Abortion
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]
Synonyms and keywords:Pregnancy loss, miscarriage, spontaneous abortion
Overview
Historical Perspective
- Abortion means termination of a pregnancy and it has been known since ancient times.
- Abortion was first describe by ancient Egyptian medical text as the Ebers Papyrus in 1550 BCE, suggests that an abortion can be induced with the use of a plant-fiber tampon coated with honey and crushed dates.[1]
- During the ancient Egyptians, Persians, and Romans eras, abortion was practiced although it was never explicitly mentioned in any book of the Judeo-Christian Bible.[2]
- In the fourth century BCE, Niddah 23a, a chapter of the Babylonian Talmud, review about abortion as determining whether a woman is "unclean." and permitting abortion during early pregnancy.[3]
" A woman can only abort something in the shape of a stone, and that can only be described as a lump."
- On 11th century BCE, Code of Assura '' a harsh set of laws restricting women in general'' was the earliest legal ban on abortion by forcing the death penalty on married women who obtain abortions without permission of their husbands.[4]
- On the fifth century BCE Hippocratic Oath prohibit physicians from inducing elective abortions.[5]
- On 19th century surgical abortion become common and Hegar dilator in 1879 who invent dilation-and-curettage (D&C).[6]
- On November 18,1920, the Commissariats of Health and Justice legalized abortion in Soviet hospitals.[7][8]
- In 1970, Hawaii, New York, Alaska and Washington declared their abortion laws. Hawaii was the first state to legalize abortions and New York allowed abortions up to the 24th week of pregnancy.[9]
Classification
Abortion can be classified into the following:[10] [11][12]
| Abortion type | Characterestics |
|---|---|
| Early Threatened | Abortion before 12 weeks gestation
Symptoms: Cervix: Ultrasound: |
| Late Inevitable | Abortion between 12 and 20 weeks gestation
Symptoms: Cervix: Ultrasound: |
| Spontaneous | Noninduced abortion |
| Missed | Undetected death of an embryo or a fetus that is not expelled and that causes no bleeding (also called blighted ovum, anembryonic pregnancy, or intrauterine embryonic demise)
Symptoms: variable, asymptomatic, light vaginal bleeding Cervix: closed Ultrasound: Nonviable fetus |
| Inevitable | Vaginal bleeding or rupture of the membranes accompanied by dilation of the cervix
Symptoms: Vaginal bleeding, uterine cramps, Cervix: Open Ultrasound: Intrauterine fetus with possible heartbeats, ruptured or collapsed gestational sac |
| Incomplete | Expulsion of some products of conception
Symptoms: Vaginal bleeding with large clots or tissue, uterine cramps, some products of conception can be visualized in the dilated cervical os Cervix: Open Ultrasound: products of conception in the cervix |
| Threatened | Vaginal bleeding occurring before 20 weeks gestation without cervical dilation and indicating that spontaneous abortion may occur
Symptoms: variable amount of bleeding Cervix: closed Ultrasound: viable pregnancy |
| Septic | Serious infection of the uterine contents during or shortly before or after an abortion. usually after induced abortion and rarely after spontaneous abortion
Symptoms: Fever, malaise, signs of sepsis, foul vaginal discharge, cervical motion tenderness, uterine tenderness, can be life threatening Cervix: open Ultrasound: retained products of conception |
| Complete | Expulsion of all products of conception
Symptoms: Cervix: Ultrasound: |
| Recurrent or habitual | ≥ 2 to 3 consecutive spontaneous abortions
Symptoms: Cervix: Ultrasound: |
| Therapeutic | Termination of pregnancy because the woman’s life or health is endangered or because the fetus is dead or has malformations incompatible with life |
| Induced | Termination of pregnancy for medical or elective reasons |
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].
