Abortion and Subsequent Pre-Term Birth, 2012

8/17/2019 Abortion and Subsequent Pre-Term Birth, 2012

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Abortion and Subsequent Pre-termBirth: Update 2012

Byron C. Calhoun, !, "AC#$, "ACS, BAByron C. Calhoun, !, "AC#$, "ACS, BA

Pro%essor and &i'e Chair, #bstetri's and $yne'olo(yPro%essor and &i'e Chair, #bstetri's and $yne'olo(y

)est &ir(inia Uni*ersity-Charleston)est &ir(inia Uni*ersity-CharlestonCharleston, )&, USACharleston, )&, USA

"ebruary, 2012"ebruary, 2012


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!is'losure

+here are no 'ommer'ial produ'ts+here are no 'ommer'ial produ'ts

mentioned in this le'ture nor is supportmentioned in this le'ture nor is support

bein( supplied by any *endor, a(en'y, or bein( supplied by any *endor, a(en'y, or(o*ernmental (ranta(ent.(o*ernmental (ranta(ent.


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#utline

ntrodu'tion#b/e'ti*es ntrodu'tion#b/e'ti*es

. "requen'y o% P+B. "requen'y o% P+B

. orbidity o% P+B. orbidity o% P+B

&. e*ie important re'ent studies&. e*ie important re'ent studies

&. atest Studies 2003-2011&. atest Studies 2003-2011 &. US So'ietal 'osts o% abortion&. US So'ietal 'osts o% abortion

&. "uture issues in abortion and P+B&. "uture issues in abortion and P+B


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. "requen'y 4 Costs

n'iden'e o% preterm deli*ery is 56 year in USn'iden'e o% preterm deli*ery is 56 year in US

Births a*era(e 7-8 millionyear in U.S.Births a*era(e 7-8 millionyear in U.S.

+here%ore, 130-280,000 birthsyear in US+here%ore, 130-280,000 birthsyear in US +he *ery preterm births 923 ee;s< in'lude+he *ery preterm births 923 ee;s< in'lude

appro=imately 16 births or 70,000-80,000 births annuallyappro=imately 16 births or 70,000-80,000 births annually

ndu'ed abortion is asso'iated ith >?1.2ndu'ed abortion is asso'iated ith >?1.2 billion (US)billion (US) toto

health 'osts annuallyhealth 'osts annually11

11Calhoun BC, Shadi(ian @, ooney B. ndu'ed abortion: 'ost 'onsequen'es o%Calhoun BC, Shadi(ian @, ooney B. ndu'ed abortion: 'ost 'onsequen'es o%

an attributable ris; %or preterm birth and its impa't on in%ormed 'onsent andan attributable ris; %or preterm birth and its impa't on in%ormed 'onsent and

medi'al malpra'ti'e. epro ed 200D2 910


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. orbidity o% Preterm Birth

&ery lo-birth 9&B)< ei(ht 'osts 23 times 9< term&ery lo-birth 9&B)< ei(ht 'osts 23 times 9< term 9?230,185 *ersus ?E,307


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Pre*ious Studies Continued

Sin(le G, ColaiHy ++, Fimmerman B,Sin(le G, ColaiHy ++, Fimmerman B,

orriss "G. Abortion and the ris; o% subsequentorriss "G. Abortion and the ris; o% subsequent

preterm birth: A systemati' re*ie ith meta- preterm birth: A systemati' re*ie ith meta-analyses. repro ed 200ED8:ED-103.analyses. repro ed 200ED8:ED-103.55

Shah PS, Fao . ndu'ed termination o% pre(nan'yShah PS, Fao . ndu'ed termination o% pre(nan'y

and lo birthei(ht and preterm birth: aand lo birthei(ht and preterm birth: a

systemati' re*ie and meta-analysis. B#$systemati' re*ie and meta-analysis. B#$200E115:182D-1882.200E115:182D-1882.BB


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eta-analysis by Sin(le, et al

200E.5

eta-analyses o% literature 1EED-200eta-analyses o% literature 1EED-200

Pro-abortion 4 pro-li%e authorsPro-abortion 4 pro-li%e authors

,3E1 titles, 78E abstra'ts, 170 papers,3E1 titles, 78E abstra'ts, 170 papers 70 abortion 4 25 SAB papers in'luded70 abortion 4 25 SAB papers in'luded

