Replacement Pregnancies/Rapid Repeat Pregnancies After Abortion
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Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: first-year results of a randomized controlled trial. Pohjoranta E, Mentula M, Gissler M, Suhonen S, Heikinheimo O. Hum Reprod. 2015 Nov;30(11):2539-46. doi: 10.1093/humrep/dev233. Epub 2015 Sep 14.
5.6% of women not provided with an IUD after their abortion were seeking another abortion within a year of their prior abortion. This was significantly higher than the rate for those received and IUD implant, 2.4%
Söderberg H. Urban Women applying for induced abortion. Studies of epidemiology, attitudes, and emotional reactions. Malmö, 1998. Doctoral Disseration. Department of Obstetrics and Gynecology and Community Medicine, Lund University, University Hospital, Malmö, Sweden.
- 18.9 percent of the 1,277 women who had abortions (n=242) became pregnant again within 12 months of their abortions. About half carried to term and the rest had another abortion. Women who refused to participate in the followup interview were significantly more likely to carry the subsequent pregnancy to term. (p 24)
Repeated requests for termination of pregnancy. Some socio-cultural and psychological aspects, B Mattauer et al, Contracept Fertil Sex (Paris) 12(4) 573-580,1984 (English Abstract)
- A French study found that women with defective parental images had three times the risk of repeat abortion. Previous difficulties of pregnancy or delivery were associated with a higher risk of repeat abortion. Religious practice was associated with a reduced risk of repeat abortion.
Repeat abortion: a qualitative study, M Tornbom, A Moller, J. Psychosom Obstet Gynaecol 20(1):21-30, 1999
- In-depth interviews of Swedish women seeking a repeat abortion found that most of the women seemed to have a psychological vulnerability with many current and previous problems, as well as problems regarding sexuality. The authors concluded that the main reason for an unplanned pregnancy is not a lack of information or even a lack of knowledge, but rather a failure to integrate the knowledge with situational, intrapsychic and social factors.
"Adolescent Mourning Reactions to Infant and Fetal Loss," NH Horowitz, Social Casework 59:551, 1978.
- Replacement pregnancies may follow adolescent abortion.
"Post-Abortion Perceptions: A Comparison of Self-Identified Distressed and Non- Distressed Populations," GK Congleton and GC Calhoun, The Int'l Journal of Social Psychiatry39(4): 255, 1993.
- Women experiencing postabortion stress were more likely to report a desire to replace the fetus, report depression around the anniversary date or due date, and immediately experience feelings of loss compared to women reporting relieving/neutral postabortion experiences.
"Post-Abortion Trauma; 9 Steps to Recovery," Jeanette Vought (Grand Rapids: Zondervan, 1991)
- 53% of women in a religiously-based postabortion recovery group stated they desired to get pregnant again to compensate for the loss.
"Physical and Psychological Injury in Women Following Abortion: Akron Pregnancy Services Survey," L Gsellman, Association for Interdisciplinary Research in Values and Social Change Newsletter 5(4): 108, Sept/Oct, 1993
- In a questionnaire survey of post-abortion women who were obtaining a variety of services at a pregnancy services center between 1988-93, 23% stated they desired to get pregnant again as a psychological reaction to abortion.
"Selection bias in a study on how women experienced induced abortion," H Soderberg et al, Eur J Obstet & Gynecol 77:67, 1998.
- Swedish researchers at Lund University calculated that of approximately 33,000 induced abortions in Sweden each year, that about 6000 of these women will become pregnant again within 12 months, with half of them carrying to term, and the other half undergoing another induced abortion. (Non-participants in the follow-up study seemed to have a sense of guilt that they did not wish to discuss. These non-participants were significantly more likely to conceive again within 12 months and carry to term compared to study participants.)
"Conception rates after abortion with methotrexate and misoprostol," MD Creinin, Int'l J Gynaecol Obstet 65: 183-188, 1999.
- 25% of women who had abortions using methotrexate and misoprostol became pregnant again within the next 12 months. The vast majority of these pregnancies resulted in another induced abortion.
"Contraception and Repeat Abortion: An Epidemiological Investigation," MJ Shephard and MB Bracken, J Biosocial Science 11:289, 1979.
