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March 20, 1981

Induced Abortion and Subsequent Pregnancy Loss

Author Affiliations

School of Public Health University of Hawaii Honolulu

JAMA. 1981;245(11):1119. doi:10.1001/jama.1981.03310360011005

To the Editor.—  The article "Association of Induced Abortion With Subsequent Pregnancy Loss" by Levin et al (1980;243:2495) reported that women who had had two or more previous induced abortions had a twofold to threefold increase in risks of pregnancy losses up to 28 weeks of gestation.This is to point out that there is an inherent statistical problem associated with a study of pregnancy loss as a sequela to previous induced abortion. The problem arises because of two factors. First, there is competition between induced abortion and early spontaneous fetal loss in pregnancies of those women who are determined not to carry the pregnancy to term. These pregnancies may be referred to as unwanted pregnancies, and they result in either spontaneous or induced abortion. When the outcome is spontaneous abortion before eventually expected induced abortion, it is included as an observation in the case group in a case-control study