AnalyHed data %rom 12 indu'ed and E SAB papersAnalyHed data %rom 12 indu'ed and E SAB papers

!emonstrated 586 in'reased ris; ith sin(le!emonstrated 586 in'reased ris; ith sin(leabortion %or *ery preterm birth 72 ee;sabortion %or *ery preterm birth 72 ee;s


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200E.3

12 studies used to 'al'ulate 'ommon #Is12 studies used to 'al'ulate 'ommon #Is

%or indu'ed abortion%or indu'ed abortion

1 indu'ed abortion 1.2D # K1.07-1.83L1 indu'ed abortion 1.2D # K1.07-1.83L

in'reased ris; preterm birth 7 ee;sin'reased ris; preterm birth 7 ee;s

> 1 indu'ed abortion 1.D1 # K1.21-1.DL> 1 indu'ed abortion 1.D1 # K1.21-1.DL

in'reased ris; preterm birth 7 ee;sin'reased ris; preterm birth 7 ee;s


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200E.5

8 studies a*ailable %or 'ommon #Is %or8 studies a*ailable %or 'ommon #Is %or

indu'ed abortion 72 ee;sindu'ed abortion 72 ee;s

Common # 1.58 K1.73-1.E1LCommon # 1.58 K1.73-1.E1L

n'reased *ery preterm deli*ery rate o% 586n'reased *ery preterm deli*ery rate o% 586

Similar to other literatureIs %indin(sSimilar to other literatureIs %indin(s


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200E.5

12 studies a*ailable %or 'ommon # ith12 studies a*ailable %or 'ommon # ith

SABIs %or preterm deli*ery 7 ee;sSABIs %or preterm deli*ery 7 ee;s

1 SAB 1.87 # K1.0D-1.55L1 SAB 1.87 # K1.0D-1.55L

> 1 SAB 2.2 # K1.E3-2.31L> 1 SAB 2.2 # K1.E3-2.31L


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eta-analysis by Shah, et al 200E

S'reened 378 papersS'reened 378 papers

@='luded 5D %or la'; dataob/e'ti*e@='luded 5D %or la'; dataob/e'ti*e

5E 'itations retrie*ed5E 'itations retrie*ed

72 e='luded72 e='luded


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eta-analysis by Shah, et al 200E: 72 e='luded studies

@='lusions@='lusions studies no neonatal out'omes studies no neonatal out'omes

reported 'ombined SABabortions reported 'ombined SABabortions D no 'omparison (roupD no 'omparison (roup

8 reports re*ies8 reports re*ies

7 reported &B) and B) only7 reported &B) and B) only

2 studies spe'i%i' population only2 studies spe'i%i' population only 2 studies pre*iously published data2 studies pre*iously published data

1 dupli'ation publi'ation1 dupli'ation publi'ation

1data not a*ailable1data not a*ailable


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eta-analysis by Shah, et al 200E: 7 in'luded studies

13 studies ith o Birth )ei(ht 9B)


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eta-analysis by Shah, et al 200E: 13 B) Studies

Jo abortion *s 1 +AB Jo abortion *s 1 +AB

13 studies13 studies

230,D2E patients230,D2E patients # 1.7D K1.20-1.D2L# 1.7D K1.20-1.D2L

Jo abortions *s > 1 Jo abortions *s > 1

D studies o% 13D studies o% 13

8E,78 patients8E,78 patients 1.2 K1.8D-2.08L1.2 K1.8D-2.08L


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eta-analysis by Shah, et al 200E: 22 P+B Studies


22 studies22 studies

253,7E patients253,7E patients # 1.75 K1.28-1.D0L# 1.75 K1.28-1.D0L


studies o% 22 studies o% 22

1D3,821 patients1D3,821 patients 1.E7 K1.73-2.1L1.E7 K1.73-2.1L


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eta-analysis by Shah, et al 200E: 7 S$A Studies


