Pregnancy Outcome Patterns of Medicaid-Eligible Women, 1999-2014: A National Prospective Longitudinal Study

Abstract

Introduction: The number and outcomes of pregnancies experienced by a woman are consequential determinants of her health status. However, there is no published research comparing the patterns of subsequent pregnancy outcomes following a live birth, natural fetal loss, or induced abortion. Objectives: The objective of this study was to describe the characteristic patterns of subsequent pregnancy outcomes evolving from each of three initiating outcome events (birth, induced abortion, natural fetal loss) occurring in a Medicaid population fully insured for all reproductive health services. Methods: We identified 7,388,842 pregnancy outcomes occurring to Medicaid-eligible women in the 17 states which paid for abortion services between 1999-2014. The first known pregnancy outcome for each woman was marked as the index outcome which assigned each woman to one of three cohorts. All subsequent outcomes occurring up to the fifth known pregnancy were identified. Analyses of the three index outcome cohorts were conducted separately for all pregnancy outcomes, three age bands (<17, 17-35, 36+), and three race/ethnicity groups (Hispanic, Black, White). Results: Women with index abortions experienced more lifetime pregnancies than women with index births or natural fetal losses and were increasingly more likely to experience another pregnancy with each subsequent pregnancy. Women whose index pregnancy ended in abortion were also increasingly more likely to experience another abortion at each subsequent pregnancy. Both births and natural fetal losses were likely to result in a subsequent birth, rather than abortion. Women with natural losses were increasingly more likely to have a subsequent birth than women with an index birth. All age and racial/ethnic groups exhibited the characteristic pattern we have described for all pregnancy outcomes: abortion is associated with more subsequent pregnancies and abortions; births and fetal losses are associated with subsequent births. Other differences between groups are, however, apparent. Age is positively associated with the likelihood of a birth following an index birth, but negatively associated with the likelihood of a birth following an index abortion. Hispanic women are always more likely to have a birth and less likely to have an abortion than Black or White women, for all combinations of index outcome and the number of subsequent pregnancies. Similarly, Black women are always more likely to have an abortion and less likely to experience a birth than Hispanic or White women. Conclusion: Women experiencing repeated pregnancies and subsequent abortions following an index abortion are subjected to an increased exposure to hemorrhage and infection, the major causes of maternal mortality, and other adverse consequences resulting from multiple separation events.

Estimating the Period Prevalence of Publicly Funded Abortion to Space Live Births, 1999 to 2014

“…Recent research findings from the same study population also indicate that an abortion greatly increases the likelihood of another abortion in subsequent pregnancies, and that this tendency is found across all races, ethnicities, and age groups. 20 A low incidence of B-A-B sequences is consistent with these results since it requires an abortion to be followed by a live birth in a subsequent pregnancy, a sequence of pregnancy outcomes which is relatively uncommon.…”

The Enduring Association of a First Pregnancy Abortion with Subsequent Pregnancy Outcomes: A Longitudinal Cohort Study

“…27 , 28 In a previous analysis, we determined that women 36 + years of age are increasingly more likely to abort a subsequent pregnancy and less likely to experience childbirth following an index abortion, no matter the pregnancy for which the abortion occurred. 23 The results of the current study also indicate that abortion is increasingly likely with increasing age and pregnancy order, independent of the first pregnancy outcome. Therefore, there is no reason to believe that the missing pregnancy outcomes in later reproductive years are a threat to the validity of our findings.…”

“…In a previous study, we determined that women who experience an abortion for any pregnancy in their reproductive history were more likely to become pregnant again and to experience another abortion in the next subsequent pregnancy. 23 We also found that 23% of Medicaid beneficiaries whose first pregnancy ended in an abortion were pregnant a second time within 12 months with approximately 60% undergoing a second abortion. 24 An important Finnish study followed a cohort of 1269 women who underwent chemical abortion for a follow-up period of 4.2 years ( + /− 1.5) and determined that young women with previous abortions were most likely to experience abortion in the subsequent pregnancy.…”

Estimating the Period Prevalence of Mothers Who Have Abortions: A Population Based Study of Inclusive Pregnancy Outcomes

“…This finding is consistent with previous research which indicates that abortion results in a higher number of rapid repeat pregnancies which result in more abortions. 15,16 Within the group of women with both births and abortions, 38.5% had an abortion timed consistent with an attempt to delay a first birth, 17.9% had an abortion that spaced live births, and 52.3% had an abortion that could indicate a desire to end childbearing. The estimated period prevalence for each of these patterns is 2.2%, 1.0%, and 3.0% respectively.…”