Journal Article

Abortion, Changed Paternity, and Risk of Preeclampsia in Nulliparous Women

Audrey F. Saftlas, Richard J. Levine, Mark A. Klebanoff, Karen L. Martz, Marian G. Ewell, Cynthia D. Morris and Baha M. Sibai

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 157, issue 12, pages 1108-1114
Published in print June 2003 | ISSN: 0002-9262
Published online June 2003 | e-ISSN: 1476-6256 | DOI: https://dx.doi.org/10.1093/aje/kwg101
Abortion, Changed Paternity, and Risk of Preeclampsia in Nulliparous Women

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A prior birth confers a strong protective effect against preeclampsia, whereas a prior abortion confers a weaker protective effect. Parous women who change partners in a subsequent pregnancy appear to lose the protective effect of a prior birth. This study (Calcium for Preeclampsia Prevention Trial, 1992–1995) examines whether nulliparous women with a prior abortion who change partners also lose the protective effect of the prior pregnancy. A cohort analysis was conducted among participants in this large clinical trial of calcium supplementation to prevent preeclampsia. Subjects were nulliparous, had one prior pregnancy or less, delivered after 20 weeks’ gestation, and were interviewed at 5–21 weeks about prior pregnancies and paternity. Women without a history of abortion served as the reference group in logistic regression analyses. Women with a history of abortion who conceived again with the same partner had nearly half the risk of preeclampsia (adjusted odds ratio = 0.54, 95 percent confidence interval: 0.31, 0.97). In contrast, women with an abortion history who conceived with a new partner had the same risk of preeclampsia as women without a history of abortion (adjusted odds ratio = 1.03, 95 percent confidence interval: 0.72, 1.47). Thus, the protective effect of a prior abortion operated only among women who conceived again with the same partner. An immune-based etiologic mechanism is proposed, whereby prolonged exposure to fetal antigens from a previous pregnancy protects against preeclampsia in a subsequent pregnancy with the same father.

Keywords: abortion, induced; abortion, spontaneous; paternity; pre-eclampsia; pregnancy; Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; CPEP, Calcium for Preeclampsia Prevention.

Journal Article.  5351 words. 

Subjects: Public Health and Epidemiology

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