Document Type : Original Article

Authors

1 Student in Epidemiology, Student Research committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Non-Communicable Diseases Research Center, Research Center for Health Sciences, Institute of Health, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran

4 Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Introduction: Therapeutic Abortion (TA) has been defined as termination of pregnancy before the 20th week of gestation in order to save the mother’s life and prevent birth defects.The present study aimed to investigate the incidence of TA and its related maternal-fetal risk factors.
Methods: This historical cohort study reviewed 11000 birth records. Among these reviewed records, 83 cases of TA were identified. Then, for each case, three controls of live infants born in the same hospital on the same day were selected and  matched for gestational age. We used a researcher-made questionnaire for data collection.
Results: The cumulative incidence of TA was computed 7.54 per 1000 live births. The results of multiple Cox regression model revealed that four risk factors including male gender; parental consanguinity; maternal diseases including gestational hypertension, gestational diabetes mellitus, hypothyroidism, infertility, the use of In Vitro Fertilization (IVF) and urinary tract infection; and maternal medication consumption increased the risk of TA (all hazard ratios > 1: p<0.05).
Conclusion: For the first time, we assessed the incidence of TA through this population-based cohort study in Iran. Importantly, parental consanguinity was one of the predictors of TA revealed in this study. Identification of the causes of TA would prevent the birth of infants with congenital anomalies.