Pathophysiology
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
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[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
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The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Causes
Fetal causes:
- Genetic or chromosomal abnormalities (45,X karyotype, Trisomies (Trisomy 16 is the most common))
- Teratogenic and mutagenic factors
Maternal causes:
- Genetic: Maternal age is directly related to the aneuploidy risk,
- Parental chromosomal anomaly balanced translocation
Acute causes:
- Corpus luteum deficiency
- Active infection such as rubella virus, cytomegalovirus
Chronic maternal comorbidities
- Antiphospholipid syndrome
- Severe hypertension
- Systemic lupus erythematosus (SLE)
- Renal disease
- Poorly controlled diabetes mellitus
- Polycystic ovary syndrome
Differentiating abortion from other Diseases
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Epidemiology and Demographics
- The incidence of abortion Worldwide, was estimated to be 35 per 1000 women ages 15 to 44 from 2010 to 2014.[15]
- The rate in resource-rich countries was 27 per 1000 and in resource-limited countries was 37 per 1000. The incidence was highest in the Caribbean (65 per 1000), and the lowest in North America (17 per 1000). [16]
- In the United States, one in four women will have an abortion during their reproductive life.[16]
- The incidence of abortion is approximately 31%, the true incidence of abortion is difficult to ascertain, as many losses are not recognized[17][18]
- The rate of abortion influenced by maternal age and history of prior pregnancy loss.[19] 15% of women experience sporadic abortion, 2% of pregnant women experience two consecutive abortion and only 0.4 to 1% have three consecutive abortion. [20]
- The incidence of Abortions in the united state were highest in women ages 20 to 24 (19.1 per 1000 women) and 25 to 29 (18.5 per 1000 women)[21]
- Most abortions were done in women who were unmarried (85%) and had one or more children (59%).[21]
- Abortion rates in individuals of non-Hispanic White were 38.7 ,20.0 for Hispanic, and 7.7 for other races per 1000 women. [21]
- In the United States in 2018, 78% of abortions occur at 9 weeks or earlier, 92% at 13 weeks or earlier, and 8% at or after 14 weeks.[22]
Risk Factors
Non-modifiable risk factor :[23]
- Advanced age >35 years the most significant risk factor because of the associated fetal chromosomal abnormalities.
- Extremes of age
- Advanced paternal age
- Previous pregnancy loss increase the risk of later pregnancy loss.[24]
modifiable risk factor:
- obesity[25]
- Infection (eg: Parvovirus B19 infection,syphilis, cytomegalovirus (CMV) infection)[26][27][28]
- Pregestational diabetes increase the risk of miscarriage two- to threefold.[29]
- hyper- and hypothyroidism[30]
- Acute and chronic stress[31]
- Medication and substance use, example are NSAIDs (ibuprofen and diclofenac), Cocaine, methamphetamines[32]
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Diagnosis
Diagnostic Study of Choice
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
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The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
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There are no established criteria for the diagnosis of [disease name].
History and Symptoms
The majority of patients with [disease name] are asymptomatic.
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The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
Physical Examination
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
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Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Laboratory Findings
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
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There are no diagnostic laboratory findings associated with [disease name].
Electrocardiogram
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
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The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
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The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
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[Therapy] is recommended among all patients who develop [disease name].
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Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
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Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
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Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
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Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Surgery
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
Primary Prevention
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
References
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ "Internet History Sourcebooks".
- ↑ "The Hippocratic Oath in Roe v. Wade | by Tara Mulder | EIDOLON".
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ Endres, Richard J. (1971). "Abortion in perspective". American Journal of Obstetrics and Gynecology. 111 (3): 436–439. doi:10.1016/0002-9378(71)90791-5. ISSN 0002-9378.
- ↑ Rushton DI (1978). "Simplified classification of spontaneous abortions". J Med Genet. 15 (1): 1–9. doi:10.1136/jmg.15.1.1. PMC 1012814. PMID 564967.
- ↑ Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A; et al. (2017). "Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model". Lancet. 390 (10110): 2372–2381. doi:10.1016/S0140-6736(17)31794-4. PMC 5711001. PMID 28964589.
- ↑ Fujikura T, Froehlich LA, Driscoll SG (1966). "A simplified anatomic classification of abortions". Am J Obstet Gynecol. 95 (7): 902–5. doi:10.1016/0002-9378(66)90537-0. PMID 5914126.
- ↑ Pereza N, Ostojić S, Kapović M, Peterlin B (2017). "Systematic review and meta-analysis of genetic association studies in idiopathic recurrent spontaneous abortion". Fertil Steril. 107 (1): 150–159.e2. doi:10.1016/j.fertnstert.2016.10.007. PMID 27842992.
- ↑ Barut MU, Bozkurt M, Kahraman M, Yıldırım E, Imirzalioğlu N, Kubar A; et al. (2018). "Thrombophilia and Recurrent Pregnancy Loss: The Enigma Continues". Med Sci Monit. 24: 4288–4294. doi:10.12659/MSM.908832. PMC 6045916. PMID 29932168.
- ↑ Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B; et al. (2016). "Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends". Lancet. 388 (10041): 258–67. doi:10.1016/S0140-6736(16)30380-4. PMC 5498988. PMID 27179755.
- ↑ 16.0 16.1 Jones RK, Jerman J (2017). "Abortion Incidence and Service Availability In the United States, 2014". Perspect Sex Reprod Health. 49 (1): 17–27. doi:10.1363/psrh.12015. PMC 5487028. PMID 28094905.
- ↑ Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE (2019). "Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study". BMJ. 364: l869. doi:10.1136/bmj.l869. PMC 6425455. PMID 30894356.
- ↑ Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE; et al. (1988). "Incidence of early loss of pregnancy". N Engl J Med. 319 (4): 189–94. doi:10.1056/NEJM198807283190401. PMID 3393170.
