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Second-trimester medical termination with mifepristone and misoprostol does not significantly raise the risk of spontaneous preterm birth in future pregnancies. However, higher gestational age at termination shows a small but significant link to increased risk.
A large cohort study suggests that second-trimester medical termination of pregnancy (using mifepristone and/or misoprostol) does not markedly increase the risk of spontaneous preterm birth in a subsequent pregnancy.
The research, conducted between 2008 and 2023, analyzed all the females who underwent a second-trimester medical termination and later had a known pregnancy outcome up to 2024. Exclusions applied to those whose termination was performed via other methods—such as cesarean delivery, curettage, hysterectomy, or Foley catheter—or whose indication was preterm premature rupture of membranes or intrauterine fetal demise.
Of the 1,438 eligible cases, 1,033 people went on to have a subsequent pregnancy, with outcomes available for 986 (962 singleton and 24 multiple pregnancies). In singleton pregnancies progressing beyond 16 weeks, spontaneous preterm birth before 37 weeks occurred in 4.7% (39 of 831 cases). The rate was notably higher in multiple pregnancies at 16.7% (4 of 24 cases). Subgroup analysis revealed some patterns—though not statistically significant. Singleton pregnancies conceived within 3 months of the termination exhibited higher rates of spontaneous preterm birth when compared to those with an interval of 12–24 months (6.8% vs 3.2%; adjusted odds ratio [aOR] 2.2).
Similarly, terminations performed at over 20 weeks' gestation exhibited higher rates of subsequent preterm birth than those between 12 and 15 weeks (5.9% vs 2.6%; aOR 2.2). When gestational age at termination was treated as a continuous variable in linear regression, a substantial positive association with later spontaneous preterm birth was found (B=0.56; R²=0.31). Researchers concluded that second-trimester medical termination is generally safe concerning future spontaneous preterm birth risk.
However, they emphasized the importance of post-procedure counseling—similar to recommendations after any preterm or term birth—advising adequate time for cervical remodeling before conceiving again, especially for those undergoing termination at more advanced gestational ages.
American Journal of Obstetrics & Gynecology
Subsequent risk of preterm birth after second-trimester medical termination of pregnancy
Annabelle L. van Gils et al.
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