Published by Oxford University Press on behalf of the International Epidemiological Association International Journal of Epidemiology 2008;37:13331340

The Author 2008; all rights reserved. Advance Access publication 21 October 2008 doi:10.1093/ije/dyn167

REPRODUCTIVE HEALTH

Previous abortions and risk of pre-eclampsia

Lill Trogstad,1,2* Per Magnus,1 Rolv Skjrven1 and Camilla Stoltenberg1

Accepted 21 July 2008

Background The risk of pre-eclampsia is reduced for second and later births. The
causes and mechanisms behind this reduction are unknown. The aim
of the study was to estimate the risk of pre-eclampsia in primiparous
women according to history of spontaneous and induced abortions,
while controlling for several potentially confounding factors.
Methods The sample consisted of 20 846 primiparous women participating in
the Norwegian Mother and Child Cohort Study (MoBa). Informa-
tion on abortions and confounders were self-reported in postal
questionnaires. The diagnosis of pre-eclampsia was retrieved from
the Medical Birth Registry of Norway. Estimation and confounder
control was performed with multiple, logistic regression.
Results One previous induced abortion reduced the risk moderately [odds
ratio (OR) 0.84, 95% confidence interval (CI) 0.691.02]. Two
or more induced abortions reduced the risk more significantly
(OR 0.36, 95% CI 0.180.73). Adjustment for confounders did not
change the estimates.
Conclusions The protective effect of two prior induced abortions was similar to
what is commonly seen after one birth. Spontaneous abortions may
to a larger extent than induced abortions be associated with other
factors, such as infertility, that may increase the risk of pre-
eclampsia. Normal pregnancies interrupted in early pregnancy may
induce immunological changes that reduce the risk of pre-eclampsia
in a subsequent pregnancy.
Keywords Pre-eclampsia, induced abortion, spontaneous abortion, paternity

Introduction may add to our understanding of the reduced risk

A previous birth offers substantial protection against
pre-eclampsia. The protective effect seems to abate
with long intervals between the two pregnancies.13
The mechanisms underlying these observations have
not been identified. Whether previous abortions offer
any protection against pre-eclampsia in primiparous
women is unresolved. Better knowledge of this issue
1 spontaneous abortions9,10 the results are conflicting.
Division of Epidemiology, Norwegian Institute of Public
Health, Oslo, Norway.
2
Department of Obstetrics and Gynecology, Ullevaal University
Hospital, Oslo, Norway.
* Corresponding author. Division of Epidemiology, Norwegian
Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo,
Norway. E-mail: lill.trogstad@fhi.no
among multiparous women, and may thereby provide
new insight into the immunological basis of pre-
eclampsia. Most studies that have addressed this
question have been limited by small numbers. Also,
many studies48 have not differentiated between
previous spontaneous and previous induced abortions,
which from both a social and pathophysiological point
of view are very different conditions. Among the
studies that have differentiated between induced and
The time interval from the abortion to the next preg-
nancy that leads to a birth depends on the type of
abortion. One study has corrected for pregnancy
interval, but found no significant effect on pre-
eclampsia risk.11 No previous studies have had the
opportunity to correct for time intervals, change in

