Chinese Study

Dear ProLife Colleague,

One of the most egregious omissions in the medical education abortion complication literature is the association between induced abortion and subsequent preterm birth. Everyone recognizes that we have a major problem with increasing preterm births, now over 12% of all births. All authorities list similar risk factors, and all authorities agree that 50% of PTB has “unknown” etiology. But basically it is simply not mentioned that induced abortion is one of the largest risk factors in the “unknown” category. It is only “unknown if one is willfully blind. Have you heard this in your training program?? Or medical school lectures? Or on rounds?? Probably not, since it is not politically correct. But it IS scientifically correct. Surveying the literature would be a great residency project!! Suggest it at your program. There are 127 statistically significant articles in the literature confrming the association. These are either ignored, or downplayed by the “Authorities” For typical trivialization (abortions are“…associated with a very small but apparently real increase…..”) , see Iams study at http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/2010-iams-review/

All the studies are listed, and the major ones summarized at http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/

The most recent study comes from China in 2011. See summary below, or go to http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/2011-chinese-study-on-mifeprex-and-subsequent-preterm-birth/ This study confirms what we already know about abortion and preterm birth, and, in addition, it confirms that mifeprex abortions are ALSO associated with inceased preterm birth. Of course the conclusion in the abstract misrepresents this by taking all the mifeprex abortions, then separating the 20% that required surgical intervention, and putting them in a DIFFERENT category called medical/surgical abortions. In this way they can sell the falsehood in the Abstract that mifeprex abortions do not result in an increased rate of preterm birth.

Below, FYI, is our summary of the Chinese study. For the audio presentation of this material, go to http://www.aaplog.org/media_files/2-12/2-12Calhoun.mp3

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.