Keywords

1. Mahdavi SA, Jafari A, Azimi K, Dehghanizadeh N, Barzegar A. Therapeutic abortion in Iran: an epidemiologic study of legal abortion in 2 years. BMC Research Notes. 2020 Dec;13:1-6.
2. Dawson AJ, Nicolls R, Bateson D, Doab A, Estoesta J, Brassil A, Sullivan EA. Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study. Reproductive health. 2017 Dec;14(1):1-3.
3. Lamichhane P, Harken T, Puri M, Darney PD, Blum M, Harper CC, Henderson JT. Sex-selective abortion in Nepal: a qualitative study of health workers' perspectives. Women's Health Issues. 2011 May 1;21(3):S37-41.
4. Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. American journal of epidemiology. 2004 Mar 1;159(5):475-80.
5. Daskalakis GJ, Mesogitis SA, Papantoniou NE, Moulopoulos GG, Papapanagiotou AA, Antsaklis AJ. Misoprostol for second trimester pregnancy termination in women with prior caesarean section. BJOG: An International Journal of Obstetrics & Gynaecology. 2005 Jan;112(1):97-9.
6. Erfani A, McQuillan K. Rates of induced abortion in Iran: the roles of contraceptive use and religiosity. Studies in family planning. 2008 Jun;39(2):111-22.
7. Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. The Lancet. 2006 Nov 25;368(9550):1887-92.
8. Solymanpour A, Magharehzadeh M, Pourbakhteyar M, Mehmandoust M, J. k (2017) Investigation congenital anomaly in legal abortion in esfahan.The Journal of Obstetrics and Gynecology of India. 2014;20 (4):25-33
9. du Toit-Prinsloo L, Pickles C, Smith Z, Jordaan J, Saayman G. The medico-legal investigation of abandoned fetuses and newborns—a review of cases admitted to the Pretoria Medico-Legal Laboratory, South Africa. International journal of legal medicine. 2016 Mar 1;130(2):569-74.
10. Finer L, Fine JB. Abortion law around the world: progress and pushback. American journal of public health. 2013 Apr;103(4):585-9.
11. Sharifi A, Janatolmakan M, Khatony A. The prevalence and the reasons of issuing permission for therapeutic abortion in department of forensic medicine, Kermanshah, Iran, during 2005 to 2010. BMC research notes. 2019 Dec;12(1):1-5.
12. Tofighi H, Mousavipour F, Barooni S. Investigation of patients requesting permission for abortion to the legal medicine center from June 1999 to the end of May 2000. Journal Forensic Medecin. 2000;7(22):21-7.
13. Bazmi S, Behnoush B, Kiani M, Bazmi E. Comparative study of therapeutic abortion permissions in central clinical department of Tehran Legal Medicine Organization before and after approval of law on abortion in Iran. 2008:315-322.
14. Sharifi A, Janatolmakan M, Khatony A. The prevalence and the reasons of issuing permission for therapeutic abortion in department of forensic medicine, Kermanshah, Iran, during 2005 to 2010. BMC research notes. 2019 Dec;12(1):1-5.
15. Madeiro AP, Diniz D. Legal abortion services in Brazil–a national study. Ciencia & saude coletiva. 2016;21:563-72.
16. dos Santos Mutta D, Angerame Yela D. Sociodemographic characteristics of women in a public hospital in Campinas who underwent legal abortion due to sexual violence: cross-sectional study. Sao Paulo Medical Journal. 2017 Jul 31;135:363-8.
17. Motaghi Z, Poorolajal J, Keramat A, Shariati M, Yunesian M, Masoumi SZ. Induced abortion rate in Iran: a meta-analysis. Archives of Iranian medicine. 2013 Oct 1;16(10):594-598.
18. Hosseini H, Erfani A, Nojomi M. Factors associated with incidence of induced abortion in Hamedan Iran. Arch Iran Med. 2017;20(5):282.
19. Godrati F, Saadatmand N, Dinpazhoh M, Akbarzadeh M. Epidemiological study of legal abortion due to fetal defects in the files referred to Fars province forensic medicine centers from 2007 to 2013. Shiraz E-Medical Journal. 2016 Nov 1;17(11).
20. Naeeji H, Mirtorabi SD, Shojamoradi MH, A. K. The Requests for Therapeutic Abortion in Legal Medicine Organization of Tehran: Indications for Acceptance and Rejection. Journal Forensic Medecin. 2011:17 (61):41-47.
21. Polis CB, Mhango C, Philbin J, Chimwaza W, Chipeta E, Msusa A. Incidence of induced abortion in Malawi, 2015. PLOS one. 2017 Apr 3;12(4):e0173639.
22. Sully EA, Madziyire MG, Riley T, Moore AM, Crowell M, Nyandoro MT, Madzima B, Chipato T. Abortion in Zimbabwe: a national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016. PloS one. 2018 Oct 24;13(10):e0205239.
23. Sully E, Giorgio M, Anjur-Dietrich S. Estimating abortion incidence using the network scale-up method. Demographic Research. 2020 Jul 1;43:1651-84.
24. Koonin LM, Smith JC, M. R. Abortion surveillance.Morbidity and Mortality Weekly Report.1992: 41 (1):1-33
25. Berhan Y, Berhan A. Meta-analysis of selected maternal and fetal factors for perinatal mortality. Ethiop Journal Health Science. 2014: 24:55-68
26. Hadden D. Diabetes in pregnancy 1985. Diabetologia.1986: 29 (1):1-9
27. Karamizadeh Z, Saneifard H, Amirhakimi G, Karamifar H, Alavi M. Evaluation of Congenital Hypothyroidism in Fars Province, Iran. Iran J Pediat. 2012;22(1):107-112.
28. Azizi F. Hypothyroidism after treatment with Bamethasemol in Iran, Comparison of the Effect of Methimazol in Tehran and Boston. Research in Medicine.1985;9(1):1-7.
29. Levy M, Read SE. Erythema infectiosum and pregnancy-related complications. CMAJ: Canadian Medical Association Journal. 1990:143 (9):849
30. Sommerhäuser G, Borgmann-Staudt A, Astrahantseff K, Baust K, Calaminus G, Dittrich R, Fernández-González MJ, Hölling H, König CJ, Schilling R, Schuster T. Health outcomes in offspring born to survivors of childhood cancers following assisted reproductive technologies. Journal of Cancer Survivorship. 2021 Apr;15(2):259-72.
31. Dieamant F, Petersen CG, Vagnini LD, Renzi A, Petersen B, Massaro F, Zamara C, Nicoletti A, Ricci J, Oliani AH, Oliveira JB. Impact of Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) on Birth Defects: A Systematic Review and Meta-Analysis. JBRA Assisted Reproduction. 2021 Jul;25(3):466.
32. Lemardeley G, Pirrello O, Dieterlé S, Zebina A, Astrugue C, Jonveaux P, Lucas-Samuel S, Couchoud C. Overview of hospitalizations in women undergoing oocyte retrieval for ART in the French national health data system. Human Reproduction. 2021 Oct;36(10):2769-81.
33. Bazyar J, Daliri S, Sayehmiri K, Karimi A, Delpisheh A. Assessing the relationship between maternal and neonatal factors and low birth weight in Iran; a systematic review and meta-analysis. Journal of medicine and life.2015;(4):23:1-8.
34. Vatankhah S, Jalilvand M, Sarkhosh S, Azarmi M, Mohseni M. Prevalence of congenital anomalies in Iran: A review article. Iran J Public Health. 2017; 46 (6):733-736.
35. Golalipour MJ, Mirfazeli A, Mobasheri E (2013) Incidence and pattern of congenital malformations in Gorgan-north of Iran. Journal Medecine Science (Faisalabad, Pakistan).2013; 13 (8):834-838.
36. Daliri S, Safarpour H, Bazyar J, Sayehmiri K, Karimi A, Anvary R. The relationship between some neonatal and maternal factors during pregnancy with the prevalence of congenital malformations in Iran: a systematic review and meta-analysis. Journal Matern Fetal Medecine. 2018;1-9
37. Ghadipasha M, Z. A. The Study of Abortion Licences Being Issued by Legal Medicine office of Kerman in 2005 and a Short Comparison with Last Years Issued Licences. Journal Kerman University Medecal Science. 2008;14 (2):147-152. [Persian].
38. Maleki Z, Ghaem H, Seif M, Foruhari S. Incidence and maternal-fetal risk factors of stillbirth. A population-based historical cohort and a nested casecontrol study. Ann Ig. 2021;33(3):231-241. https://doi.org/10.7416/ai.2021.2430