Does Elective Abortion Increase Risk of Future Miscarriage?

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Question: Does Elective Abortion Increase Risk of Future Miscarriage?

Anything that relates to elective abortion tends to inspire heated debate, and a lot of myths and half truths are circulating about how abortion affects a woman's physical and mental health. So is it true that elective abortion increases the risk of miscarriage in the subsequent pregnancy?

Answer:

It's hard to know. Some evidence suggests that elective abortion could mean increased risk of miscarriage in a future pregnancy, but no proof of a causal link in general.

A few studies have found a general increased risk after one elective pregnancy termination, but most find increased risk of miscarriage only in women who have had multiple induced abortions.

Studies also exist that have found no link between having an elective abortion and the risk of miscarriage in a future pregnancy. Some researchers have speculated that if there is an increased risk, the risk is likely to come not from the abortion but from other lifestyle factors that might be more common in women who have had an elective abortion.

Further complicating the matter is the possibility that any theoretical risk comes only from the slight chance of scarring due to surgical abortions (such as abortions by D & C), as opposed to medically induced abortions, and that the latter may not increase risk at all. One large 2007 study examined 11,800 women and found that medically induced abortions did not cause an increase in the risk of future miscarriage or other pregnancy complications.

If you are concerned, your best bet is to discuss the matter with your doctor. Here are some things to keep in mind depending on the specifics of your concern:

  • If you have had an elective abortion in the past and are worried about the risk of miscarriage in a future pregnancy, remember that most women who have had an elective abortion will not have any serious physical complications. Your odds for a good outcome in your next pregnancy are higher than your odds of miscarriage.

  • If you have had a miscarriage after a previous elective termination, and you are wondering whether there is a link, realize that there is no way to know whether or not the two were related -- and it is probably more likely that they are not related. There are a lot of different reasons why you may have miscarried, and the most common cause of miscarriages is chromosomal abnormalities in the baby, which cannot be caused by a past abortion.

  • If you are currently considering an elective abortion in an unwanted pregnancy, but you are worried about the ramifications for your future health, talk to your doctor about the least risky option -- and about what you can do to avoid the need for another elective abortion, given the possibility that multiple elective abortions could increase the risk of future complications.

Sources:

Chen, Aimin, Wei Yuan, Olav Meirik, Xianmi Wang, Shi-Zhong Wu, Lifeng Zhou, Lin Luo, Ersheng Gao, and Yimin Cheng, "Mifepristone-induced Early Abortion and Outcome of Subsequent Wanted Pregnancy." American Journal of Epidemiology 2004. Accessed 10 Oct 2008.

Gan, C., Y. Zou, S. Wu, Y. Li, and Q. Liu, "The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome." In J. Gynaecol. Obstet. Jun 2008. Accessed 10 Oct 2008.

Raatikainen, Kaisa, Nonna Heiskanen, and Seppo Heinonen, "Induced Abortion: Not an Independent Risk Factor for Pregnancy Outcome, But a Challenge for Health Counseling." Annals of Epidemiology 2006. Accessed 10 Oct 2008.

Sun, Yuelian, Yan Che, Ersheng Gao, Jørn Olsen, and Weijin Zhou, "Induced abortion and risk of subsequent miscarriage." International Journal of Epidemiology 2003. Accessed 10 Oct 2008.

Virk, Jasveer, Jun Zhang, and Jorn Olsen, "Medical Abortion and the Risk of Subsequent Adverse Pregnancy Outcome." New England Journal of Medicine Aug 2007. Accessed 10 Oct 2008.

Zou, Y., J. Luo, Y.F. Xiao, Y.J. Fan, and R. Luo, "Study on the influence of medical abortion and surgical abortion on subsequent pregnancy." Sichuan Da Xue Xue Bao Yi Xue Ban. Jul 2004. Accessed 10 Oct 2008.

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