Pregnancy Loss 'Increases Risk Of Drug And Alcohol Use'

Main Category: Pregnancy / Obstetrics
Also Included In: Psychology / Psychiatry;  Alcohol / Addiction / Illegal Drugs
Article Date: 30 Nov 2008 - 1:00 PST

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Young women who have a miscarriage or an abortion are three times more likely to experience a drug or alcohol problem during their lifetime, according to new research published in the December issue of the British Journal of Psychiatry.

Recent evidence has suggested that induced abortion may be associated with later psychiatric disorders in women. However, this study indicates that such disorders are more likely to be associated with pregnancy loss per se, rather than being caused by the experience of induced abortion.

To date, no studies have directly compared the psychiatric outcomes of women who have had an abortion and those who have experienced a miscarriage. In this study, researchers from the University of Queensland examined 1,123 women from a cohort born in Australia between 1981 and 1984. The women were assessed at the age of 21 to find out how many pregnancies, abortions, miscarriages and births they had experienced.

943 women had never been pregnant and 280 (22.9%) reported one or more pregnancies. Over a quarter of those pregnant had complex lifetime histories, meaning they had experienced two or three of the pregnancy outcomes (birth, abortion, miscarriage).

The study showed that women who had experienced pregnancy loss - whether abortion or miscarriage - were at increased risk of illicit drug and alcohol use compared with women who had never been pregnant or who gave birth.

Because abortion and miscarriage showed similar associations with drug and alcohol use disorders, the researchers claim their study challenges the existing evidence of a causal link between abortion and illicit drug and alcohol use disorders.

Writing in the British Journal of Psychiatry, the authors said: "The findings suggest that poor outcomes reported for women who had an induced abortion may be associated with pregnancy loss rather than simply the experience of abortion. Induced abortion and miscarriage are both stressful life events that have been shown to lead to anxiety, sadness and grief and, for some women, serious depression and substance use disorders."

The precise reasons behind the link are unclear, but the authors put forward a number of possible explanations. Pregnancy loss and substance misuse may have shared risk factors. Unplanned pregnancy commonly occurs alongside individual and social risk factors such as early sexual activity, poor school performance, alcohol and illicit drug taking and behaviour problems.

In addition, pregnancy loss may be directly associated with an increased risk of later substance misuse, particularly if alcohol and illicit drugs are used to decrease emotional responses to the loss.

The researchers call for further studies to better understand the relationship between pregnancy loss and adverse psychiatric outcomes in young women.

Reference:
"Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study"
Dingle K, Alati R, Clavarino A, Najman JM and Williams GM (2008)
British Journal of Psychiatry, 193: 455-460

British Journal of Psychiatry

Royal College of Psychiatrists