Supplement 2
Supplement No.2 to Detrimental Effects of Induced Abortion: An Annotated Bibliography
Editing Notes
Citations should be italicized using 2 apostrophes before and after the citation. Indent the text with a colon. Move the material to the appropriate place in the main index and delete from this page.
Informed Consent
Abortion, Information and the Law: What Every Doctor Needs to Know, Issues in Law & Medicine 16(3):283-284, 2001
It has not been proved that pregnancy and delivery are more dangerous than abortion.
Long-Term Physical and Psychological Health Consequences of Induced Abortion: Review of the Evidence, JM Thorp et al, Obstetrical & Gynecological Survey 58(1):67-79, 2003
Informed consent before induced abortion should include information about the subsequent risk of preterm delivery and depression. Although it remains uncertain whether elective abortion increases subsequent breast cancer, it is clear that a decision to abort and delay having a baby results in a loss of protection with the net effect being an increased risk.
Grief and Loss Following Abortion
Short-term grief after an elective abortion, GB Williams, J Obstet Gynecol Neonatal Nursing 30(2): 174-183, 2001.
A study of short-term grief responses using the Grief Experience Inventory compared women with an elective abortion within the past one month to 48 months to women who never had an elective abortion. Women with a history of elective abortion experienced grief in terms of loss of control, death anxiety, and dependency. There was an overall trend toward higher grief intensity in the abortion group. Presence of living children, perceived pressure to have the abortion, and the number of abortions appeared to affect the intensity of the grief response.
Abortion-Related Guilt/Regret/Violation of Conscience or Belief
Women's Experiences of and Reactions to Antiabortion Counseling, C Cozzarelli et al, Basic and Applied Social Psychology 22(4): 265-275,2000.
Women who encountered abortion protestors when they were about to enter an abortion facility responded with considerable guilt and shame as well as anger. Women who were personally conflicted about abortion were more likely to experience guilt but not anger. Emotional responses of women also included being sad, afraid, confused , and wrong.
Dissociation
Attachment Style and Broken Attachments: Violence, Pregnancy, and Abortion, S Allanson and J Astbury, Australian Journal of Psychology 53(3): 146, 2001
Maladaptive interpersonal relationships, irrational repetition, and ambivalence may be linked to a person having developed contradictory models of the same aspect of reality. Multiple working models may direct attention and memory to exclude information about the self, about important others, and relationships to the point where primitive defenses of dissociation, splitting and self-deception may lead to a dissociated self. (Analysis within a traumatic stress-attachment framework where anxious and avoidant attachments were identified among women seeking a first trimester abortion.).
Self-Punishment (Masochism) or Punishment of Others (Sadism)
Unplanned pregnancies and abortion counseling.Some thoughts on unconscious motivations, B Loader, Psychodyn Couns. 1(3):363-376, 1995 (Abstract)
Many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism for self-harm.
Short Term Depressive Reactions
Women's Experiences of a Reactions to Antiabortion Picketing, C Cozzarelli et al, Basic and Applied Social Psychology 22(4):265, 2000.
In a study of 442 women entering one of three abortion clinics in the Buffalo, New York area in 1993, 87% saw abortion demonstrators. At a two year follow- up, 24.5% of the women were clinically depressed. On average, women were significantly less depressed immediately after their abortion then they were two years later.
Long Term Depressive Reactions (5 years or more since abortion) see also Long Term Effects from Abortion
Depression associated with abortion and childbirth: A long-term analysis of the NLSY cohort, J Cougle et al, Medical Science Monitor 9: CR105-112, 2003.
A national sample of unintended pregnancies from the National Longitudinal Survey of Youth found that, compared to women whose first pregnancy was delivered, women whose first pregnancy ended in abortion were 65% more likely to score in the "high-risk" range for clinical depression. Differences between the abortion and birth groups were higher for white women (79% higher) , married women (116% higher) , and women whose first marriage did not end in divorce (119% higher).
Abortion and Race or Poverty
Underreporting Sensitive Behaviors: The Case of Young Women's Willingness to Report Abortion, LB Smith et al, Health Psychology 18(1):37-43, 1999.
White and Asian-American young women aged 14-21 were more likely to be honest about having had an abortion than African-American and Latina participants.
Abortion and Religion
Repeated requests for termination of pregnancy.Some sociocultural and psychological aspects, B Mattauer et al, Contracept Fertil Sex (Paris) 12(4): 573-580, 1984 (English Abstract).
A French study found that religious practice was associated with a reduced risk of repeat abortion.
