Dose Effect

Dose Effect Evidence

Mental Health Dose Effect

Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy. McCarthy F, Moss-Morris R, Khashan A, et al.BJOG An Int J Obstet Gynaecol. 2015;122(13):1757-1764. doi:10.1111/1471-0528.13233.

Women with one previous termination displayed elevated perceived stress (adjusted mean difference 0.65; 95% CI 0.08–1.23) and depression (aOR 1.25; 95% 1.08–1.45) at 15 weeks of gestation. Women with two previous terminations displayed increased perceived stress (adjusted mean difference 1.43; 95% CI 0.00–2.87) and depression (aOR 1.67; 95% 1.28–2.18).

Depression Following Induced Abortion. Koyun, A., Kır Şahin, F., Çevrioğlu, S., Demirel, R., & Geçici, Ö. (2016). Gynecology Obstetrics & Reproductive Medicine, 13(2). doi:http://dx.doi.org/10.21613/GORM.2007.521

Note. The researchers also observed a dose effect, with multiple abortions increasing depression risk.

Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. Giannandrea SAM, Cerulli C, Anson E, Chaudron LH. J Womens Health (Larchmt) [Internet]. 2013;22(9):760–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24007380 PMID: 24007380

Multiple losses, either from miscarriage or induced abortion, predict elevated rates of postpartum anxiety.(2)

Physical Health Dose Effect

Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland. Klemetti R, Gissler M, Niinimäki M, Hemminki E. Hum Reprod. 2012 Nov;27(11):3315-20. doi: 10.1093/humrep/des294. Epub 2012 Aug 29.

After adjustment, perinatal deaths and very preterm birth (<28 gestational week) suggested worse outcomes after IA. Increased odds for very preterm birth were seen in all the subgroups and exhibited a dose-response relationship: 1.19 [95% confidence interval (CI) 0.98-1.44] after one IA, 1.69 (1.14-2.51) after two and 2.78 (1.48-5.24) after three IAs. Increased odds for preterm birth (<37 weeks) and low birthweight (<2500 g and <1500 g) were seen only among mothers with three or more IAs: 1.35 (1.07-1.71), 1.43 (1.12-1.84) and 2.25 (1.43-3.52), respectively.

Life Expectancy/Elevated Mortality Rate Dose Effect

Reproductive history patterns and long-term mortality rates: a Danish, population-based record linkage study. Coleman PK, Reardon DC, Calhoun BC. Eur J Public Health. 2012 Sep 5.

Risk of death was more than six times greater among women who had never been pregnant compared with those who only had birth(s). Increased risks of death were 45%, 114% and 191% for 1, 2 and 3 abortions, respectively, compared with no abortions after controlling for other reproductive outcomes and last pregnancy age.