Lauren J. Ralph, PhD; Eleanor Bimla Schwarz, MD; Daniel Grossman, MD; Diana Greene Foster, PhD
Acknowledgment: The authors thank Rana Barar, Heather Gould, and Sandy Stonesifer for study coordination and management; Dr. Charles McCullough and Dr. Corinne Rocca for statistical guidance; Mattie Boehler-Tatman, Janine Carpenter, Undine Darney, Ivette Gomez, Selena Phipps, Brenly Rowland, Claire Schreiber, and Danielle Sinkford for conducting interviews; Jasmine Powell, Michaela Ferrari, Debbie Nguyen, and Elisette Weiss for project support; and Jay Fraser for database assistance. They also thank the participating health care professionals for their assistance with recruitment.
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1666.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Funding: By the Wallace Alexander Gerbode Foundation, the David and Lucile Packard Foundation, the William and Flora Hewlett Foundation, and an anonymous foundation. Dr. Ralph is supported by a Eunice Kennedy Shriver National Institute of Child Health and Human Development, Office of Research on Women's Health, Building Interdisciplinary Research Careers in Women's Health grant (2K12 HD052163).
Reproducible Research Statement: Study protocol: Available from Dr. Ralph (firstname.lastname@example.org). Statistical code: Selected portions available from Dr. Ralph (email@example.com). Data set: Selected data available from Dr. Ralph (firstname.lastname@example.org).
Corresponding Author: Lauren J. Ralph, PhD, Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612; e-mail, Lauren.Ralph@ucsf.edu.
Current Author Addresses: Drs. Ralph, Grossman, and Foster: Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612.
Dr. Bimla Schwarz: Department of Medicine, University of California, Davis, 4860 Y Street, Suites 0101 and 0400, Sacramento, CA 95817.
Author Contributions: Conception and design: L.J. Ralph, E. Bimla Schwarz, D. Greene Foster.
Analysis and interpretation of the data: L.J. Ralph, E. Bimla Schwarz, D. Grossman, D. Greene Foster.
Drafting of the article: L.J. Ralph, E. Bimla Schwarz, D. Grossman, D. Greene Foster.
Critical revision of the article for important intellectual content: L.J. Ralph, E. Bimla Schwarz, D. Grossman, D. Greene Foster.
Final approval of the article: L.J. Ralph, E. Bimla Schwarz, D. Grossman, D. Greene Foster.
Provision of study materials or patients: D. Greene Foster.
Statistical expertise: L.J. Ralph.
Obtaining of funding: D. Greene Foster.
Administrative, technical, or logistic support: D. Greene Foster.
Collection and assembly of data: D. Greene Foster.
Research demonstrates worse short-term morbidity and mortality associated with childbirth than with abortion, but little research has examined long-term physical health in women with unwanted pregnancies after abortion versus childbirth.
To examine the physical health of women who seek and receive or are denied abortion.
Prospective cohort study.
30 U.S. abortion facilities from 2008 to 2010.
Of 1132 women seeking abortion who consented to participate, 874 were included in this analysis (328 who had first-trimester abortion, 383 who had second-trimester abortion, and 163 who gave birth).
Self-reported overall health; chronic abdominal, pelvic, back, and joint pain; chronic headaches or migraines; obesity; asthma; gestational and nongestational hypertension and diabetes; and hyperlipidemia were assessed semiannually for 5 years. Mortality was assessed by using verbal autopsy and public records.
No significant differences were observed in self-rated health or chronic pain after first-trimester versus second-trimester abortion. At 5 years, 27% (95% CI, 21% to 34%) of women who gave birth reported fair or poor health compared with 20% (CI, 16% to 24%) of women who had first-trimester abortion and 21% (CI, 18% to 25%) who had second-trimester abortion. Women who gave birth also reported more chronic headaches or migraines and joint pain, but experienced similar levels of other types of chronic pain and obesity. Gestational hypertension was reported by 9.4% of participants who gave birth. Eight of 1132 participants died during follow-up, 2 in the postpartum period. Maternal mortality did not differ statistically by group.
Self-reported outcome measures, uncertain generalizability, and 41% loss to follow-up at 5 years.
Although some argue that abortion is detrimental to women's health, these study data indicate that physical health is no worse in women who sought and underwent abortion than in women who were denied abortion. Indeed, differences emerged suggesting worse health among those who gave birth.
An anonymous foundation.
Ralph LJ, Schwarz EB, Grossman D, et al. Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study. Ann Intern Med. 2019;171:238–247. [Epub ahead of print 11 June 2019]. doi: https://doi.org/10.7326/M18-1666
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Published: Ann Intern Med. 2019;171(4):238-247.
Published at www.annals.org on 11 June 2019
Headache, Neurology, Obesity.
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