporting in the 1995 National Survey of Family Growth. Fam Plann Perspect 1998; 30 (3) 128-133 , 138
    CrossrefPubMedGoogle Scholar
  • 36 Bhattacharya S, Lowit A, Bhattacharya S , et al. Reproductive outcomes following induced abortion: a national register-based cohort study in Scotland. BMJ Open 2012; 2 (4)
    PubMedGoogle Scholar
  • 37 Edlow AG, Srinivas SK, Elovitz MA. Second-trimester loss and subsequent pregnancy outcomes: What is the real risk?. Am J Obstet Gynecol 2007; 197 (6) e1-e6
    PubMedGoogle Scholar
  • 38 Goldenberg RL, Mayberry SK, Copper RL, Dubard MB, Hauth JC. Pregnancy outcome following a second-trimester loss. Obstet Gynecol 1993; 81 (3) 444-446
    PubMedGoogle Scholar