Deaths associated with pregnancy outcome: A record linkage study of low income women
Abstract and Figures
A national study in Finland showed significantly higher death rates associated with abortion than with childbirth. Our objective was to examine this association using an American population over a longer period.
California Medicaid records for 173,279 women who had an induced abortion or a delivery in 1989 were linked to death certificates for 1989 to 1997.
Compared with women who delivered, those who aborted had a significantly higher age-adjusted risk of death from all causes (1.62), from suicide (2.54), and from accidents (1.82), as well as a higher relative risk of death from natural causes (1.44), including the acquired immunodeficiency syndrome (AIDS) (2.18), circulatory diseases (2.87), and cerebrovascular disease (5.46). Results are stratified by age and time.
Higher death rates associated with abortion persist over time and across socioeconomic boundaries. This may be explained by self-destructive tendencies, depression, and other unhealthy behavior aggravated by the abortion experience.
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... Comparisons have been made to each of the following: the general population of women, 77,195 women who have never been pregnant, 94 women with no reported history of abortion, 74,84,85,91,92,94,95,100,101 women giving birth, 30,69,71-73, 75-77,81,83,86-90,94,97-99,102 women giving birth to a first pregnancy, 69,86,113 women having miscarriages or other involuntary losses, 81,88,91,94,[195][196][197] women experiencing both births and pregnancy loss (abortions or miscarriages), 69,82,107 women giving birth to unintended pregnancies, 69,72,75,76,86,90,92,98 and women denied abortions. 179,198 Together, these findings show that women with a history of abortion are statistically more likely to experience significantly more mental health issues relative to every comparison group that has been examined. ...
... Acting on that premise, many researchers have chosen to simultaneously compare women who abort to multiple other groups whenever the data allow it. 72,88,92,94 By contrast, Charles et al., 6 have argued that the only "appropriate" comparison group for AMH studies is to women who have "unwanted deliveries." But this argument is weak for three major reasons. ...
... This is important since significantly different outcome patterns have been observed relative to multiple pregnancy outcomes and their sequences, including both multiple losses and losses followed or preceded by live births. 88,94 While comparisons of first pregnancy outcomes are valuable, it should be noted that it is a very poor methodological choice to include in the group of women experiencing a "first live birth" women who are known to have had one or more abortions before their first live birth or between the birth and the date of the mental health assessment. 69,107 Unfortunately, these flawed studies 69,82,107,[208][209][210] ignore the extensive evidence showing that a history of pregnancy loss (abortion or miscarriage) is associated with higher rates of mental health problems during subsequent pregnancies. ...
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
... Cougle and Reardon's United States National Longitudinal Study of Youth (NLSY) study found that eight years after pregnancy, married women who had an abortion were 65 percent more likely to score in the high-risk range for clinical depression than those who gave birth (Reardon, 2002) [15]. Reardon also studied psychiatric admissions up to four years after abortion and childbirth (Reardon et al., 2003). ...
... It found the abortion group had significantly more admissions for depression (both single episode and recurrent), for bipolar and for adjustment disorders. Another study also looked at the NLSY data and claimed the evidence that having an abortion led to a higher risk of depression than giving birth (Schmiege& Russo, 2005) [16]. ...
This review intends to provide brief data about the psychological consequences of induced unsafe abortion. The data were collected from different articles, journals, guidelines and related published materials. Emerging data report 30% of women worldwide who practiced abortion experience negative and persistent psychological distress afterward. It is estimated that there are 3.27 million pregnancies in Ethiopia every year, of which approximately 500,000 ends in either spontaneous or unsafely induced abortion. Reasons for seeking abortion are socioeconomic concerns (including poverty, no support from the partner, and disruption of education or employment); family-building preferences (including the need to postpone childbearing or achieve a healthy spacing between births); relationship problems with the husband or partner; risks to maternal or fetal health; and pregnancy resulting from rape or incest; poor access to contraceptives and contraceptive failure. Smoking, drug abuse, eating disorder, depression, anxiety disorders, attempted suicide, guilt, regret, nightmare, decreased self-esteem, and worry about not being able to conceive again were the psychological consequences of abortion.
... Our findings are consistent with the previous findings suggesting that a history of pregnancy loss is associated with a greater risk of poor cardiovascular health. Current evidence mainly comes from retrospective cohorts and disease registry databases (38)(39)(40), most of which have reported a higher CVD risk in women with pregnancy loss. Similarly, prospective cohort studies also revealed that women with reported exposure to pregnancy loss had a greater risk of CVD than women without pregnancies ending in pregnancy loss (38,41). ...