1333
1334 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
paternity as well as for smoking and socioeconomic
background.
The aim of the study was to assess the risk of pre-
eclampsia in primiparous women with a history of
abortion as compared with primiparous women with-
out such history using a large pregnancy cohort.
Materials and methods
Subjects
This study is a subproject in the Norwegian Mother
and Child Cohort Study (MoBa).12 MoBa is a cohort
that aims to include 100 000 pregnancies by 2008.
Pregnant women are recruited to the study through
a postal invitation after they have signed up for the
routine ultrasound examination in their local hospital.
A questionnaire is filled in at about week 15 of preg-
nancy. Questions are asked about the timing and
outcomes of all previous pregnancies as well as ques-
tions about education, habits and health. The record
in the Medical Birth Registry of Norway (MBRN)13
from the present pregnancy is included as part of the
data set. The study has been approved by the Regional
Committee for Ethics in Medical Research and the
Data Inspectorate. The present sample comprises
20 846 singleton pregnancies to primiparous women.
Variables
The main outcome was pre-eclampsia in the present
pregnancy as registered in MBRN, including the
HELLP syndrome and eclampsia. The recommended
diagnostic criteria for pre-eclampsia in Norway are
blood pressure 4140/90 after 20 weeks gestation,
combined with proteinuria 41 dipstick on at least
two occasions.14
Information on parity (used to select the study
sample), previous abortions (the main exposure) and
other variables are taken from the questionnaire sent
to the pregnant women at week 15 (www.fhi.no/
morogbarn). Abortions were subdivided as induced
and spontaneous. All pregnancies that ended prior
to the 22nd gestational week were considered to be
abortions. Extra-uterine pregnancies were treated as
spontaneous abortions. Maternal age, pre-pregnancy
body mass index (BMI), smoking in pregnancy, edu-
cational attainment (in years), the time interval since
last pregnancy, infertility treatment prior to the index
pregnancy and change in paternity were considered
potentially confounding factors. Pre-pregnancy height
and body weight were used to calculate BMI kg/m2.
Smoking in pregnancy was coded no, occasionally (spontaneous or induced) was 4.2% (55/1325).
or daily. The time interval between the pregnancies
was calculated by subtracting the year of the previous
pregnancy from the year of birth in the present
pregnancy. Women with no previous abortions
(n 15 322) consequently had missing information
on interval. Data on infertility treatment prior to the
index pregnancy included information on surgical
interventions, treatment for endometriosis, hormone
therapy, vaginal insemination, in vitro fertilization and
other methods. The variable was dichotomized and
coded infertility treatment no and yes. The MoBa
database contains no direct information on paternity
in pregnancies that ended in abortion. A proxy vari-
able was constructed. The questionnaire contains
information on duration (in months and years) of
sexual cohabitation prior to conception. Women who
reported their relationship with the current partner to
have lasted longer than the time interval since the
previous pregnancy were considered to have the index
pregnancy by the same partner. The categorization of
the confounders is shown in Table 1.
Statistical analyses
The relative risks of pre-eclampsia according to
abortion history were calculated as crude odds ratios
(cOR) with 95% CI. Adjustment for confounding was
obtained by estimating adjusted odds ratios (aOR)
in multiple logistic regression analyses (SPSS Inc,
version 11, Chicago, IL, USA).
Results
A total of 5524 women (26%) reported one or more
previous abortions (Table 1). One or more sponta-
neous abortions and no induced abortions were
reported by 12.8%, while 11.3% reported one or
more induced abortions and no spontaneous ones.
Of the women, 2.3% reported both spontaneous and
induced abortions. Women with a history of abortions
were slightly older and tended to have a higher pre-
pregnancy BMI than women with no history of
abortion (Table 1). Women with induced abortions
were more likely to be daily smokers in their current
pregnancy, while women with spontaneous abortions
more often reported treatment for infertility. Women
with spontaneous abortions had shorter intervals
from time of abortion to birth and were less likely
to have a new partner as compared with women with
induced abortions.
Risk of pre-eclampsia
The risk of pre-eclampsia was 5.4% (1121/20 846), while
the risk of pre-eclampsia in primigravid women was
5.5% (850/15 322) (Table 2). The risk of pre-eclampsia
in women with one previous abortion (spontaneous
or induced) was 5.1% (216/4199). The risk of pre-
eclampsia in women with two or more abortions
Risk of pre-eclampsia according to
previous spontaneous abortions
No significant difference in risk of pre-eclampsia was
observed in women with spontaneous abortions as
compared with women without spontaneous abor-
tions (Table 2). Adjustment for maternal age, smok-
ing in pregnancy, infertility treatment, pre-pregnancy
 PREVIOUS ABORTIONS AND RISK OF PRE-ECLAMPSIA 1335

Table 1 Abortions in relation to characteristics of the study participants

One or more One or more

No. abortion spontaneous (S) induced (I) S1I No. of women
n^15 322 n^2670 n^2365 n^489 in category
Maternal age (years)
<20 80.3 6.8 11.2 1.7 528
2024 77.2 10.3 10.9 1.6 3870
2529 76.3 11.7 10.3 1.7 9028
3034 70.2 14.7 12.1 2.9 5772
35 58.8 19.8 15.8 5.6 1648

Pre-pregnancy BMI
<20 73.9 11.9 12.1 2.0 2748
2024 73.7 12.5 11.4 2.3 11 382
2529 71.6 14.0 11.7 2.6 4094
30 71.3 15.3 10.5 2.9 1822
No response 83.4 8.3 7.1 1.3 800

