European Medical Journal exposes Abortion-Cerebral-Palsy Elective Surgery boosts Cerebral Palsy risk [Letter: European Journal of Obstetrics & Gynecology and Reproductive Biology 2001;96:239-240] In their excellent review of CP (Cerebral Palsy) history, Schifrin and Longo end with the words, "We need to let the truth take us where it will."(1) This letter assumes that there is the courage to do exactly that. Although the etiology of CP has many uncertainties, preterm birth and incompetent cervix are considered to be risk factors.(2) A preterm new-born is much more likely to be Very Low Birth Weight (VLBW: birth weight under 1500 grams) than a full-term newborn. A Swedish study of 19 year-old boys reported fifty-five times the normal risk of CP for boys with VLBW (95% CI 40.8-75.2).(3) From a 1991 CP-VLBW meta-analysis: "If one assumes the incidence of cerebral palsy in the general population to be 2/1000 live births .... then the relative risk for cerebral palsy among surviving VLBW infants would be 38 times that in the general population."(4) Elective Surgery and Preterm Birth risk There are at least seventeen (17) studies that have found that previous induced abortions increase preterm birth risk.(8-24) The latest of these studies reported on 61,000 Danish women and is one of the largest studies ever linking "terminations" to later prematurity.(9) The relative risk of a very preterm birth (before 34 weeks' gestation) for Danish women with one pre-vious induced abortion is 1.99. The relative risk of a pre-term birth for women with two previous "evacuation" type abortions is 12.55.(5) The RR for one previous "evacuation" abortion is 2.27.(5) Why the silence about the abortion-prematurity risk and cerebral palsy from medical researchers? Let's have the courage to explore this credible risk with the definite possibility that what is learned may help reduce the cerebral palsy rate and the heartache that it causes the affected infants and parents. Is it biologically plausible that abortions can increase risk of a subsequent preterm birth? Highly regarded obstetric expert, Barbara Luke (PhD), has identified one mechanism that explains abortion causing prematurity risk. "The procedures for first-trimester abortion involve dilating the cervix slightly and suctioning the contents of the uterus (see Figure 3).The procedures for second-trimester abortion are more involved, including dilating the cervix wider and for longer periods, and scraping the inside of the uterus. Women who had had several second-trimester abortions may have a higher incidence of incompetent cervix, a premature spontaneous dilation of the cervix, because the cervix has been artificially dilated several times before this pregnancy." (5) The second biological risk that helps to explain higher prematurity is infection risk. "Our findings indicate that an abortion in a woman's first pregnancy does not have the same protective effect of lowering the risk for intrapartum infection in the following pregnancy as does a live birth." So wrote researchers from the University of Washington in the journal Epidemiology in 1996.(6) Infection is a leading cause of death from induced abortion (if one ignores breast cancer and suicide from abortion ). Infection is often mentioned as a risk factor for premature birth. In 1992 Dr. Janet Daling and colleagues reported that if the previous pregnancy ended in induced abortion, the risk of intra-amniotic infection increased by 140%.(7) "One possible mechanism is that cervical instrumentation can facilitate the passage of organisms into the upper part of the uterus, increasing the probability of inapparent infection and subsequent preterm birth", wrote Judith Lumley in 1998.8 Informed Medical Consent is a must Over the past two decades the rate of Cerebral Palsy has been increasing in the United States and other developed countries. If there is an elective medical procedure that increases prematurity risk, then potential patients of that procedure must be made aware of subsequent preterm birth risk and the associated Cerebral Palsy risk. Since it is conceded by abortion practitioners that induced abortion is normally an elective procedure, full information about serious possible risks must appear on consent forms. Informed medical consent is a legal right of all women. Let's stop denying them this right at abortion clinics. "We need to let the truth take us where it will."