Pregnancies, Births and Abortions in the United States, 1973–2017: National and State Trends by Age

Maddow‐Zimet, Isaac; Kost, Kathryn; Finn, Sean M.

doi:10.1363/2021.32709

Cited by 41 publications

(32 citation statements)

References 12 publications

(13 reference statements)

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“…Information in this report on the number of abortions performed through different methods (e.g., medical or surgical) and at different gestational ages provides the denominator data that are necessary for analyses of the relative safety of abortion practices (38). Finally, information on the number of pregnancies ending in abortion is needed in conjunction with data on births and fetal losses to estimate the number of pregnancies in the United States and determine rates for various outcomes of public health importance (e.g., adolescent pregnancies) (11). § Percentage is calculated as the number of abortions reported by known age divided by the sum of abortions reported by known and unknown age.…”

Section: Public Health Implicationsmentioning

confidence: 99%

“…In 2017, the total number, rate, and ratio of reported abortions reached historic lows, followed by 1%-2% increases across all measures from 2017 to 2018 (5). Nonetheless, despite the overall decreases, abortion incidence and practices have varied over the years and continue to vary across subpopulations (7)(8)(9)(10)(11), highlighting the need for continued surveillance.…”

Section: Introductionmentioning

confidence: 99%

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Abortion Surveillance — United States, 2019

Kortsmit

Mandel

Reeves

et al. 2021

MMWR Surveill. Summ.

104

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Problem/Condition CDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States. Period Covered 2019. Description of System Each year, CDC requests abortion data from the central health agencies for 50 states, the District of Columbia, and New York City. For 2019, 49 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 48 reporting areas provided data each year during 2010–2019. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15–44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2018 were assessed as part of CDC’s Pregnancy Mortality Surveillance System (PMSS). Results A total of 629,898 abortions for 2019 were reported to CDC from 49 reporting areas. Among 48 reporting areas with data each year during 2010–2019, in 2019, a total of 625,346 abortions were reported, the abortion rate was 11.4 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 195 abortions per 1,000 live births. From 2018 to 2019, the total number of abortions increased 2% (from 614,820 total abortions), the abortion rate increased 0.9% (from 11.3 abortions per 1,000 women aged 15–44 years), and the abortion ratio increased 3% (from 189 abortions per 1,000 live births). From 2010 to 2019, the total number of reported abortions, abortion rate, and abortion ratio decreased 18% (from 762,755), 21% (from 14.4 abortions per 1,000 women aged 15–44 years), and 13% (from 225 abortions per 1,000 live births), respectively. In 2019, women in their 20s accounted for more than half of abortions (56.9%). Women aged 20–24 and 25–29 years accounted for the highest percentages of abortions (27.6% and 29.3%, respectively) and had the highest abortion rates (19.0 and 18.6 abortions per 1,000 women aged 20–24 and 25–29 years, respectively). By contrast, adolescents aged <15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.7%, respectively) and had the lowest abortion rates (0.4 and 2.7 abortions per 1,000 women aged <15 and ≥40 years, respectively). However, abortion ratios in 2019 were highest among adolescents (aged ≤19 years) and lowest among women aged 25–39 years. Abortion rates decreased from 2010 to 2019 for all women, regardless of age. The decrease in abortion rate was highest among adolescents compared with any other age group. From 2018 to 2019, abortion rates decreased or did not change among women aged ≤24 years; however, the abortion rate increased among those aged ≥25 years. Abortion ratios also decreased or did not change from 2010 to 2019 for all age groups, except adolescents aged <15 years. The decrease in abortion ratio was highest among women aged ≥40 years compared with any other age group. From 2018 to 2019, ab...

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Section: Public Health Implicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Abortion Surveillance — United States, 2019

Kortsmit

Mandel

Reeves

et al. 2021

MMWR Surveill. Summ.

104

View full text Add to dashboard Cite

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“…1 In instances of a multiple birth (i.e., twins and higher order births), we count each infant delivered as a single pregnancy, an approach consistent with published overall pregnancy rates by state. 2 Data on the proportion of births in each pregnancy desire group was obtained from annual Pregnancy Risk Assessment Monitoring System (PRAMS) surveys, a surveillance project conducted by the Centers for Disease Control and Prevention (CDC) and individual states, for the years 2012-2017. PRAMS consists of annual surveys of residents who have delivered a recent live birth (respondents are typically surveyed two to six months after delivery).…”

Section: Births: Counts and Pregnancy Desiresmentioning

confidence: 99%

“…We therefore used counts of abortions by state of residence for 2012-2017 estimated from a periodic national census of abortion providers and ancillary surveys of clinics conducted by the Guttmacher Institute, in conjunction with data on the state of residence of individuals having abortions in each state from the CDC and state-level health departments. 2 There are currently no representative state-level data that allow for categorizing pregnancy desires among individuals whose pregnancies resulted in induced abortion (PRAMS data are limited to births). However, we do have national-level estimates of pregnancy desires among individuals obtaining an induced abortion from a periodic, nationally representative sample interviewed in the Guttmacher Institute's Abortion Patient Survey.…”