Smoking in pregnancy
Never 74.4 13.0 10.5 2.2 18 015
Occasionally 65.3 13.3 18.2 3.3 829
Daily 64.1 11.8 19.9 4.2 1417
No response 80.9 10.1 7.5 1.5 585

Time interval since last abortion (years)

<2 78.8 7.7 13.4 1941
25 46.0 45.6 8.5 1991
610 16.2 79.5 4.3 1047
11 9.1 88.8 2.1 526
No response 36.8 47.4 15.8 19

Infertility treatment
No 73.4 12.2 12.0 2.3 18 102
Yes 69.0 20.8 7.1 3.0 1318
No response 79.0 12.8 6.3 1.9 1426

Change in paternity
No 73.8 14.9 11.4 2615
Yes 24.5 68.8 6.7 2795
No response 48.2 46.5 5.3 114

Education (years)
<12 70.2 13.4 13.3 3.1 4261
12 70.0 13.0 14.2 2.8 2753
1316 75.0 12.8 10.2 2.0 8732
17 75.8 12.4 9.9 1.9 4477
No response 74.3 10.9 11.7 3.0 623
Distribution (percentages) of maternal age, pre-pregnancy BMI, smoking in pregnancy, pregnancy interval, infertility treatment,
change in paternity and length of education according to abortion history in 20 846 primiparous women in the MoBa.
1336 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

Table 2 Risk of pre-eclampsia according to abortions for all participants

Pre-eclampsia
No Yes Percentage cOR 95% CI aOR 95% CI
Number of previous abortions
0 14 472 850 5.5 1.0 1.0
1 3983 216 5.1 0.92 0.791.08 0.93 0.801.09
2 1270 55 4.2 0.74 0.560.97 0.73 0.550.97
Number of previous spontaneous abortions
0 16 731 956 5.4 1.0 1.0
1 2423 133 5.2 0.96 0.801.16 0.94 0.781.13
2 571 32 5.3 0.98 0.681.41 0.91 0.631.32
Number of previous induced abortions
0 16 955 997 5.5 1.0 1.0
1 2353 116 4.7 0.84 0.691.02 0.87 0.711.06
2 377 8 2.1 0.36 0.180.73 0.39 0.190.80
Total 19 725 1121 5.4
Relative risks (estimated as cOR and aOR with 95% CI) of pre-eclampsia according to the number of previous abortions among
20 846 primiparous women in the MoBa. Adjustment was made for maternal age, smoking in pregnancy, infertility treatment,
pre-pregnancy BMI and education.

Table 3 Risk of pre-eclampsia according to abortions controlled for pregnancy interval and paternity change

Pre-eclampsia
No Yes Percentage cOR 95% CI aOR 95% CI
Type and number of previous abortions
One induced 1952 99 4.8 1.0 1.0
Two or more induced 307 7 2.3 0.45 0.210.98 0.47 0.211.03
One spontaneous 2031 117 5.4 1.14 0.861.50 1.05 0.731.51
Two or more spontaneous 492 30 5.7 1.20 0.791.83 1.02 0.611.71
Total 4782 253 5.0
Relative risks (estimated as cOR and aOR with 95% CI) of pre-eclampsia according to type of abortion for 5035 primiparous women
participating in the MoBa who had previous abortions. Women with both spontaneous and induced abortions (n 489) were
excluded from the analyses. Adjustment was made for maternal age, smoking in pregnancy, infertility treatment, time interval
since last abortion, change in paternity, pre-pregnancy BMI and education.

BMI and education did not change the estimates.
The mean time interval from the last spontaneous
abortion to birth was 2.2 years [standard error of the
mean (SEM) 0.05].
Risk of pre-eclampsia according to
previous induced abortions
A slightly reduced risk of pre-eclampsia was
observed in women with one induced abortion, as
compared with women without induced abortions
(aOR 0.84, 95% CI 0.691.02). For women with
two or more induced abortions the risk of pre-
eclampsia was reduced by 460% (aOR 0.36, 95% CI
0.180.73) as compared with women without induced
abortions (Table 2). The mean time interval from the
last induced abortion to birth was 6.8 years
(SEM 0.09).
Adjusting for time interval and change in
paternity
Analyses of women with previous abortions only
(excluding primigravid women) allowed us to include
time interval since the last abortion and change in
paternity between the pregnancies to the list of
potentially confounding factors. After adjustment for
these variables, in addition to the adjustment for
maternal age, smoking, infertility treatment, BMI and
education, women with one spontaneous abortion
had the same risk of pre-eclampsia as women with
one induced abortion (Table 3). The adjustment did
not change the low risk of pre-eclampsia (aOR 0.47)
in women with two or more induced abortions.
Additional analyses on changed paternity
Additional analyses were performed to explore
the impact of changed paternity on pre-eclampsia
 PREVIOUS ABORTIONS AND RISK OF PRE-ECLAMPSIA 1337