7 studies7 studies

73,37D patients73,37D patients # 0.3 K0.5E-1.0EL# 0.3 K0.5E-1.0EL


2 studies o% 72 studies o% 7

7D,822 patients7D,822 patients 1.05 K0.38-1.77L1.05 K0.38-1.77L


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2011: another busy year %or preterm birth

and abortion studies 9no 12 studies<

• 7 ne interestin( studies on preterm birth7 ne interestin( studies on preterm birth

and abortionand abortion3-103-10

• 1 data based lin;ed1 data based lin;ed33

• 2 'ohort studies2 'ohort studiesE-10E-10


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!i enHo, et al3

• ulti'enter, obser*ational, retrospe'ti*e andulti'enter, obser*ational, retrospe'ti*e and

'ross-se'tional study in E 'enters in taly'ross-se'tional study in E 'enters in taly

•

e'ords lin;ed to out'omese'ords lin;ed to out'omes• Poer analysis done prior %ound needed 5,000Poer analysis done prior %ound needed 5,000

omen to determine a di%%eren'e in preterm birthomen to determine a di%%eren'e in preterm birth

9baseline P+B rate D6


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!i enHo, et al3

• 1D *ariables e*aluated as 'o-%a'tors1D *ariables e*aluated as 'o-%a'tors

• n'luded B, a(e, medi'al 'omorbidities,n'luded B, a(e, medi'al 'omorbidities,

toba''o abuse, pre*ious 'esarean se'tion,toba''o abuse, pre*ious 'esarean se'tion,

and abortionand abortion

• !id not separate out hen abortions!id not separate out hen abortions

o''urred or numbers o% abortionso''urred or numbers o% abortions

• ulti*ariate analysisulti*ariate analysis


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!i enHo, et al3

• # in'reased ris; preterm birth 1.ED8# in'reased ris; preterm birth 1.ED8

91.152-7.23D< ith pre*ious abortion91.152-7.23D< ith pre*ious abortion

• Also %ound in the study in'reased ris; ith:Also %ound in the study in'reased ris; ith:• B >2D # 1.552 91.077-2.552D # 1.552 91.077-2.55<

• Pre*ious 'esarean # 2.E08 91.55-.E10


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!i enHo, et al3

• Con'lusions:Con'lusions:

• Positi*esPositi*es• ar(e, lin;ed data base ith poermulti*ariatear(e, lin;ed data base ith poermulti*ariate

analysisanalysis

• "ound in'reased P+B ris; in"ound in'reased P+B ris; in ALL ALL patients ith patients ith

pre*ious abortions as separate %a'tor pre*ious abortions as separate %a'tor

• Je(ati*es Je(ati*es• !id not separate out abortion timin(!id not separate out abortion timin(

• !id not do analysis %or multiple abortions!id not do analysis %or multiple abortions


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iao, et alE

• Cohort studyCohort study

• 8 years %rom anuary 2005-!e'ember 200E8 years %rom anuary 2005-!e'ember 200E

• nter*ie based ith deli*ery out'omesnter*ie based ith deli*ery out'omes

• 13,727 omen 91E,D2 inter*ieed


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iao, et alE

• !i*ided into 7 'omparison (roups:!i*ided into 7 'omparison (roups:

• Julliparous omen ith 1 or more %irst Julliparous omen ith 1 or more %irst

trimester medi'al abortions 9me%epristone


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iao, et alE

• ,83 ith 'omplete %ollo up in abortion,83 ith 'omplete %ollo up in abortion

(roup out o% ori(inal ,DD3 9E3.E6


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iao, et alE

• n no abortion (roup there ere 772n no abortion (roup there ere 772

spontaneous abortions 77210,D85 or 7.1D6spontaneous abortions 77210,D85 or 7.1D6

• n the abortion (roup there ere:n the abortion (roup there ere:• 1,5E one medi'al abortion 1,5E,8539286


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iao, et alE

• # 1.8 91.1-1.3< preterm birth ith 1# 1.8 91.1-1.3< preterm birth ith 1

sur(i'al abortionsur(i'al abortion

• # 1.52 91.2-7.82< preterm birth# 1.52 91.2-7.82< preterm birth >> 77sur(i'al abortions 9dose e%%e't


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iao, et alE

• # 1.07 90.D7-1.57< no in'rease ris; o% preterm birth ith# 1.07 90.D7-1.57< no in'rease ris; o% preterm birth ith

medi'al abortions 'ompared to no abortionsmedi'al abortions 'ompared to no abortions

• Goe*er, buried in arti'le %ound 20.76 o% patients needed aGoe*er, buried in arti'le %ound 20.76 o% patients needed a

post-abortion su'tion 'uretta(e post-abortion su'tion 'uretta(e

• # 1.5E 91.02-7.15< preterm birth ris; in omen ith# 1.5E 91.02-7.15< preterm birth ris; in omen ith

medi'al abortion ee;smedi'al abortion ee;s with curettage!with curettage!