Objectives
To estimate the association of previous pregnancy loss with subsequent cardiovascular health during gestation and to examine the role of high-sensitivity C reactive protein (hs-CRP) in the association.
Methods
A total of 2,778 nulliparous pregnant women were recruited between March 2015 and November 2020 in Hefei city, China. Their cardiovascular health (CVH) including prepregnancy body mass index (BMI), blood pressure, total cholesterol, fasting plasma glucose, and smoke status were recorded at 24–28 weeks’ gestation, as well as their reproductive history. Multivariate linear and logistic regression were performed to examine the association of pregnancy loss with cardiovascular health. And the role of hs-CRP between pregnancy loss and CVH was assessed by the mediation analysis.
Results
Compared with women who have no pregnancy loss, women with a history of spontaneous or induced abortions had higher BMI ( β , 0.72, 95% CI , 0.50 to 0.94) and fasting plasma glucose ( β , 0.04, 95% CI , 0.01 to 0.07), and had lower total CVH scores after adjusting for confounders ( β , −0.09, 95% CI , −0.18 to −0.01). CVH scores were most significantly decreased among women with 3 or more induced abortions ( β , −0.26, 95% CI , −0.49, −0.02). The contribution of pregnancy loss to poorer gestational CVH mediated by increased hs-CRP levels was 23.17%.
Conclusion
Previous pregnancy loss was associated with poorer cardiovascular health during gestation, which may be mediated by their gestational inflammatory status. Exposure to miscarriage alone was not a significant predictor of poorer CVH.
... Eighteen studies conducted in the USA related to causality loop PPM and 17 to causality loop TRC. Those too, varied in designs: twelve systematic reviews (Adams & Nelson, 2008;Asaria et al., 2007;DeZern & Guinan, 2014;Hague, 2009;Hecht, 2002;Schane et al., 2010;Shaw et al., 2016;Shields, 2002;Smith et al., 2009;Torre, 2015;van Doorslaer et al., 2000;Zamzaireen et al., 2018), four randomized clinical trials (Amemori et al., 2011;Ickovics et al., 2007;Kolu et al., 2012;McMahon et al., 2011), one histopathology screening (Lima et al., 2016); fifteen retrospective population-based case control or linkage studies (Anderson et al., 2004;Bernstein et al., 2000;Dasenbrock et al., 2018;Deneux-Tharaux et al., 2005;Selvan et al., 2019;Kawakita et al., 2016;Kozhimannil et al., 2013;Lisonkova et al., 2017;Marshall et al., 2001;Reardon et al., 2002;Russell et al., 2007;Patel et al., 2004;Pesch et al., 2012;Underwood et al., 2007;Vintzileos et al., 2000), and three cross-section surveys (Long et al., 2011;Miller et al., 1999;Weinstein et al., 2004)-covering patient populations of 3,996,495 (PPM loop) and 307,554 (TRC loop). Table 1 shows the map of study-distribution per country and per causality loops. ...
A bid is made to measure health as a value. Continuous and conceptual variables pertaining to healthcare distribution, expenses and outcomes are obtained from 70 studies presenting 4,245,866 patient-population from Finland and 4,304,049 from the USA—clustered for three periods: biennium, lustrum, decade. Two causality loops are sampled per country of interest: prematurity–perinatal mortality (PPM), tobacco consumption–respiratory cancer (TRC). Both in Finland and the USA, attribute risk for hypothyroidism, autoimmune disorders, and cardiomyopathy outstage other predictors of perinatal mortality. Diabetes mellitus, diabetes insipidus, obesity, and urinary tract infections are increasingly dominating PPM risks in the USA. Perinatal and maternal mortality ratios are consistently lower in Finland (RR 1.8–4.35). The mean duration of NICU-stay among the surviving and non-surviving low-weight infants is higher in Finland (RR 1.3–3.0). Regardless the term, cost of one NICU-day is 36–53-fold higher in the USA. The state-sponsored prenatal care is 2.58 times more consumed in Finland where the cost of basic prenatal care (excluding childbirth expenses) is 1.6 times lower. Low income is a substantial contributor to tobacco smoking (OR 5.0–15.6)—with a stronger connection (RR 3.56) in the USA. The US mortality rates from active smoking (R 1.5) and nicotine consumption by non-smoking means (RR 2.22) are higher even when the leading death predictors (COPD, Fanconi anemia, thromboembolism, TP53 gene mutation, KRAS mutation) are significantly higher in Finland (RR 2.57–12.85). High asthma rates among the US smokers (RR 4.21) are distinct predictors of poor survival rates from lung cancer—also reflected in higher Tiffeneau-Pinelli index reduction (RR 3.96). Delays in detection of respiratory cancer inversely relate to the survival rates (r =− 0.56). Where results are chaotic, data are assessed through holomorphic operation, each domain as complex-valued function of differentiable variable(s). Under the Riemannian and Finsler reasoning, each variable is a manifold in a spatial unit where tangent sits with the fourth root of differential expression. Such indexing could interprete functional relationships between healthcare value, demand elasticity, attributable or relative risk, prognosis—in the non-cohort samples, as suggested by the following equation matrix: R = ( [η (t) η (t’)/δ (t−t’) ]−D¹xμ r − D¹[μ xr + μ r x] − D²x(1 − λ s) + D²[λ xs + λ s x])ik (lj Rjikl ll). Due to its inherent dissonance property enabling data triangulation in infinitesimal points, Euclidean reasoning may help devise comprehensive healthcare index to predict perinatal and tobacco mortality. Findings of this study suggest that health value is higher in Finland. The need for health policy reform in the USA is warranted.