Table 4 Risk of pre-eclampsia according to abortions, stratified by change of partner

Type and number of Pre-eclampsia

previous abortions
by paternity No Yes Percentage cOR 95% CI aOR 95% CI a*OR 95% CI
Primigravid 14 472 850 5.5 1.0 Ref. 1.0 Ref. 1.0 Ref.
Same paternity
One induced 307 12 3.8 0.67 0.371.19 0.69 0.381.23 0.68 0.381.24
Two or more induced 69 1 1.4 0.25 0.031.78 0.26 0.041.91 0.26 0.041.91
One spontaneous 1428 82 5.4 0.98 0.771.23 0.97 0.761.22 0.96 0.691.34
Two or more spontaneous 394 25 6.0 1.08 0.721.63 1.01 0.671.54 1.03 0.621.64
New paternity
One induced 1599 86 5.1 0.92 0.731.15 0.96 0.761.21 0.95 0.681.32
Two or more induced 232 6 2.5 0.44 0.200.99 0.48 0.211.09 0.48 0.211.11
One spontaneous 558 33 5.6 1.01 0.701.44 0.95 0.661.37 0.95 0.641.41
Two or more spontaneous 91 4 4.2 0.75 0.272.04 0.74 0.272.03 0.73 0.262.04
Total 19 150 1099 5.4
Number, percent, relative risks (estimated as cOR and aOR with 95% CI) of pre-eclampsia according to type of abortion in 20 249
primiparous women with a history of induced or spontaneous abortions according to paternity status, participating in the MoBa.
Women with both spontaneous and induced abortions and/or with missing information on paternity were exluded from the
analyses (n 597).
aOR: Adjusted for maternal age, smoking in pregnancy, infertility treatment, pre-pregnancy BMI and education.
a*OR: Adjusted for maternal age, smoking in pregnancy, infertility treatment, time interval since last abortion, pre-pregnancy
BMI and education.

