2006 Institute of Medicine Report
Reference: Preterm Birth: Causes, Consequences, and Prevention,” (National Academy of Science Press, July 06)
This major publication has been applauded by ACOG, SART, and ASRM as an exceptional and comprehensive work on the problem of preterm birth.. ACOG is a co-sponsor of this work.
With a careful search, one will find a single reference to induced abortion as a risk factor for PreTerm Birth, found in the Appendix, on page 517-18, where abortion is noted as an “immutable” risk factor (meaning, once this pregnancy has started, there is no intervention to correct for the increased risk. Example of immutable factor: Congenital incompetent cervix). Obviously, in the case of induced abortion, this risk factor is totally avoidable, if the woman is given adequate informed consent prior to the abortion and chooses NOT to have the abortion. The truth is, induced abortion is a preventable risk factor for future preterm birth: Do not have the abortion, and you will not have the associated increased risk of preterm birth.
The Report contains this additional very significant information on preterm birth:
African-American women and PTB and abortion
“African-American women deliver their infants before 37 weeks of gestation twice as often as women of other races, and deliver their infants before 32 weeks of gestation three times as often as white women. . .” “Findings related to SES (socioeconomic status) suggest that the disparities in the rates
of preterm birth between African-American and white women persist after attempts to adjust for socioeconomic differences (Collins and David, 1997; McGrady, 1992; Shiono, 1997; Schoendorf, 1992).”
“Other behavioral and social differences between African-American and white women have been evaluated as potential causes of the disparity in preterm birth rates. Proportionately fewer African-American women smoke cigarettes (Lu, 2005; Beck et al., 2002; Ebraham, 2000)and their rate of use of drugs and alcohol is no higher than white women’s (Serdula 1991).”
Isn’t it interesting that preterm birth rates are increased for African-Americans even when socio-economic-behavioral status is taken into account? Further, smoking, which has been associated with preterm birth, is less in the African-American pregnant population. But the induced abortion rate is three times higher among African-American women than among other American women. Might this influence their increased preterm birth rates?
Regarding “very” preterm and “extreme” preterm births and the IOM Report
The recent European prospective studies have demonstrated a stronger association of induced abortion with ‘very” (<32 wk) preterm birth compared to preterm birth overall (as do many of the previous studies). The IOM report establishes the fact that Black women have triple the rate of “very” preterm birth (<32 Wk) than white women. National statistics establish the fact that 12% of the population is Black, while 33% of induced abortions are done on Black women. Simple arithmetic establishes the fact that Black women, per capita, have about triple the rate of induced abortion as white women.
In summary: Black women have 3 times the rate of induced abortion. Black women have 3 times the rate of “very” preterm labor. SES and behavioral factors do not account for the difference. These facts should not be ignored. This strong association should be studied. Perhaps ACOG could share their IOM findings with the March of Dimes, who might, in turn, share it with the women they seek to help to prevent this difficult outcome. (The word “abortion” does not appear on the March of Dimes website material on preterm birth.)
It is true that none of this establishes with certainty a specific cause–and-effect
relationship, but shouldn’t this at least raise some intellectual research curiosity among those who day-in and day-out study this problem?
The IOM document repeatedly says that there are multiple and overlapping factors involved in the etiology of preterm birth. The writers spend a lot of time exploring things like environmental tobacco exposure, lead exposure, maternal stress/anxiety and so forth—-all things which are in some ways harder to assess scientifically for a relationship to preterm birth than it would be to assess for induced abortion relationship to preterm birth. AAPLOG (and common sense) would suggest that if exposure to toxic levels of lead are worth study, how much more is the association of PTB with abortion worthy of study. Why are abortion rates basically ignored in discussions of risk factors associated with preterm birth. Would this not be a fitting—indeed, a crucial– subject for research?