INDUCED ABORTION AND THE RISK OF SUBSEQUENT PREMATURE BIRTH: General comments reflecting the current literature
Preterm Birth has become a very significant and extremely expensive medical reality in the United States (and other countries as well). Premature birth (birth before 37 weeks) has increased 27% since 1981. In 2007 the premature (preterm, or PTB) rate in America was 12.6% of all live births (and over 17% of all African-American births).
In 2003, the American College of ObGyn and the March of Dimes foundation announced a major campaign to decrease the number of premature births in America Partnering with them in this campaign were the American Academy of Pediatrics, and the Association of Women’s Health, Obstetrics, and Neonatal Nurses.
This campaign has identified a number of risk factors of premature birth, including infection, maternal or fetal stress, , bleeding or abruption, uterine stretch, maternal age, weight, smoking, drug use, and genetic component. But, they conclude, “There is no known cause in HALF of premature births.” AAPLOG is very concerned that they fail to mention induced abortion as a risk factor. It simply does not come up on their radar screen (nor on their Website). Yet the existing medical literature strongly confirms that induced abortion may play a significant role in premature (preterm) birth (PTB) in a subsequent pregnancy. By 2008, at least 59 studies have demonstrated a statistically significant increase in premature birth or low birth weight risk in women with prior induced abortions.
The March of Dimes failure to mention induced abortion as a risk factor for preterm birth is consistent with the published position of the American College of Obstetrics and Gynecology. The ACOG Practice Bulletin #26 (April, 2001) states: “Long term risks sometimes attributed to surgical abortion include potential effects on reproductive function, cancer incidence, and psychologic sequelae. However, the medical literature, when carefully evaluated, clearly demonstrates no significant negative impact on any of these factors with surgical abortion.” This Bulletin was replaced in Oct, 2006 with Practice Bulletin #67, which does not repeat this gross misinformation. However, neither is there correction of this misinformation in any ACOG literature we have seen to date. (Dec 2008). Consistent with this position, the ACOG Amicus Brief for the 2006 Ayotte US Supreme Court Case declares authoritatively: “….. Contrary to the claims of the State and its amici, there is simply no reliable evidence that abortions are harmful to minors’ health. Extensive reviews have concluded that there are no documented negative psychological or medical sequelae to abortion among teen-aged women. Minors who obtain an abortion are not at greater risk of complications in future pregnancies, future medical problems, or future psychological problems.”
AAPLOG does not feel this sweeping conclusion can be defended in the medical literature. To the contrary, there is a very strong case in the medical literature implicating induced abortion as a risk factor for preterm birth, and as a factor in the escalating PTB rate seen over the past 30 years.
Understanding and addressing the risk factors for the preterm birth “epidemic’ is crucial because low birth weight (LBW) and preterm birth (PTB) are the most important risk factors for infant mortality or later disabilities, as well as for lower cognitive abilities and greater behavioral problems. In addition to the huge human cost, the economic cost required to properly care for these premature babies is a severe challenge to medical care system.
The sections which follow are comments on the prominent studies focusing on the association between induced abortion and risk of subsequent preterm birth, from 1993 to the present. Updated 2010.
ADDITIONAL AAPLOG COMMENTS:
The latest statistics in the USA (2007) show a preterm (less than 37 weeks) birth rate of 12.6%. Of these, Early Preterm Birth (EPB—under 32 weeks, infants weighing under 1500 grams, or about three pounds.) is at 7.8%, the highest rate in the past 30 years of stats. As noted in the studies above, previous induced abortions’ have an inordinately increased association with “extreme” (<27 wk) and “early”(<32 wk) premature deliveries (compared to 32 – 37 week premature births.) Thus, it follows that abortion will also have an inordinately increased association with cerebral palsy and other disabilities linked to extreme prematurity.
The total prematurity rate for women in America before 1970, before abortion became legal and common, was approximately 6%. It is of interest to note that in Ireland, where induced abortion is illegal, the prematurity rate in 2003 was 5.48%, less than half the U.S. rate of 12.3%. Is there a message here??
Further very interesting statistics come from the Polish experience. Between 1989 and 1993, Poland’s induced abortion rate decreased 98% due to a new restrictive abortion law. The Demographic Yearbook of Poland reports that, between 1995 and 1997 the rate of extremely preterm births (<28 weeks gestation) dropped by 21%. Is there a message here??
Induced abortion has a significant association with subsequent premature birth, and particularly “very” premature birth (i.e, before 32 weeks gestation). “Very” premature birth has a significant association with cerebral palsy and other developmental difficulties. Preemies under 32 weeks have a Cerebral Palsy rates 55 times higher that the rates for a term baby.
AAPLOG calls upon the involved medical disciplines, in particular perinatologists (MFMs) and neonatologists, to recognize this reality, and to act in the best interest of the women and babies who would be at risk. Public education and adequate informed consent are an essential place to start. But all physicians caring for women must be cognizant of this preventable risk factor, and educate their vulnerable patients accordingly. Simply ignoring induced abortion as a risk factor for subsequent premature birth is not an acceptable standard of care.