• AND AND ris; %or 72 ee; deli*ery # as 7.51 91.87-8.E7


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iao, et alE

• Con'lusions:Con'lusions:• Positi*esPositi*es

•

ar(e (roup o% patients 913,727


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iao, et alE

• Je(ati*es Je(ati*es

• !id not share most startlin( %indin(s re(ardin(!id not share most startlin( %indin(s re(ardin(

abortion in this paper abortion in this paper • # 1.8 91.1-1.3< preterm birth ith 1 sur(i'al# 1.8 91.1-1.3< preterm birth ith 1 sur(i'al

abortionabortion

• # 1.52 91.2-7.82< preterm birth# 1.52 91.2-7.82< preterm birth >> 7 sur(i'al7 sur(i'al

abortions 9dose e%%e't


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iao, et alE

• Je(ati*es 'ontinued Je(ati*es 'ontinued•

need %or 'uretta(e in 206 medi'al abortionsneed %or 'uretta(e in 206 medi'al abortions• # 1.5E 91.02-7.15< preterm birth ris; in omen ith medi'al# 1.5E 91.02-7.15< preterm birth ris; in omen ith medi'al

abortion ee;sabortion ee;s with curettage!with curettage!

• AND AND ris; %or 72 ee; deli*ery # as 7.51 91.87-8.E7


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Almedia et al10

• Abstra't only in @n(lish 9Portu(uese %romAbstra't only in @n(lish 9Portu(uese %rom

BraHil


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&. So'ietal Costs o% Abortion11

Child bornM?1.8 million 9US< bene%it to so'ietyChild bornM?1.8 million 9US< bene%it to so'iety Child aborted-?200,000 9US< 'ost to so'ietyChild aborted-?200,000 9US< 'ost to so'iety

Child bornM?200,000 9US< input into treasuryChild bornM?200,000 9US< input into treasury Child abortedM?72,000 9US< 'ost to treasuryChild abortedM?72,000 9US< 'ost to treasury

1111"in(er , Garden G. So'ietal 'osts o% abortion. "o'us on "amily, "o'us on So'ial ssues,"in(er , Garden G. So'ietal 'osts o% abortion. "o'us on "amily, "o'us on So'ial ssues,

)orld*ie and Culture, September 22, 200D.)orld*ie and Culture, September 22, 200D.

http:%amily.or('%orum%osiorld*ieessaysa0073002.'%mhttp:%amily.or('%orum%osiorld*ieessaysa0073002.'%m


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&. "uture ssues: iability and

n%ormed Consent

alpra'ti'e 'osts 'ontinue to s;y-ro';etalpra'ti'e 'osts 'ontinue to s;y-ro';et

edian dama(e aard %or 'hildbirth:edian dama(e aard %or 'hildbirth:

>?2 million 9US< beteen 1EE8-2000>?2 million 9US< beteen 1EE8-20001212

alpra'ti'e premiums rat'het up 706-D06year in USalpra'ti'e premiums rat'het up 706-D06year in US

atest )ashin(ton Supreme Court 912200E< stru';atest )ashin(ton Supreme Court 912200E< stru';don malpra'ti'e 'aps-opens hole tort problem updon malpra'ti'e 'aps-opens hole tort problem upa(aina(ain

1212Fimmerman , #ster C. Assi(nin( liability: insurersI missteps helpedFimmerman , #ster C. Assi(nin( liability: insurersI missteps helped pro*o;e malpra'ti'e N'risisO. )all St 2002 une 28:A1. pro*o;e malpra'ti'e N'risisO. )all St 2002 une 28:A1.


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uestions re(ardin( Abortion and

Publi' Gealth

Gas patient had an abortion prior to in'identGas patient had an abortion prior to in'ident pre(nan'yQ pre(nan'yQ

Go many abortions did patient ha*eQGo many abortions did patient ha*eQ !ose response!ose response

)as patient in%ormed o% in'reased P+B ris; ith)as patient in%ormed o% in'reased P+B ris; ith pre*ious abortionQ Parti'ularly ethni' ris;s. pre*ious abortionQ Parti'ularly ethni' ris;s.