HIV/AIDS
Post-abortion endometritis-myometritis and HIV infection, P Okong et al, Int'l J. STD &AIDS 13:729-732, 2002.
A 1997 study of women in an urban hospital in Kampala, Uganda found that HIV-1 seroprevalence was 32.7%-36.5% among post-abortion women compared to 14.6% among antenatal women in the same hospital.
Hepatitis
Hepatitis C virus, hepatitis B virus and human immune infection in pregnant women in North-East Italy: a case-control study, V Baldo et al, Eur J Epidemiol 16(1):87-91, 2000
A history of a previous abortion significantly increased the likelihood of HCV infection in pregnant women (OR 2.8,95%CI , 1.4-5.5).
Hypertension (High Blood Pressure)/Preeclampsia
Pregnancy-Related Mortality from Preeclampsia and Eclampsia, AP MacKay et al, Obstet Gynecol 97 (4): 533, 2001.
Based upon data from the Centers for Disease Control for 1979-1992, the mortality ratio (deaths from preeclampsia or eclampsia at 20 weeks or more gestational age per 100,000 births ) for U.S. women with a first live birth was 1.4, for women with a second live birth was 0.7, for women with a third live birth was 0.7, for women with a fourth live birth was 0.9, and for women with a fifth live birth or higher was 1.7. Women who gave birth at 28 weeks or less had a mortality ratio of 12.5 compared to women who gave birth at 29-32 gestational weeks (11.2) , or who gave birth at 33-36 gestational weeks (3.3), or who gave birth at 37 gestational weeks or more (0.5). Mortality ratios were higher for black women compared to white women, and were higher for older women compared to younger women.
History of abortion, preterm, term birth, and risk of preeclampsia: A population based study, Xu Xiong et al, Am J Obstet Gynecol 187:1013, 2002.
A large population-based study of Canadian women who delivered in 49 hospitals in Northern and Central Alberta between 1993 and 1999 found no significant difference in the incidence of preeclampsia among women with a previous abortion (2.6%) as compared to women without previous abortion (2.9%); Adjusted Odds Ratio 0.89 (0.78-1.01; P=0.05). The adjusted odds ratio of women with one, two, three, and four or more previous term pregnancies were 0.32 (95%CI, 0.28-0.36) , 0.27 (95%CI, 0.22-0.34), 0.22 (95%CI, 0.15-0.33), and 0.21 (95%CI, 0.12-0.35) respectively. The researchers also found that the protective effect from preeclampsia was not as great where women had previous preterm births compared to previous term births. It was concluded that a history of a term pregnancy i.e. 37 weeks or more, confers a substantial protection against preeclampsia in the subsequent pregnancy.
Risk Factors for Pregnancy-Induced Hypertension in Women at High-Risk for the Condition, F Parazzini et al, Epidemiology 7:306-308, 1996.
A study of 765 Italian women enrolled in a study of aspirin in pregnancy found that a total of 132 developed pregnancy-induced hypertension (PIH) during the study. The women who developed PIH were then compared to those who did not develop PIH. Compared to nulliparous women (1.0), women at parity one had a significant protective effect (OR 0.7, 95%CI, 0.4-1.0), while women at parity two had a further protective effect (OR 0.5, 95%CI, 0.3-0.9). Compared to women with no induced abortions (1.0), women with one or more induced abortions had no significant effect (OR 1.2, 95%CI, 0.6-2.5) on the incidence of PIH.
Abortion, changed paternity, and risk of preeclampsia in nulliparous women, AF Saftlas et al, Am J Epidemiology 157(12): 1108-1114, 2003.
In a U.S. Calcium for Prevention Trial during 1992-1995 researchers examined whether or not nulliparous women with a prior abortion who changed partners lost the protective effect of the prior pregnancy. Compared to women without a history of abortion, women with a history of abortion who conceived again with the same partner had a reduced risk of preeclampsia (OR 0.54,95% CI, 0.31-0.97). In contrast, women with an abortion history who conceived with a new partner had the same risk of preeclampsia as women without a history of abortion (OR 1.03,95%CI, 0.72-1.47). Women who had a prior induced abortion were more likely to conceive again with a new partner (59%) compared to women with a prior spontaneous loss (41%).
Change in paternity: a risk factor for preeclampsia in multiparous women?, P Tubbergen et al, J Reprod Immunol. 45(1):81-88, 1999.
A Dutch study found that multiparous patients with diastolic blood pressure of 100 mmHg or greater had a significantly higher risk for hypertension with a new partner compared to a control group with normotensive pregnancies without hypertension (OR 8.6,95%CI, 3.1-23.5).
