Iams and Berghella’s recent article in the August 2010 issue on the care of women with prior preterm birth was comprehensive and helpful. They comment on the association of preterm birth with a prior history of elective abortion.

“Contrary to common belief, population-based studies, ^34-36 have found that elective pregnancy terminations in the first and second trimesters are associated with a very small but apparently real increase in the risk of subsequent spontaneous preterm birth (PTB). ³⁷ ”

Contrary to the description of a “very small” increase, the 2009 systematic review and metaanalysis referred to in reference 37 actually concluded that a single elective termination was associated with a subsequent preterm birth odds ratio of 1.36 and more than 1 termination was associated with an odds ratio of 1.93. These increases are significant.

In light of this information, could the authors comment on whether: (1) the troubling doubled preterm birth risk for African American women might plausibly be related to the increased rate of pregnancy termination in African American women, and (2) since the abortion/preterm birth link has now been acknowledged, should this information be included in informed consent for abortion? The choice for or against an initial or repeat abortion is certainly a prospectively modifiable risk factor for preterm birth.