Abstract
BackgroundWomen with previous terminations of pregnancy (TOPs) before their first birth have been associated with poorer perinatal outcomes. However, previous studies on the perinatal outcomes by the method in previous TOPs are inconsistent.ObjectiveTo examine the perinatal outcomes of the first-time mothers with singleton births, by the method of previous TOP (medical and surgical vs no TOP, and surgical vs medical).MethodThis is a nationwide register-based study including 419,879 first-time Finnish mothers with singleton birth during the time period 1996–2013. Mothers having their first birth were identified from the Medical Birth Register and linked to the Abortion Register by their identification numbers. Multinomial logistic regression analysis was performed to examine the risk for preterm birth, low birth weight, small for gestational age and perinatal death by the method in previous TOPs.ResultsAmong the first-time mothers, 87.0% had no history of TOPs, 3.2% had a history of medical TOP(s), 9.2% had a history of surgical TOP(s) and 0.6% had a history of both (medical and surgical) TOP(s). No significant differences in perinatal outcomes were found among the women with surgical TOPs, compared to the women with no TOPs. In unadjusted analysis, increased odds for preterm birth and low birth weight were found when comparing women having previous surgical TOPs with medical TOPs. Even after the adjustment of potential confounders, odds for preterm birth < 37 weeks (OR = 1.19, 95% CI = 1.04–1.36) and low birth weight < 2500 g (OR = 1.16, 95% CI = 1.00–1.35) remained significant. After restricting data to the single TOP, the results were similar; OR for both preterm birth and low birth weight was 1.18 (95% CIs = 1.02–1.36 and 1.01–1.38).ConclusionPerinatal outcomes did not differ among the mothers with surgical TOPs compared to the mothers with no TOPs, while the outcomes were poorer after surgical TOP(s) than after medical TOP(s).
Highlights
In Europe, termination of pregnancies are common, and in Western European countries most TOPs are performed before the first birth [1]
Among the first-time mothers, 87.0% had no history of TOPs, 3.2% had a history of medical TOP(s), 9.2% had a history of surgical TOP(s) and 0.6% had a history of both TOP(s)
No significant differences in perinatal outcomes were found among the women with surgical TOPs, compared to the women with no TOPs
Summary
In Europe, termination of pregnancies (subsequently TOPs) are common, and in Western European countries most TOPs are performed before the first birth [1]. Finland has low rate of TOP, and in 2014 the rate was 8.5 per 1,000 women aged 15–49 years old. A termination of pregnancy can be performed by surgical (dilatation and uterine evacuation) or medical (antiprogestin mifepristone and misoprostol) methods. In Europe, medical TOPs began in France in 1998 [3]. There have been increased use of medical termination of pregnancy and it was nearly 90% in 2014 [2]. Women with previous terminations of pregnancy (TOPs) before their first birth have been associated with poorer perinatal outcomes. Previous studies on the perinatal outcomes by the method in previous TOPs are inconsistent
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