Risk factors for recurrent abortion after induced abortion in Chinese women: a prospective study

The increasing risk of complications after repeat induced abortions seriously threatens women's reproductive health and lives. This study aimed to identify risk factors for repeat abortion through time-stratified analysis to improve post-abortion care (PAC).

A prospective cohort study was conducted on patients undergoing abortion at Fengcheng Hospital, Fengxian District, Shanghai, between September 2022 and December 2024 (n = 557). Data were collected using structured questionnaires and hospital records. Participants were categorized into two groups based on the number of existing children: ≤1 birth (n = 133) and ≥2 births (n = 424). Univariate analyses were employed to identify variables with p < 0.05 for inclusion in multifactorial logistic regression models. Three time-stratified models (1-3, 4-6, and 7-12 months) were established to analyze the temporal characteristics of repeat abortion.

Multiple regression analyses revealed significant associations between repeat abortion outcomes and several independent variables at different time intervals. Within 12 months, ethnic minorities exhibited 21.86-fold higher adjusted odds of repeat abortion compared to Han Chinese ethnicity (adjusted odds ratio (aOR) = 21.86, 95% CI: 4.92-97.17). Preoperative self-rating anxiety scale (SAS) scores ≥50 exhibited 83% risk reduction compared to SAS scores <50 (aOR = 0.17, 95% CI: 0.03-0.91). Preoperative self-rating depression scale (SDS) scores ≥53 revealed a 74% lower risk of repeat abortion compared to SDS scores <53 (aOR = 0.26, 95% CI: 0.07-0.94). Time-stratified analysis showed that the risk of repeat abortion was significantly higher among ethnic minorities from January to March (aOR = 35.56, 95% CI: 5.95-212.68). Furthermore, the risk was significantly higher among ethnic minorities from April to June (aOR = 32.73, 95% CI: 7.80-137.29). From July to December, ethnic minorities (aOR = 36.19, 95% CI: 9.69-135.18), a preoperative SAS score ≥50 (aOR = 0.15, 95% CI: 0.03-0.78), and a postoperative C-CSE score ≥30 (aOR = 0.21, 95% CI: 0.08-0.54) were significantly associated with repeat abortion. There were no significant differences in the incidence of repeat abortion across different time intervals.

Ethnic minorities served as an independent risk factor for repeat abortion among Chinese women. However, due to the small sample size, our findings regarding the role of ethnic minorities should be interpreted cautiously. Additionally, psychological factors were identified as significant factors. In particular, preoperative anxiety (SAS ≥50) was associated with reduced odds of repeat abortion. This suggests that moderate anxiety may improve contraceptive adherence and lower the risk of repeat abortion. Postoperative contraceptive self-efficacy (C-CSE ≥30) protects against repeat abortion in the long term; therefore, enhancing contraceptive confidence is crucial for preventing repeat abortion.