Section: Abortions: Counts and Pregnancy Desiresmentioning

confidence: 99%

“…Also, fetal loss is likely to be underreported in surveys of pregnancy histories because many spontaneous abortions occur at very early gestations and are not detected. 2 A reasonable approximation of the total number of fetal losses is the sum of 20% of all births and 10% of all induced abortions. 1,8 We applied this approximation separately for wanted-then-or-sooner, wanted-lateror-unwanted and wasn't-sure pregnancies.…”

Section: Fetal Losses: Counts and Pregnancy Desiresmentioning

confidence: 99%

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Pregnancies and Pregnancy Desires at the State Level: Estimates for 2017 and Trends Since 2012

Maddow‐Zimet¹,

Kost²

2021

Self Cite

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Key Points In almost all U.S. states, pregnancies reported as occurring at the right time or being wanted sooner than they occurred comprised the largest share of pregnancies in 2017, though proportions varied widely by state. The proportion of pregnancies that were wanted later or unwanted was higher in the South and Northeast than in other regions, and the proportion of pregnancies that occurred at the right time or were wanted sooner was higher in the West and Midwest. From 2012 to 2017, the wanted-later-or-unwanted pregnancy rate fell in the majority of states. However, no clear pattern emerged for any changes in the rate of pregnancies that were reported as wanted then or sooner or in the rate of those for which individuals expressed uncertainty.

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Prenatal Exposure to Valproic Acid Across Various Indications for Use

Smolinski,

Sarayani,

Thai

et al. 2024

JAMA Netw Open

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ImportanceTeratogenic outcomes associated with valproic acid use represent a substantial concern for persons of childbearing age. Regulatory agencies worldwide have enhanced warnings or implemented risk minimization programs to reduce exposure during pregnancy.ObjectivesTo determine pregnancy rates during valproic acid use and concomitant contraception use across indications.Design, Setting, and ParticipantsThis retrospective cohort study used data from the Merative MarketScan commercial claims databases from January 1, 2005, to December 31, 2020, to identify female patients aged 12 to 44 years who initiated valproic acid treatment and had continuous insurance enrollment 6 months before initiation and 9 months after treatment end. A treatment episode included consecutive prescription fills that occurred within 7 days from the end of the days’ supply of the previous dispensing. Data were analyzed from March 1 to September 10, 2023.Main Outcomes and MeasuresTreatment episodes were categorized by inferred indication using diagnoses preceding treatment initiation, including epilepsy, migraine or headache, mood disorders, and unknown or off-label uses. Pregnancy incidence rate ratios (IRRs) were calculated and were adjusted for age and calendar year. Contraceptive use (prescription contraceptives, intrauterine devices, and implants) during treatment was examined.ResultsThe cohort included 165 772 valproic acid treatment episodes among 69 390 women (mean [SD] age, 29.8 [10.0] years). Mood disorders (42.5%) were the most common indication, followed by migraine or headache (20.1%), with epilepsy playing a minor role (14.9%). Pregnancy incidence rates during valproic acid use remained unchanged, with a rate of 1.74 (95% CI, 1.14-2.53) per 100 person-years in 2005 and a rate of 1.90 (95% CI, 1.16-3.12) per 100 person-years in 2019. Compared with epilepsy, pregnancy rates were more than double for mood disorder (IRR, 2.16 [95% CI, 1.93-2.42]) and migraine or headache (IRR, 2.01 [95% CI, 1.92-2.09]). Few treatment episodes coincided with contraceptive use (37 012 [22.3%]), and oral dosage forms were the most common (27 069 [73.1%]).Conclusions and RelevanceIn this cohort study of patients of childbearing age who used valproic acid, pregnancy rates during valproic acid use did not decrease despite enhanced US Food and Drug Administration safety communications, and contraception use remained low. Patients with migraine and mood disorders accounted for the largest proportion of valproic acid use and had the highest pregnancy rates, while patients with epilepsy had the lowest. These findings suggest a need to enhance efforts to mitigate prenatal exposure to valproic acid, especially for indications where the risk of use during pregnancy outweighs the benefit.

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Pregnancies, Births and Abortions in the United States, 1973–2017: National and State Trends by Age

Cited by 41 publications

References 12 publications

Abortion Surveillance — United States, 2019

Abortion Surveillance — United States, 2019

Pregnancies and Pregnancy Desires at the State Level: Estimates for 2017 and Trends Since 2012

Prenatal Exposure to Valproic Acid Across Various Indications for Use

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