Preeclampsia in the parous woman: who is at risk?, D Mostello et al, Am J Obstet Gynecol 187(2): 425-429, 2002.
A Missouri study to identify risk factors for preeclampsia in second pregnancies found that the same paternity for the first and second pregnancies was protective against preeclampsia in the second pregnancy.
Preeclampsia Associated with Chronic Hypertension Among African-American and White Women, AR Samadi et al, Ethn Dis. 11:192-200, 2001.
Preeclampsia was more than eleven times more likely among women with chronic hypertension compared to normotensive women for both African- American women (OR 12.4,95%CI, 10.2-15.2) and white women (OR 11.3, 95%CI, 9.7-13.2).
The Effect of Cigarette Smoking on the Risk of Preeclampsia and Gestational Hypertension, S Marcoux et al, Am J Epidemiology 130(5):950-957, 1989.
A case-control study of primiparous women without a history of high blood pressure who gave birth in Quebec City or Montreal Hospitals between 1984- 1986 , found that women who were smokers at the onset of pregnancy had a reduced risk of preeclampsia (OR 0.51,95%CI, 0.34-0.77), and a reduced risk of gestational hypertension (OR 0.78,95%CI, 0.54-1.12) compared to women who never smoked.
Ectopic Pregnancy
. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. J Bouyer et al, Am J Epidemiol 157(3): 185-194, 2003.
Prior medical induced abortion was associated with an increased of ectopic pregnancy (OR 2.8, 95%CI, 1.1-7.2). No significant association was observed for surgical abortion (OR 1.1,95% CI, 0.8-1.6). Other main risk factors were infectious history, previous pelvic infectious disease and smoking. (Ed. Note: The unadjusted association between ectopic pregnancy and prior surgical abortion was statistically significant (OR 1.4,95%CI, 1.1-1.8). However, by adjusting for pelvic infectious disease and smoking, the actual risk of surgical abortion would be understated.)
==Placenta Previa/Abruptio Placentae/Retained Placenta
Induced abortion and placenta complications in the subsequent pregnancy, W Zhou et al, Acta Obstet Gynecol Scand 80(12): 1115-1120, 2001.
A Danish record linkage study from 1980-1982 found that there was an increased risk for retained placenta (OR 1.17,95%CI, 1.02-1.35) for women with one previous induced abortion , and an increased risk for retained placenta for women with two or more previous induced abortions (OR 1.68, 95%CI, 1.23-2.30) compared with a control cohort with similar gravidity who did not terminate a pregnancy with an induced abortion. No significant association with placenta previa was found.
Intraamniotic Infection/Intrapartum Infection/ Premature Rupture of Membranes/Prolonged Third Stage of Labor
Prolonged Third Stage of Labor: Morbidity and Risk Factors, C Combs and RK Laros, Obstet Gynecol 77:863, 1991
A study of 12, 979 singleton vaginal deliveries over an 11 year period at the University of California, San Francisco using logistic regression analysis, fund that nulliparous women were more likely to have a prolonged third stage of labor compared to parous women (OR 1.47, 95%CI, 1.15-1.89). Women with any previous abortions were significantly more likely to have a prolonged third stage of labor compared to women with no previous abortions. (OR 1.32, 95%CI,1.06-1.66).
Protective Effect of Early Childbirth/Breastfeeding
National Survey of Family Growth-1995, U.S. Department of Health and Human Services, Nat'l Center for Health Statistics, 1997.
In a national sample of ever-pregnant U.S. women age 35 or more, 14.9% of the women with a history of abortion never had a live birth.
Cervical Cancer
Determinants of cervical human papillomavirus infection:differences between high and low onocogenic risk types, PK Chang et al, J Infect Dis 185(1):28, 2002.
A survey of Hong Kong women who participated in cervical cancer screening found that the overall prevalence of HPV was 7.3%. Previous induced abortion was an 87% statistically significant increased risk for HPV for women at high risk for HPV, a 51% statistically significant increased risk for women with any HPV, and a 97% statistically significant increased risk for women with unknown risk for HPV. Other risk factors for HPV included lifetime number of sexual partners, smoking, and having smokers in the family.
Ovarian Cancer
Factors related to inflammation of the ovarian epithelium and the risk of ovarian cancer, RB Ness et al, Epidemiology 11(2):111, 2000.
A population based case-control study by researchers at the University of Pennsylvania found that factors that suppress ovulation such as gravidity, breast feeding and oral contraception reduced the risk of ovarian cancer.
Univariate and Multivariate analysis of risk factors for ovarian cancer. case- control study, Mexico City, A Bernal et al, Arch Med Res. 26(3):245, 1995 (Abstract).
