AAPLOG comments on the huge 2011 paper from China by Liao et al, “Repeated medical abortions and the risk of preterm birth in the subsequent pregnancy,” Arch Gynecol Obstet (2011) 284:579–586: This study reported on more than 18,000 women in seven hospitals, over 4 years- comparing over 7,000 women who had had abortions, with over 10,000 who had not. Nulliparous women who had an abortion were divided into 5 comparison groups: 1. One Medical abortion, 24% ; 2. More than one medical abortion, 7.4%; 3. One Surgical abortion, 38%; 4. More than one surgical abortion, 15%; 5 Medical/surgical, 16% (ie, medical abortion requiring D&C to complete it). Compared to delivered women with no previous abortion history, the findings regarding preterm birth after surgical and/or combined surgical-medical abortions were as follows: Surgical abortions had a 40% increase in the preterm birth rate with 1 surgical abortion; a 62% increase in the preterm birth rate with greater than 3 surgical abortions (the so-called “dose effect”). These findings are very consistent with the many previous studies on abortion/preterm birth, which generally demonstrate a 30% increase in PTB following one surgical abortion, and a 70% increase after 2 surgical abortions. The “medical/surgical” abortions had a 218% increase over the “no abortion” control group. And the “very preterm” (<32 wk) rate was 361% increased! (This is also consistent with the major world studies which show that premature birth rates following abortion have an inordinate shift toward “very preterm” birth when compared to the women who have never had an abortion-- thus predisposing these babies to significantly more risk of disability/death than the “later” preterm babies would have.) The authors of the study state in their abstract, “A history of multiple first trimester mifepristone induced abortions is not associated with a higher risk of preterm delivery among singleton births in the first subsequent pregnancy.” This is a gross miscarriage of the truth. How do they get away with it? Simple. They don’t include the “failed” mifeprex (i.e., the “medical/surgical) abortions in the figures for “medical” abortions. Please note that 20% of the mifeprex abortions “failed”, ie, required a D&C to complete the abortion. In this group, called “medical/surgical” abortion, the subsequent prematurity rate was increased, as noted, by 218%, and the “very preterm birth” rate was increased by 361%. But the authors chose to bury the increased PTB rate associated with medial abortions by segregating the “failed” medial abortions into a different category, “medical/surgical.” But this is not honest. All of these (medical and medical/surgical) started out to be strictly medical. So by not including the medical/surgical category, the authors can colclude in their abstract, “A history of multiple first trimester mifepristone induced abortions is not associated with a higher risk of preterm delivery among singleton births in the first subsequent pregnancy.” Since one in five women choosing a medical abortion required a surgical procedure to complete the abortion, the authors’ conclusion (above) is simply a gross mis-statement of what the study actually reveals. Download the study (pdf, 257KB)
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