- ↑ Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE (2019). "Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study". BMJ. 364: l869. doi:10.1136/bmj.l869. PMC 6425455. PMID 30894356.
- ↑ Salat-Baroux J (1988). "[Recurrent spontaneous abortions]". Reprod Nutr Dev. 28 (6B): 1555–68. PMID 3073445.
- ↑ 21.0 21.1 21.2 Kortsmit K, Jatlaoui TC, Mandel MG, Reeves JA, Oduyebo T, Petersen E; et al. (2020). "Abortion Surveillance - United States, 2018". MMWR Surveill Summ. 69 (7): 1–29. doi:10.15585/mmwr.ss6907a1. PMC 7713711 Check
|pmc=value (help). PMID 33237897 Check|pmid=value (help). - ↑ Kortsmit K, Jatlaoui TC, Mandel MG, Reeves JA, Oduyebo T, Petersen E; et al. (2020). "Abortion Surveillance - United States, 2018". MMWR Surveill Summ. 69 (7): 1–29. doi:10.15585/mmwr.ss6907a1. PMC 7713711 Check
|pmc=value (help). PMID 33237897 Check|pmid=value (help). - ↑ Hu X, Miao M, Bai Y, Cheng N, Ren X (2018). "Reproductive Factors and Risk of Spontaneous Abortion in the Jinchang Cohort". Int J Environ Res Public Health. 15 (11). doi:10.3390/ijerph15112444. PMC 6266092. PMID 30400160.
- ↑ Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE (2019). "Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study". BMJ. 364: l869. doi:10.1136/bmj.l869. PMC 6425455. PMID 30894356.
- ↑ Metwally M, Ong KJ, Ledger WL, Li TC (2008). "Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence". Fertil Steril. 90 (3): 714–26. doi:10.1016/j.fertnstert.2007.07.1290. PMID 18068166.
- ↑ Frazier T, Hogue CJR, Bonney EA, Yount KM, Pearce BD (2018). "Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion". Psychoneuroendocrinology. 92: 142–154. doi:10.1016/j.psyneuen.2018.03.001. PMID 29628283.
- ↑ Rasti S, Ghasemi FS, Abdoli A, Piroozmand A, Mousavi SG, Fakhrie-Kashan Z (2016). "ToRCH "co-infections" are associated with increased risk of abortion in pregnant women". Congenit Anom (Kyoto). 56 (2): 73–8. doi:10.1111/cga.12138. PMID 26499091.
- ↑ Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ (2013). "Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis". Bull World Health Organ. 91 (3): 217–26. doi:10.2471/BLT.12.107623. PMC 3590617. PMID 23476094.
- ↑ Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R (2014). "Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study". Diabetologia. 57 (2): 285–94. doi:10.1007/s00125-013-3108-5. PMID 24292565.
- ↑ Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ; et al. (2016). "Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis". Thyroid. 26 (4): 580–90. doi:10.1089/thy.2015.0418. PMC 4827301. PMID 26837268.
- ↑ Li Y, Margerison-Zilko C, Strutz KL, Holzman C (2018). "Life Course Adversity and Prior Miscarriage in a Pregnancy Cohort". Womens Health Issues. 28 (3): 232–238. doi:10.1016/j.whi.2018.02.001. PMID 29530382.
- ↑ Nakhai-Pour HR, Broy P, Sheehy O, Bérard A (2011). "Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion". CMAJ. 183 (15): 1713–20. doi:10.1503/cmaj.110454. PMC 3193112. PMID 21896698. Review in: Evid Based Nurs. 2012 Jul;15(3):76-7
- ↑ Avalos LA, Roberts SC, Kaskutas LA, Block G, Li DK (2014). "Volume and type of alcohol during early pregnancy and the risk of miscarriage". Subst Use Misuse. 49 (11): 1437–45. doi:10.3109/10826084.2014.912228. PMC 4183196. PMID 24810392.
- ↑ Ness RB, Grisso JA, Hirschinger N, Markovic N, Shaw LM, Day NL; et al. (1999). "Cocaine and tobacco use and the risk of spontaneous abortion". N Engl J Med. 340 (5): 333–9. doi:10.1056/NEJM199902043400501. PMID 9929522.
- ↑ Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM (2016). "Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies". Public Health Nutr. 19 (7): 1233–44. doi:10.1017/S1368980015002463. PMID 26329421.
- ↑ Lee SW, Han YJ, Cho DH, Kwak HS, Ko K, Park MH; et al. (2018). "Smoking Exposure in Early Pregnancy and Adverse Pregnancy Outcomes: Usefulness of Urinary Tobacco-Specific Nitrosamine Metabolite 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol Levels". Gynecol Obstet Invest. 83 (4): 365–374. doi:10.1159/000485617. PMID 29739005.