risk (Table 4). When compared with primigravid
women, one previous induced abortion tended to
reduce the risk of pre-eclampsia for women with
same paternity pregnancies but not for women with
new paternity pregnancies, however the CIs were
wide due to small numbers. For both same paternity
and new paternity pregnancies two or more previous
induced abortions tended to reduce the risk of pre-
eclampsia. The risk appeared to be lower in same
paternity as compared with new paternity pregnancies
(Table 4). For women with two or more previous
spontaneous abortions, a change in paternity tended
to lower the estimated risk of pre-eclampsia as com-
pared with spontaneous abortions with unchanged
paternity, and compared with primigravid women,
but again the CIs were wide (Table 4). Adjustment for
potential confounders did not change the estimates.
Discussion
The present study sample included 20 846 primiparous
women selected from a study population of 51 960
women. To our knowledge, no study of this magni-
tude has previously been conducted to explore the
effect of prior abortions on pre-eclampsia risk.
In accordance with the long established fact that
a previous birth is protective of pre-eclampsia in later
pregnancies, the results from the present study show
that this is true also for previous induced abortions in
primiparous women. We found a 450% reduced risk
of pre-eclampsia in primiparous women with two or
more induced abortions as compared with all other
subgroups, including women with one induced abor-
tion. When compared with all women with singleton
pregnancies in the study population (n 47 304),
the risk of pre-eclampsia in primiparous women
with two prior induced abortions was similar to the
pre-eclampsia risk in women with one prior birth
(2.1% vs 2.5%). The pre-eclampsia risk in primiparous
women was 5.4%.
The risk of pre-eclampsia in women with two or
more induced abortions tended to be lower in both
same paternity and new paternity pregnancies, as
compared with primigravid women (1.4% and 2.5% vs
5.5%, Table 4). Stratified analyses to further explore
the impact of changed paternity and gestational
length at the time of the abortion on the pre-
eclampsia risk were restricted by small numbers.
The strength of the present study, in addition to the
large study sample, is the distinction between induced
and spontaneous abortions and the ability to adjust
for several confounders, including time interval since
the last abortion and change in paternity. No previous
study has corrected for pregnancy interval. The pres-
ent study used a prospective cohort design where
information on previous pregnancies, smoking habits
and other exposures were collected before pre-
eclampsia had developed clinically.
Misclassification due to under- or over-reporting
of prior abortions by the women in the study may
represent a potential weakness. However, the propor-
tion of women in the study reporting one or more
previous spontaneous abortions (15.1%) is similar to
1338 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
the proportion of women registered in the MBRN
(15.0%) with previous spontaneous abortion(s).
Nevertheless, the information on abortions both in
MoBa and in the MBRN may be subject to under-
reporting leading to an underestimation of the effect
of abortions on the pre-eclampsia risk.
Twice as many women in the induced abortion
group were daily smokers as compared with primi-
gravid women or women with previous spontaneous
abortions. Smoking is associated with a reduced risk
of pre-eclampsia,15 thus residual confounding due to
lack of control for the amount of cigarettes smoked
by women with induced abortions could be argued
to explain the reduced risk in this group. Additional
analyses adjusting for the number of cigarettes
smoked did, however, not change the estimates.
For information on change in paternity between the
last abortion and the index pregnancy, a proxy vari-
able based on the duration of cohabitation was used.
This represents an inaccuracy that may potentially
influence the results. In Table 4, we aimed to assess
whether the reduced risk after two induced abortions
was seen both for women with the same partner
and with a new partner. Random misclassification of
paternity would tend to reduce any differences
between these two groups.
Some previous studies on the effect of abortions on
later pre-eclampsia risk have been published. Using a
dataset including 2947 healthy women from a clinical
trial of aspirin, Sibai et al.4 reported that primiparous
women with no earlier abortions had a pre-eclampsia
risk of 5.7%, while women with one prior abortion
had a risk of 4.7% and women with two earlier abor-
tions had a risk of 1.8%. They did not differentiate
between spontaneous and induced abortions. In a
similar trial, the Calcium for Preeclampsia Prevention
(CPEP) trial, Sibai et al.5 studied 4314 primiparous
women and reported that the risk of pre-eclampsia
was 8.0%, 6.5% and 5.7% for women with none, one
and two earlier abortions, although these differences
were not statistically significant. Again, no differen-
tiation between induced and spontaneous abortions
was made. Saftlas et al.6 also used the CPEP data set,
restricting the sample to 3242 primigravidas and 822
women with one previous abortion, and reported that
a substantial pre-eclampsia risk reduction (from 8.0%
to 4.3%) occurred for the subgroup of women with
one abortion (without reporting effects of induced vs
spontaneous abortions) and the same father, whereas
the risk was not reduced if a change of partner
had taken place. The mean maternal age in the CPEP
study was 22 years, limiting the possibility of studying
long pregnancy intervals. Xiong et al.7 used a large
Canadian data set based on hospital records and
found that the risk of pre-eclampsia was 2.9% in
primigravid women and 2.6% in primiparous women
with a previous abortion, but could not differenti-
ate between induced and spontaneous abortions.
Thus, all these studies suggest a certain reduction in
risk if a primiparous woman has experienced any
abortion.
Eras et al.,9 using records from obstetric practices for
2739 births, reported a significant reduction in pre-
eclampsia risk both for women who had experienced
one spontaneous abortion and one induced abortion
as compared with primigravidas. Beck11 reviewed case
records of 220 women who had had an abortion
before the first term pregnancy. He found that the
incidence of pre-eclampsia was significantly lower
when there had been a previous induced abortion as
compared with no previous abortion or previous spon-
taneous abortion. Also, the interval between the first
and second pregnancy was longer in women having
had a previous induced abortion as compared with
a previous spontaneous abortion, but there were no
difference in the mean time interval between normal
pregnancies and pregnancies complicated by pre-
eclampsia. In a sample of 9771 women pregnant for
the first or second time, Seidman and colleagues10
found a protective effect of a prior induced abor-
tion after adjustment for maternal age, social class,
ethnic origin and smoking, but no protective effect
of a previous spontaneous abortion. Campbell et al.16
found that the incidence of pre-eclampsia after early
abortion (<13 weeks), either spontaneous or induced,
was similar to the population incidence in a first
pregnancy. Thus, our results are consistent with the
findings of Beck and with the findings of Seidman
and colleagues, but not with Campbells observation.
The mechanisms behind the parity effect are not
understood. A relatively new observation is that the
inter-pregnancy interval may be a major determinant.
If the time since the previous birth is 11 years of
more, the risk of pre-eclampsia in second births
appears to be as high as in a first birth.13 In our
study, the mean time interval from an induced abor-
tion to birth was about 6 years, which may dilute
a protective effect. Women with prior induced abor-
tions had a much longer time interval between the
abortion and the subsequent delivery than women
with prior spontaneous abortions. Nevertheless,
adjustment for the time interval between the abortion
and the subsequent birth did not change the pre-
eclampsia risk among women with same paternity
pregnancies, nor in new paternity pregnancies. Thus,
the increased risk of pre-eclampsia with increasing
interval between the first and second birth demon-
strated in a previous study1 could not be demon-
strated for abortions and subsequent pre-eclampsia
risk in the present study. The lack of association may
perhaps be explained by differences in gestational age,
however small numbers restricted us from further
analyses.
Recent studies have reported that both maternal and
paternal genes influence the risk of pre-eclampsia.
Mothers and fathers themselves born from pre-
eclamptic pregnancies contribute to an increased
risk in the next generation.1719 Although there was
 PREVIOUS ABORTIONS AND RISK OF PRE-ECLAMPSIA 1339

