New Year, New Article, but Old Mindset?

Dear Prolife Colleague,

Could you believe your eyes as you scanned the December 2010 ObGyn News. There on page 10 is an article entitled “Induced Abortions Linked to Preterm Delivery.” It is relatively rare to find that kind of information printed in American obgyn literature. Look on the ACOG website. You will strain find an admission of that association. The ACOG Practice Bulletin #26 (effective from 2001 stated: “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.” When evidence to the contrary became just too obvious,, this Bulletin was replaced in Oct, 2006 with Practice Bulletin #67, which did not repeat this egregious misinformation. Was silent on the issue. Two recent ACOG patient information bulletins do acknowledge the abortion/PTB association, however briefly…. as does the Iams review in the Aug 2010 AJOG. http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/2010-iams-review/ But Dr. Iams concludes “…terminations….are associated with a very small but apparently real increase in the risk of subsequent spontaneous preterm birth (PTB).” Here he references the 2009 BJOG Shaw article, which found a 1.36 RR (36% increase) for PTB with a previous induced abortion. Additionally, 50% of women have more than one abortion, and the literature finds the PTB risk for them nearly doubles, to 1.6 RR. See: http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/march-2009-swingle-metanalysis/ That is a 60% increase in PTB in subsequent pregnancies for half the women involved. AAPLOG contends that a 36% to 60% increase in preterm birth is definitely NOT a “very small” increase in PTB. More importantly, to those of you in training: are you being taught that induced abortion constitutes a significant risk factor for preterm birth? Please let us hear from you on this.

The ObGyn News article reported the major finding that “one or more abortions is associated with a twofold increase in Preterm delivery at less that 24 weeks gestation.” Note these are very preterm babies who have a high risk of death or disability. The finding was presented at the annual meeting of the Society of Ob&Gyns of Canada. The chairman of the session hastened to say that the findings should be interpreted with caution, since the study has not yet been published. Fair enough. But what about the 118 statistically significant studies showing the association between induced abortion and subsequent preterm birth? One of the most recent is from Canada (Shah P. et al. Induced termination of pregnancy and low birth weight and preterm birth: a systematic review and meta-analysis BJOG 2009;116(11):1425-1442) For a listing of the other 117, see: http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/bibliography-of-112-studies/ (None of these articles is written by prolife authors, as far as we know—just scientists doing their job).

The relative indifference displayed by medical authorities and professional colleges in general regarding the association of abortion with subsequent increased Preterm Birth risk is simply stunning. (practically all of you knew that smoking is a risk factor for PTB. How many of you knew that abortion has a very similar risk profile, and for just one abortion?) We know these doctors have better than average reading and cognitive skills. We know they have access to medical libraries, both traditional and on-line. Why do they fail to adequately recognize this abundance of evidence?? Why do many OBGYN doctor associations not feel responsible to their patients to make this complication known to them…. Especially to women considering having an abortion? They and their children are the ones who will be hurt. Or to the general public (many of whom will face abortion vulnerable situations)? Why does the medical community display such anguish over the rising Preterm and Very Preterm Birth rates in America, while practically ignoring a major known risk factor? It looks like a kind of informational malpractice. (interesting Note: in Ireland , an industrialized country where abortion is illegal, the preterm birth rate is about 6%—that is what it was in the USA before abortion on demand. It is now 12.7% in the USA)

Are you are an obgyn, mfm, pediatric, neonatology, or f’p resident? Suggest to your program director an educational review hour on a pressing American medical issue: the PreTerm Birth explosion. See how many articles you can find on both sides of the issue regarding abortion as a risk factor (you already have 118 articles on one side). See what conclusions your department can come up with. Let us know what your experience is with this project! The AAPLOG collection of evidence is found at: http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/

Jdc/aaplog