- In a Connecticut study of abortion and contraceptive practice, it was found that 42% of women repeating abortion had had an abortion within the previous year.
"Repeat Pregnancies Among Metropolitan Area Teenagers, 1971-1979," MA Koenig and M Zelnik, Family Planning Perspectives 14(6):341, Nov/Dec 1982.
- Among metropolitan teenagers age 15-19 whose first premarital pregnancy ended in abortion, 27% had a second premarital pregnancy within 12 months, 49.8% within 18 months and 74.9% within 24 months postabortion.
"Rapid Repeat Pregnancy and Experiences of Interpersonal Violence Among Low- Income Adolescents," M Jacoby et al, Am J Prev Med 16(4):318-321, 1999.
- A Michigan study of low income women aged 13-21 found that within 12 months of a prior pregnancy outcome (delivery, spontaneous abortion, elective abortion), 43.6% of the women were again pregnant within 12 months, and by 18 months 63.2% had experienced at least one additional pregnancy. Women whose pregnancies ended in spontaneous or elective abortion were more likely to experience rapid repeat pregnancy than women who carried to term.
- Interpregnancy interval is defined as that interval between the termination of one pregnancy and the conception of another. Numerous investigators have found a univariate association between short interpregnancy interval and a number of adverse perinatal outcomes, including preterm birth, low birth weight, and stillbirth (Adams et al., 1997; Al-Jasmi et al., 2002; Basso et al., 1998; Blackmore-Prince et al., 2000; Brody and Bracken, 1987; Conde-Agudelo et al., 2005; Dafopoulos et al., 2002; Ekwo and Moawad, 1998; Erickson and Bjerkedal, 1978; Ferraz et al., 1988; Fuentes-Afflick and Hessol, 2000; Hsieh et al., 2005; Kallan, 1992, 1997; Klebanoff, 1988; Lang et al., 1990; Miller, 1994; Rawlings et al., 1995; Shults et al., 1999; Smith et al., 2003; Zhu and Le, 2003; Zhu et al., 2001). These published reports did not distinguish spontaneous from indicated preterm birth, however. The definition of short interpregnancy interval varies widely across studies; the most common definition is less than or equal to 6 months.
Contraceptive discontinuation and repeat unintended pregnancy within 1 year after an abortion.
Upadhyay UD, Brown BA, Sokoloff A, Raine TR.Contraception. 2012 Jan;85(1):56-62. doi: 10.1016/j.contraception.2011.05.009. Epub 2011 Jun 30.
- Women who had a recent abortion or previous abortion were 60% more likely to have another pregnancy during the next 12 months than women who never had an abortion (AHR=1.63, 95% CI =1.21-2.20, and AHR=1.66, 95% CI=1.18-2.33, respectively).
Repeat Abortion / Multiple Abortions
Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors model. Steinberg JR, Finer LB. Soc Sci Med. 2011 Jan;72(1):72-82. doi: 10.1016/j.socscimed.2010.10.006. Epub 2010 Oct 23.
- After controlling for numerous factors, women who had a history of multiple abortions were significantly more likely to be diagnosed substance abuse and anxiety disorders compared to women with no history of abortion and women with a history of only one abortion. They site the following as additional studies examining multiple versus one versus zero abortions: (Russo & Dabul, 1997; Russo & Zierk,1992; Steinberg & Russo, 2008; Taft &Watson, 2008).
Characteristics of women undergoing repeat induced abortion.] Fisher WA, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, et al. CMAJ 2005;172(5):637-41
- Background: Although repeat induced abortion is common, data concerning characteristics of women undergoing this procedure are lacking. We conducted this study to identify the characteristics, including history of physical abuse by a male partner and history of sexual abuse, of women who present for repeat induced abortion.
- Methods: We surveyed a consecutive series of women presenting for initial or repeat pregnancy termination to a regional provider of abortion services for a wide geographic area in southwestern Ontario between August 1998 and May 1999. Self-reported demographic characteristics, attitudes and practices regarding contraception, history of relationship violence, history of sexual abuse or coercion, and related variables were assessed as potential correlates of repeat induced abortion. We used χ2 tests for linear trend to examine characteristics of women undergoing a first, second, or third or subsequent abortion. We analyzed significant correlates of repeat abortion using stepwise multivariate multinomial logistic regression to identify factors uniquely associated with repeat abortion.