a tendency that women with changed paternity
were slightly less protected by two or more previous
induced abortions, and slightly more protected by two
or more previous spontaneous abortions as compared
with women with no change in paternity, these
findings were not significant and caution should be
taken to draw conclusions. Thus the impact of
changed paternity on the pre-eclampsia risk remains
unresolved. However, it seems likely that a change
in paternity may increase or decrease the risk of
pre-eclampsia, depending on the paternal genes
transmitted to the foetus and their interaction with
maternal genes. This is opposed to the immune based
primipaternity hypothesis suggesting the first preg-
nancy of any father will increase pre-eclampsia risk.20
We have not been able to control for the genetic
predisposition to pre-eclampsia in the parenting men
and women in this study.
Although genetic factors inevitably are important in
the development of pre-eclampsia, they are unlikely to
explain the reduced risk in second and later preg-
nancies. We speculate whether any pregnancy to a
woman induces a memory which reduces the risk of
pre-eclampsia in a subsequent pregnancy, regardless
of the parental genetic contributions which may also
alter the risk between pregnancies. This memory
may be hypothesized to decrease with increasing time
since the pregnancy, as reflected by the increased
risk observed with long interpregnancy intervals.1 An
induced abortion can in most instances be assumed
to be a normal pregnancy in contrast to a pregnancy
that ends in a spontaneous abortion. The underly-
ing pathology behind a spontaneous abortion may
in itself predispose to pre-eclampsia.21 We found
that women with spontaneous abortions more often
had been treated for infertility. Basso et al.22 have
suggested that subfecundity and pre-eclampsia may
share the same etiology. Thus, the protective effect
of a spontaneous abortion on pre-eclampsia risk in
a subsequent pregnancy may be overshadowed by
risk-increasing factors, and should be studied further.
In summary, we have found a significant protective
effect of having two or more induced abortions prior
to the first birth on the risk of pre-eclampsia. The
protective effect of two prior induced abortions is
similar to the protective effect of one prior birth. The
time interval between the abortion and the subse-
quent birth did not influence the results. The impact
of changed paternity remains unresolved. We specu-
late that normal pregnancies that are interrupted in
early pregnancy may induce immunological changes
that reduce the risk of pre-eclampsia in a subsequent
pregnancy, regardless of partner change.
Funding
This study was supported by The Norwegian Founda-
tion for Health and Rehabilitation (2002/2/0088 to
L.T.); The Norwegian Research Council (151918/S10);
National Institute of Environmental Health Sciences
(N01-ES85433); National Institute of Neurological
Diseases and Stroke (1 UO1 NS 047537); The sixth
Research Framework of the European Union
(EARNEST).
Acknowledgements
The efforts of all staff members in the Norwegian
Mother and Child Cohort Study and at the Medical
Birth Registry of Norway are greatly appreciated.
Conflict of interest: None declared.

KEY MESSAGES

Having had two or more induced abortions halves the risk of pre-eclampsia in primiparous women.

The reduction in risk after two induced abortions is of the same magnitude as a previous full-term
pregnancy.

Having had spontaneous abortions does not change the risk.

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