... Completed suicide A total of 4 studies reporting completed suicide as their outcome were included [13,17,28,30]. The results of the meta-analysis showed that abortion might be associated with an increased risk of completed suicide(OR=3.16, ...
Background Abortion had been suggested to be associated with the risk of suicide with inconclusive results. The objective of this study was to assess the association by systematic review and meta-analysis.
Methods We searched PubMed, EMbase, PsycINFO, CNKI, WanFang Data and VIP databases for all studies investigating the association between abortion and the risk of suicide. We included Studies investigating the association between abortion and the risk of suicide. Two reviewers collected the data and assessed risk of bias of included studies. Outcomes included completed suicide, suicide behavior, and suicidal ideation. Data were analyzed by using Revman5.2 software.
Results A total of 13 studies were included in the meta-analysis, including 1 case-control study, 6 cohort studies, and 6 cross-sectional studies. The results of meta-analysis showed that, abortion might be associated with increased risk of completed suicide (OR=3.16, 95CI 2.49 to 3.99, P <0.00001), suicide behavior (OR=1.92, 95CI 1.64 to 2.26, P <0.00001) and suicidal ideation (OR=1.52, 95%CI 1.32 to 1.75, P <0.00001).
Conclusions The current meta-analysis suggested that abortion might be associated with increased risk of suicide. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusions.
... This data gap is particularly problematic for the category of natural or induced fetal losses for two reasons. First, research has indicated that pregnant women who do not successfully carry to term may be at significantly greater risk of premature mortality, often from emotional or social factors such as suicide or violence whether the fetal loss was by induced abortion or a spontaneous loss [5,6]. Second, the loss of fully 1/3 of all pregnancies, nearly half of them for unknown causes, has a significant impact on the Total Fertility Rate (TFR) of the nation. ...
Background
The current measuring metric and reporting methods for assessing maternal mortality are seriously flawed. Evidence-based prevention strategies require consistently reported surveillance data and validated measurement metrics.Main BodyThe denominator of live births used in the maternal mortality ratio reinforces the mistaken notion that all maternal deaths are consequent to a live birth and, at the same time, inappropriately inflates the value of the ratio for subpopulations of women with the highest percentage of pregnancies ending in outcomes other than a live birth. Inadequate methods for identifying induced or spontaneous abortion complications assure that most maternal deaths associated with those pregnancy outcomes are unlikely to be attributed. Absent the ability to identify all maternal deaths, and without the ability to differentiate those deaths by specific pregnancy outcomes, existing variations in pregnancy outcome-specific maternal deaths are masked by the use of an aggregated (all outcome) numerator. Under these circumstances, clear and accurate data is not available to inform evidence-based preventive strategies. As the result, algorithms applied for analyzing maternal mortality data may return distorted results.Conclusion
Improvement in the effectiveness of maternal mortality surveillance will require: mandatory certification of all fetal losses; linkage of death, birth and all fetal loss (induced and natural) certificates; modification of the structure of the overall maternal mortality ratio to enable pregnancy outcome-specific ratio calculations; development of the appropriate ICD codes which are specific to induced and spontaneous abortions; education for providers on identifying and reporting early pregnancy losses; and, flexible information systems and methods which integrate these capabilities and inform users.