)as patient in%ormed o% P+B ris; abortion ith)as patient in%ormed o% P+B ris; abortion ith'erebral palsy ris;Q'erebral palsy ris;Q


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Abortion and P+B

n'rease aareness o% s'ien'e, ris;, 'ostsn'rease aareness o% s'ien'e, ris;, 'osts

Publish papers do'umentin( ;non ris;sPublish papers do'umentin( ;non ris;s

@mphasiHe ris; been ;non %or many years@mphasiHe ris; been ;non %or many years

@n'oura(e poli'y ma;ers to address@n'oura(e poli'y ma;ers to address

!e*elop strate(ies to de'rease abortions!e*elop strate(ies to de'rease abortions


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Con'lusions

ndu'ed abortion in'reases P+B rates substantially in latest lar(endu'ed abortion in'reases P+B rates substantially in latest lar(estudiesmeta analysesstudiesmeta analyses

@thni' in%luen'e 'ompounds the dama(e in Bla';s@thni' in%luen'e 'ompounds the dama(e in Bla';s Jo 12 studies no ith statisti'al si(ni%i'an'e 9"ebruary, 2012


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uestions

&oi'e ail: 708-733-1DEE&oi'e ail: 708-733-1DEE

"a=: 708-733-2E1D"a=: 708-733-2E1D

@mail: byron.'alhounR'am'.or(@mail: byron.'alhounR'am'.or(


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e%eren'es

11Calhoun BCCalhoun BC,, Shadi(ian @, ooney B. ndu'ed abortion: 'ost 'onsequen'es o% anShadi(ian @, ooney B. ndu'ed abortion: 'ost 'onsequen'es o% an

attributable ris; %or preterm birth and its impa't on in%ormed 'onsent andattributable ris; %or preterm birth and its impa't on in%ormed 'onsent and

medi'al malpra'ti'e. epro ed 200D2 910


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e%eren'es

55Sin(le G, ColaiHy ++, Fimmerman B, orriss "G. Abortion andSin(le G, ColaiHy ++, Fimmerman B, orriss "G. Abortion and

the ris; o% subsequent preterm birth: A systemati' re*ie ith meta-the ris; o% subsequent preterm birth: A systemati' re*ie ith meta-

analyses. repro ed 200ED8:ED-103.analyses. repro ed 200ED8:ED-103.

Shah PS, Fao . ndu'ed termination o% pre(nan'y and lo birthei(htShah PS, Fao . ndu'ed termination o% pre(nan'y and lo birthei(htand preterm birth: a systemati' re*ie and meta-analysis. B#$and preterm birth: a systemati' re*ie and meta-analysis. B#$

200E115:182D-1882.200E115:182D-1882.


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e%eren'es

33!i enHo $C, $iardia , osati A, Cleri'i $, +orri'elli , Petra(lia ".!i enHo $C, $iardia , osati A, Cleri'i $, +orri'elli , Petra(lia ".atnernal ris; %a'tors %or preterm birth: a 'ountry-based populationatnernal ris; %a'tors %or preterm birth: a 'ountry-based populationanalysis. @ur #B$J epro Bio 20111DE:782-785analysis. @ur #B$J epro Bio 20111DE:782-785

EEiao G, )eu , !uan , $e , Fhou , Fen( ). epeated medi'aliao G, )eu , !uan , $e , Fhou , Fen( ). epeated medi'alabortions and the ris; o% preterm birth in the subsequent pre(nan'y.abortions and the ris; o% preterm birth in the subsequent pre(nan'y.Ar'h $yne'ol #bstet 2011238:DE-D35.Ar'h $yne'ol #bstet 2011238:DE-D35.


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e%eren'es

1010Almeda ", et al. Sur*i*al and ris; %a'tors %or neonatal mortality in aAlmeda ", et al. Sur*i*al and ris; %a'tors %or neonatal mortality in a

'ohort o% *ery lo birth ei(ht in%ants in the southern re(ion o% Sao'ohort o% *ery lo birth ei(ht in%ants in the southern re(ion o% Sao

Paulo 'ity, BraHil Cad Saude Publi'a 2011:2 95

Documents

Abortion and Subsequent Pre-Term Birth, 2012