Ovarian cancer risk desreased as parity increased. An elevated risk for ovarian cancer was associated with an increased number of abortions with an increased relative risk for women with four fetal losses (OR 3.66,95%CI, 1.02-13.45). Logistic regression analysis found that the number of abortions and high estimated number of ovulatory cycles increased the risk of ovarian cancer.
Menstrual and reproductive factors in relation to ovarian cancer risk, L Titus- Ernstoff et al, Br J Cancer 84(5): 714-721, 2001.
A population based case-control study of ovarian cancer risk among Massachusetts and New Hampshire women using regression analysis found that ovarian cancer risk was reduced among parous women relative to nulli- parous women (OR 0.4,95%CI, 0.3-0.6). Among parous women, higher parity, increased age at first birth, time since last birth and breast feeding were associated with reduced risk. Among women who reported abortion, there was a non-significant increase in risk compared to women with no abortion history (OR 1.1, 95%CI ,0.7-1.6). Among women who reported miscarriage, there was no significant increase in risk compared to women with no history of mis- carriage (OR 1.0, 95%CI, 0.7-1.3).
Risk Factors for Invasive Epithelial Ovarian Cancer: Results from a Swedish Case-Control Study, T Riman et al, Am J Epidemiology 156:363-373, 2002.
Compared to nulliparous women, the risk of ovarian cancer was reduced for women of parity one (OR 0.61,95%CI, 0.46-0.81) , parity two (OR 0.55, 95% CI, 0.43-0.70) , parity three (OR 0.44, 95%CI, 0.33-0.58), parity four (OR 0.35 95% CI, 0.23-0.53) and parity five or more (OR 0.32,95%CI, 0.18-0.56). Compared to women reporting no spontaneous abortion, women reporting one spontaneous or induced abortion had a reduced risk of ovarian cancer (OR 0.76 95%CI, 0.59-0.98), and women reporting two or more spontaneous or induced abortions had a non-significant reduced risk of ovarian cancer (OR 0.70,95% CI, 0.44- 1.12).
Endometrial Cancer
Childbearing and mortality from cancer of the corpus uteri, M-L Lochen and E Lund, Acta Obstet Gynecol Scand 76:373-377, 1997.
A large cohort of Norwegian married women aged 45-74 years at the time of the 1970 census compared the risk of death from cancer of the corpus uteri and found that the age-adjusted risk reduction in mortality was 9.2% (95% CI, .0) for each child.
Reproductive Factors and Risk of Endometrial Cancer, CP McPherson et al, Am J Epidemiology 143 (12): 1195, 1996.
A cohort study of 24,848 postmenopausal Iowa women age 55-69 who were cancer free at baseline in 1986 and without a hysterectomy were followed for 5 years. During the five years, 167 endometrial cancer cases were documented. The mean gravidity of cases (2.6) was significantly lower than non-cases (3.5). A history of ever having had an induced abortion compared to never having had an induced abortion significantly increased the risk of endometrial cancer (RR 2.5,95%CI, 1.1-5.7). Among non-cases of endometrial cancer among women who had a previous abortion, 48.3% went on to have their last pregnancy end in a live birth compared to only 16.7% of the cases of endometrial cancer among women with a previous abortion. The authors concluded that the findings supported the "unopposed" estrogen hypothesis of endometrial cancer.
Risk Factors among young women with endometrial cancer: A Danish case- control study, M Parslov et al, Am J Obstet Gynecol 182:23, 2000.
This study included all Danish women less than 50 years old who had endometrial cancer during 1987-1994. A reduced risk was found for both parity greater than one (0.3) as well as one or more induced abortions (0.5). The authors calculated the protective impacts of various exposures compared to a situation without the particular exposure. These were: oral contraceptive use for one year or more (-45%), 2 term pregnancies (-88%), age 30 or more when giving birth for the first time (-38%), and a history of incomplete pregnancy (-16%).
Other Cancers
Birth characteristics, maternal reproductive history, hormone use during pregnancy, and risk of childhood acute lymphocytic leukemia by immunophenotype (United States), XO Shu et al, Cancer Causes and Control 13:15-25, 2002.
A case-control study of 1842 cases of acute lymphocytic leukemia (ALL) compared to individually matched controls found that induced abortion by the childs' mother prior to the index pregnancy was a significantly higher risk factor for ALL in children compared to children of women who never had an induced abortion (OR 1.2,95%CI, 1.0-1.4). The risk for T-cell ALL during childhood where mothers reported having had an induced abortion
Thomas W. Strahan August 27, 2003