Medication and procedural abortions before 13 weeks gestation and risk of psychiatric disorders

Abstract

BackgroundThe proportion of abortions provided by medication in the US and worldwide has increased greatly since FDA-approval of mifepristone in 2000. While existing research has shown that abortion does not increase risk of mental health problems, no population-based study has examined specifically whether a procedural or medication abortion increases risk of mental health disorders. ObjectiveThis study examined whether mental health disorders increased in the shorter and longer-term after a medication or procedural abortion. Study DesignUsing Danish population registers’ data, we conducted a prospective cohort study in which we included 72,424 females born in Denmark between 1980-2006, who were ages 12-38 during the study period and had a first first-trimester abortion before 13 weeks gestation in 2000-2018. Females with no previous psychiatric diagnoses were followed from one year before their abortion until their first psychiatric diagnosis, December 31, 2018, emigration from Demark, or death, whichever came first. Risk of any first psychiatric disorder was defined as a recorded psychiatric diagnosis at an in- or out-patient facility from the one year after to more than 5 years after a medication or procedural abortion relative to the year beforehand. Results were adjusted for calendar year, age, gestational age, partner status, prior mental and physical health, childbirth history, childhood environment, and parental mental health history. ResultsFemales having medication (n = 37,155) and procedural abortions (n = 35,269) had the same risk of any first psychiatric diagnosis in the year after their abortion relative to the year before their abortion (medication abortion adjusted incidence rate ratio [MaIRR] = 1.02, 95% CI: 0.93-1.12; procedural abortion adjusted incidence rate ratio [PaIRR] = 0.94, 95% CI: 0.86-1.02). Moreover, as more time from the abortion passed, the risk of a psychiatric diagnoses decreased relative to the year before their abortion for each abortion method (MaIRR 1-2 years after = 0.89, 95% CI: 0.80-0.98; PaIRR 1-2 years after = 0.81, 95% CI: 0.88-1.05; MaIRR 2-5 years after = 0.77, 95% CI: 0.71-0.84; PaIRR 2-5 years after = 0.72, 95% CI: 0.67-0.78; MaIRR 5+ years after = 0.58, 95% CI: 0.53-0.63; PaIRR 5+ years after = 0.54, 95% CI: 0.50-=0.58). ConclusionsBecause the risk of psychiatric diagnoses was the same in the year after relative to the year before a medication and procedural abortion and the risk did not increase as more time after the abortion increased, neither abortion method increased risk of mental health disorders in the shorter or longer-term.