- Results: Of the 1221 women approached, 1145 (93.8%) consented to participate. Data regarding first versus repeat abortion were available for 1127 women. A total of 68.2%, 23.1% and 8.7% of the women were seeking a first, second, or third or subsequent abortion respectively. Adjusted odds ratios for undergoing repeat versus a first abortion increased significantly with increased age (second abortion: 1.08, 95% confidence interval [CI] 1.04–1.09; third or subsequent abortion: 1.11, 95% CI 1.07–1.15), oral contraceptive use at the time of conception (second abortion: 2.17, 95% CI 1.52–3.09; third or subsequent abortion: 2.60, 95% CI 1.51–4.46), history of physical abuse by a male partner (second abortion: 2.04, 95% CI 1.39–3.01; third or subsequent abortion: 2.78, 95% CI 1.62–4.79), history of sexual abuse or violence (second abortion: 1.58, 95% CI 1.11–2.25; third or subsequent abortion: 2.53, 95% CI 1.50–4.28), history of sexually transmitted disease (second abortion: 1.50, 95% CI 0.98–2.29; third or subsequent abortion: 2.26, 95% CI 1.28–4.02) and being born outside Canada (second abortion: 1.83, 95% CI 1.19–2.79; third or subsequent abortion: 1.75, 95% CI 0.90–3.41).
- Interpretation: Among other factors, a history of physical or sexual abuse was associated with repeat induced abortion. Presentation for repeat abortion may be an important indication to screen for a current or past history of relationship violence and sexual abuse.
Women's risk of repeat abortions is strongly associated with alcohol consumption: a longitudinal analysis of a Russian national panel study, 1994-2009. Keenan K, Grundy E, Kenward MG, Leon DA. PLoS One. 2014 Mar 26;9(3):e90356. doi: 10.1371/journal.pone.0090356. eCollection 2014.
- We investigated the longitudinal predictors of first and repeat abortion, focusing on women's alcohol use as a risk factor. Follow-up data from 2,623 women of reproductive age (16-44 years) was extracted from 14 waves of the Russian Longitudinal Monitoring Survey (RLMS), a nationally representative panel study covering the period 1994-2009. We used discrete time hazard models to estimate the probability of having a first and repeat abortion by social, demographic and health characteristics at the preceding study wave. Having a first abortion was associated with demographic factors such as age and parity, whereas repeat abortions were associated with low education and alcohol use. After adjustment for demographic and socioeconomic factors, the risk of having a repeat abortion increased significantly as women's drinking frequency increased (P<0.001), and binge drinking women were significantly more likely to have a repeat abortion than non-drinkers (OR 2.28, 95% CI 1.62-3.20). This association was not accounted for by contraceptive use or a higher risk of pregnancy. Therefore the determinants of first and repeat abortion in Russia between 1994-2009 were different. Women who had repeat abortions were distinguished by their heavier and more frequent alcohol use. The mechanism for the association is not well understood but could be explained by unmeasured personality factors, such as risk taking, or social non-conformity increasing the risk of unplanned pregnancy. Heavy or frequent drinkers constitute a particularly high risk group for repeat abortion, who could be targeted in prevention efforts.
Impact on Mental Health During Subsequent Pregnancies
See also Impact on Subsequent Pregnancies
History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the postpartum Chojenta C, Harris S,Reilly N,Forder P,Austin M.-P,Loxton D PLoS ONE-4-9 (2014)
- While grief, emotional distress and other mental health conditions have been associated with pregnancy loss, less is known about the mental health impact of these events during subsequent pregnancies and births. This paper examined the impact of any type of pregnancy loss on mental health in a subsequent pregnancy and postpartum. Data were obtained from a sub-sample (N = 584) of the 1973-78 cohort of the Australian Longitudinal Study on Women's Health, a prospective cohort study that has been collecting data since 1996. Pregnancy loss was defined as miscarriage, termination due to medical reasons, ectopic pregnancy and stillbirth. Mental health outcomes included depression, anxiety, stress or distress, sadness or low mood, excessive worry, lack of enjoyment, and feelings of guilt. Demographic factors and mental health history were controlled for in the analysis. Women with a previous pregnancy loss were more likely to experience sadness or low mood (AOR = 1.75, 95% CI: 1.11 to 2.76, p = 0.0162), and excessive worry (AOR = 2.01, 95% CI: 1.24 to 3.24, p = 0.0043) during a subsequent pregnancy, but not during the postpartum phase following a subsequent birth. These results indicate that while women who have experienced a pregnancy loss are a more vulnerable population during a subsequent pregnancy, these deficits are not evident in the postpartum.
Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study. Gong X, Hao J, Tao F, Zhang J, Wang H, Xu R. Eur J Obstet Gynecol Reprod Biol. 2013 Jan;166(1):30-6. doi: 10.1016/j.ejogrb.2012.09.024. Epub 2012 Nov 10.Source
School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- OBJECTIVE: Previous studies have shown that pregnancy loss may affect the mental health of women in subsequent pregnancies. The China Anhui Birth Defects and Child Development cohort study therefore aimed to investigate the influence of pregnancy loss on anxiety and depression in subsequent pregnancies.
- STUDY DESIGN: In total, 20,308 pregnant women provided written informed consent and completed the study questionnaire. The Self-rating Anxiety Scale and Center for Epidemiologic Studies-Depression Scale were used to evaluate anxiety and depression in pregnant women. Pearson's χ(2) test and binary logistic regression were used for statistical analyses.
- RESULTS: Of 20,308 pregnant women, 1495 (7.36%) had a history of miscarriage and 7686 (37.85%) had a history of induced abortion. The binary logistic regression model found that pregnant women with a history of miscarriage had a significantly higher risk of anxiety and depression in the first trimester than primigravidae after stratified analysis according to the timing of the first prenatal visit (p<0.05). Compared with pregnant women with no history of miscarriage, women who had a history of miscarriage and an interpregnancy interval of less than 6 months had increased risk of anxiety symptoms (p<0.05) and depression symptoms (p<0.05) during the first trimester. Women with an interpregnancy interval of 7-12 months had a 2.511-fold higher risk of depression (p<0.05) than women with no history of miscarriage. These findings were not changed after adjustment for maternal age, maternal education, family income, place of residence and pre-pregnancy body mass index.
- CONCLUSIONS: Women with a history of miscarriage experienced significant anxiety and depression during their next pregnancy. A short interpregnancy interval and the first trimester are risk factors for adverse mental health
Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. Giannandrea SA, Cerulli C, Anson E, Chaudron LH. J Womens Health (Larchmt). 2013 Sep;22(9):760-8. doi: 10.1089/jwh.2012.4011.
- Abstract Background: Scant literature exists on whether prior pregnancy loss (miscarriage, stillbirth, and/or induced abortion) increases the risk of postpartum psychiatric disorders-specifically depression and anxiety-after subsequent births. This study compares: (1) risk factors for depression and/or anxiety disorders in the postpartum year among women with and without prior pregnancy loss; and (2) rates of these disorders in women with one versus multiple pregnancy losses.
- Methods: One-hundred-ninety-two women recruited at first-year pediatric well-child care visits from an urban pediatric clinic provided demographic information, reproductive and health histories. They also completed depression screening tools and a standard semi-structured psychiatric diagnostic interview.
- Results: Almost half of the participants (49%) reported a previous pregnancy loss (miscarriage, stillbirth, or induced abortion). More than half of those with a history of pregnancy loss reported more than one loss (52%). Women with prior pregnancy loss were more likely to be diagnosed with major depression (p=0.002) than women without a history of loss. Women with multiple losses were more likely to be diagnosed with major depression (p=0.047) and/or post-traumatic stress disorder (Fisher's exact [FET]=0.028) than women with a history of one pregnancy loss. Loss type was not related to depression, although number of losses was related to the presence of depression and anxiety.
- Conclusions: Low-income urban mothers have high rates of pregnancy loss and often have experienced more than one loss and/or more than one type of loss. Women with a history of pregnancy loss are at increased risk for depression and anxiety, including post-traumatic stress disorder (PTSD), after the birth of a child. Future research is needed to understand the reasons that previous pregnancy loss is associated with subsequent postpartum depression and anxiety among this population of women.