Physical violence during pregnancy can have negative impact on health status of mother and fetus. Hence, the current study was done to determine the prevalence and determinants of physical violence and its impact on birth outcomes during pregnancy in India. We have analyzed the most recent National Family Health Survey 4 data (NFHS-4) gathered from Demographic Health Survey (DHS) program. Stratification (urban/rural) and clustering (villages/census enumeration blocks [CEBs]) in the sample design was accounted using svyset command. In total, 62,165 ever pregnant women aged 15 to 49 years were included. Prevalence of physical violence during pregnancy in India was 3.3%. Husband/partner (2.7%) was the person most commonly responsible. Women who were widowed/separated/divorced (aPR = 1.88), belonging to the poorest quantile (aPR = 2.32), women who were employed (aPR = 1.42), women in the Southern states (aPR = 3.24), and women whose husband/partner has lesser educational qualification (adjusted prevalence ratio [aPR] = 2.02) had significantly higher prevalence of physical violence during pregnancy ( p < .001). Women who faced physical violence had significantly higher proportion of miscarriage (4.3%), abortion (3.3%), and stillbirth (1.1%) when compared with women who did not face any violence (4.1% had miscarriage, 1.8% had abortion, and 0.5% had stillbirth; p < .001). These findings show the importance of providing general supportive measures and strengthen the existing punitive legislations to prevent the violence during pregnancy.
In this chapter, the focus will be on studying the consequences of various types of violent experiences on women’s health. It also opens possibilities of exploring the correlations that may exist between violent experiences and health. It explores the increasing and serious healthcare needs for those being abused within their intimate relationships. The practitioner should note that the victims can include children, the elderly and individuals currently married or engaged to be married. From the available studies, it is not very clear as to how much domestic violence contributes to pregnancy complications, antepartum hospitalization or low birth weight. It is also not very well known as to how much of these complications can be attributed to domestic violence. Therefore, there are little data on the public health impact and benefits of eliminating domestic violence during pregnancy and postpartum.
Editor-Mika Gissler and colleagues state that suicides occur more commonly after induced abortion than after a pregnancy resulting in live birth.1 We linked admissions for miscarriage, induced abortion, and normal delivery to admissions for suicide attempts in our health authority (population 408 000) during 1991-5 (table 1). Table 1 Frequency of admissions (rate per 1000 population) for attempted suicide by pregnancy event in women aged 15-49 in South Glamorgan Health Authority, 1991-5
What do professional psychologists need to know to treat women who once had an abortion? Analyses of responses from 2,525 women revealed that women who reported an abortion were more likely than others to report symptoms of depression and lower life satisfaction. However, they were also more likely to experience rape, childhood physical and sexual abuse, and a violent partner. When history of abuse, partner characteristics, and background variables were controlled, abortion was not related to poorer mental health. This underscores the need to explore the effects of violence in women's lives to avoid misattributing psychological distress to abortion experiences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Thesis (Ph. D.)--University of Minnesota, 1985. Includes bibliographical references (leaves 202-206).
A study of 576 pregnant women, whose previous pregnancy had been terminated by legally induced abortion, has shown that the rate of pregnancy and delivery complications could not be correlated with the interval between the abortion and the subsequent pregnancy, nor with the gestational age at the time of abortion, nor the number of previous induced abortions. Neither was the abortion technique found to correlate with the frequency of complications in a subsequent pregnancy. It was found, however, that more infants with a birth weight below 2 501 grams were born to women whose cervical canal during abortion had been dilated more than 12 mm, and by women who had been submitted to récurettage. The latter group also demonstrated a higher frequency of retained placenta or placental tissue.
7,270 pregnant women were registered prospectively with the purpose of evaluating if there were an increased risk of pregnancy and delivery complications in women who had previously had a pregnancy terminated by legally induced abortion. The patient material was classified according to the termination of the previous pregnancy - legally induced abortion, spontaneous abortion or stillbirth, live birth - or to whether there had been no previous pregnancy. The group of women whose previous pregnancy had been terminated by a legally induced abortion differed from one or more of the other groups with regard to age, number of previous pregnancies and their outcome, previous illnesses, previous gynecological operations, medication during pregnancy, smoking habits and socio-economic status. These factors were all correlated with low birth weight and/or short gestational age. These variables must be taken into consideration in an investigation of risk of pregnancy and delivery complications following legally induced abortion.
No strong temporal associations were found between the occurrence of stressful life events and the onset of alcohol problems.
A study of 197 women referred for termination of pregnancy on psychiatric grounds was undertaken from February 1974 to May 1975 at a specially established clinic in the Department of Psychiatry, Groote Schuur Hospital, Cape Town. The personal, social and specifically psychiatric information collected from this study, which included both women who were refused and those granted termination on psychiatric grounds, was analysed. We gained enough data to focus on the psychosocial and 'hard' psychiatric data, to statistically compare the two groups, and to isolate variables which appeared to have influenced decision-making. Eighty per cent of the women were followed up for 12 - 18 months.