Toronto—Drug-induced abortion is more likely to result in short-term adverse events than procedures to end a pregnancy, according to a new study.
Adverse events remain rare, but short-term issues are more likely after mifepristone-misoprostol–induced abortion (IA) than procedural IA, especially for less serious adverse outcomes, the University of Toronto–led authors wrote.
“Prior studies comparing first-trimester pharmaceutical induced abortion (IA) with procedural IA were prone to selection bias, were underpowered to assess serious adverse events (SAEs), and did not account for confounding by indication,” the researchers wrote in Annals of Internal Medicine.
Since 2017, mifepristone-misoprostol has been dispensed at no cost in outpatient pharmacies across Ontario, Canada. The researchers sought to compare the short-term risk for adverse outcomes after early IA by mifepristone-misoprostol versus by procedural IA.
The population-based cohort study involved all women in Ontario who had first-trimester IAs. The authors compared 39,856 women dispensed mifepristone-misoprostol as outpatients with 65,176 women undergoing procedural IA at 14-week gestation or earlier within nonhospital outpatient clinics. In a second comparison, the women prescribed mifepristone-misoprostol were compared with 8,861 women undergoing ambulatory hospital-based procedural IA at an estimated 9-week gestation or less.
The primary composite outcome was designated as any serious adverse events within 42 days after IA, including severe maternal morbidity, end-organ damage, ICU admission, or death. The researchers also looked at a coprimary broader outcome, which was comprised of any SAE, hemorrhage, retained products of conception, infection, or transfusion.
The participants having induced abortions had a mean age of 29 years, and 33% were primigravidae. Six percent were from rural areas, while 25% lived in low-income neighborhoods.
The results indicated that in comparison 1, SAEs occurred among 133 women after mifepristone-misoprostol IA (3.3 per 1,000) versus 114 after procedural IA (1.8 per 1,000; relative risk [RR], 1.87 [95% CI, 1.44-2.43]; absolute risk difference [ARD], 1.5 per 1,000 [CI, 0.9-2.2]).
According to the study, “The respective rates of any adverse event were 28.9 versus 12.4 per 1,000 (RR, 2.33 [CI, 2.11-2.57]; ARD, 16.5 per 1,000 [CI, 14.5-18.4]). In comparison 2, SAEs occurred among 133 (3.4 per 1,000) and 27 (3.3 per 1,000) women, respectively (RR, 1.04 [CI, 0.61-1.78]). The respective rates of any adverse event were 31.2 versus 24.9 per 1,000 (RR, 1.25 [CI, 1.04-1.51]).”
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