(1) Brent Rooney, Reduce Preterm Risk Coalition 3456 Dunbar St. (146) Vancouver, Canada V6S 2C2 [email protected] References 1 Schifrin BS, Longo LD. William John Little and cerebral palsy A reappraisal. European J Obstetrics & Gynecology 2000;90:139-144 2 Gersh ES. Children with Cerebral Palsy: a parent's guide / edited by Elaine Geralis. 1998; chapter 1: page 14 [Bethesda, Maryland: Woodbine House; ISBN 0933149824] 3 Ericson A, Kallen B. Very low birthweight boys at 19. Arch Dis Child Fetal Neonatal Ed 1998;78 :F171-F174 4 Escobar GJ, Littenberg B, Petitti DB. Outcome among surviving very low birthweight infants; a meta-analysis. Arch Dis Child 1991;66:204-211 5 Luke B, Every Pregnant Woman's Guide to Preventing Premature Birth (1995, pp. 32-33) 6 Muhlemann K, Germain M, Krohn M. Does an Abortion Increase the Risk of Intrapartum Infection in the Following Pregnancy? Epidem- iology 1996;7:194-198 7 Daling JR, Krohn MA, Miscarriage or Termination in the Immediately Preceding Pregnancy Increases the Risk of Intraamniotic Infection in the Following Pregnancy. American J Epi 1992;136:1013 [SER Abstracts] 8 Lumley J. The association between prior spon- taneous abortion, prior induced abortion and preterm birth in first singleton births. Prenat Neonat Med 1998;3:21-24. 9 Zhou W, Sorenson HT, Olsen H. Induced Abortion and Subsequent Pregnancy Duration. Obstetrics & Gynecology 1999;94:948-953 10 Pickering RM, Forbes J. Risk of preterm delivery and small-for-gestational age infants following abortion: a population study. British J Obstet- rics and Gynecology 1985;92:1106-1112 11 Michielutte R, Ernest JM, Moore ML, Meis PJ, Sharp PC, Wells HB, Buescher PA. A Comparison of Risk Assessment Models for Term and Preterm Low Birthweight. Preventive Medicine 1992;21:98-109 12 Berkowitz GS. An Epidemiologic Study of Preterm Delivery. American J Epidemiology 1981;113:81-92 13 Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC. Risk Factors Accounting For Racial Differences in the rate of premature birth. NEJM 1987;317: 743-748 14 Lang JM, Lieberman E, Cohen A. A Comparison of Risk Factors for Preterm Labor and Term Small-for-Gestational-Age Birth. Epidemiology 1996;7:369-376 15 Mueller-Heubach E, Guzick DS. Evaluation of risk scoring in a preterm birth prevention study of indigent patients. Am J Obstetrics & Gyn 1989;160:829-837 16 Shiono PH, Lebanoff MA. Ethnic Differences and Very Preterm Delivery. Am J Public Health 1986;76:1317-1321 17 Pantelakis SN, Papadimitriou GC, Doxiadis SA. Influence of induced and spontaneous abortions on the outcome of subsequent pregnancies. Amer J Obstet Gynecol. 1973;116:799-805 18 Van Der Slikke JW, Treffers PE. Influence of induced abortion on gestational duration in subsequent pregnancies. BMJ 1978;1:270-272 19 Richardson JA, Dixon G. Effect of legal termin- ation on subsequent pregnancy. British Med J 1976;1:1303-1304 20 Pickering RM, Deeks JJ. Risks of Delivery during 20th to the 36th Week of Gestation. Intl. J Epidemiology 1991;20:456-466 21 Koller O, Eikhom SN. Late Sequelae of Induced Abortion in Primigravidae. Acta Obstet Gynecol Scand 1977;56:311-317 22 Papaevangelou G, Vrettos AS, Papadatos D, Alexiou C. The Effect of Spontaneous and Induced Abortion on Prematurity and Birthweight. The J Obstetrics and Gynaecology of the British Commonwealth. May 1973;80:418-422 23 Bognar Z, Czeizel A. Mortality and Morbidity Associated with Legal Abortions in Hungary, 1960- 1973. AJPH 1976;66:568-575 24 Martius JA, Steck T, Oehler MK, Wulf K-H. Risk factors associated with preterm (<37+0 weeks) and early preterm (<32+0 weeks): univariate and multi- variate analysis of 106 345 singleton births from 1994 statewide perinatal survey of Bavaira. European J Obstetrics & Gynecology Reproductive Biology 1998;80:183-189 ............................................................ (end of letter) Updated list of significant studies linking PB and/or Low Birth Weight newborn to prior elective abortions