| Objective: The aims of the study were to comprehensive evaluate the psychological well-being among pregnant women during both first trimester and second trimester and investigate the possibility of an association between previous abortion and anxiety and depression during subsequent pregnancy, and to investigate the association between previous abortion and subsequent adverse pregnancy outcomes such as low birth weight (LBW), preterm birth (PB)and small for gestational-age(SGA).Methods: This study was based on Anhui Birth and Child Development Cohort Study (ABC cohort study), the ABC cohort study was an on-going prospective cohort study in Anhui in order to explore prenatal environmental exposure associated birth defects and child development. All pregnant women were invited to participate during their prenatal care visits to one of seven maternal and child health centers in Hefei and Maanshan city. From October 2008 though September 2009, a total of 7 017 pregnant women completed a written informed consent and a maternal and child health questionnaire. The structured questionnaire included demographic characteristics, gestational age when the survey was conducted, history of adverse pregnancy outcomes including miscarriage, medical abortion, induced abortion, premature birth, fetal death, stillbirth, difficult labour, hydatidiform mole, ectopic pregnancy, birth defect, neonatal death, term labor, cesarean section and other, Self-rating Anxiety Scal(eSAS) was used to explore the anxiety in pregnant women, Center for Epidemiologic Studies-depression Scale(CES-D)was used to explore the depression in pregnant women. Follow-up examinations were performed on the selected population by health care provider, information regarding pregnant outcome were collected using maternal and child health questionnaire during the third trimester when they went to apply for medical proof of birth or had their babies examined at the forth-second days. A total of 2 479 pregnant women's information regarding pregnant outcome were collected. The statistical package for the social sciences(SPSS for Windows, version 13.0)software was used for data analysis, statistical analysis included Student's t-test, Mann-Whitney U test, Pearson Chi-square, Pearson's Correlations, ANOVA, Linear regression and Logistic regression.Results: Of the 6 887 pregnant women selected for this study, 3 108(45.13%)were first trimester and 3 779(54.87%)were second trimester, 571(8.29%)had more than one history of miscarriage and 2 863(41.57%)had more than one history of induced abortion. Pregnant women during the first trimester reported significant higher score than those during the second trimester both in SAS(t=3.23, P<0.01)and CES-D score (Z=-7.92, P<0.01), and the result was the same among the one with different history of abortion(P<0.05). Pregnant women with history of induce abortion had significantly higher SAS score than those with no history of abortion and those with history of miscarriage(P<0.05). Stratified analysis by pregnant weeks showed that pregnant women with history of induce abortion had significantly higher SAS score than those with no history of abortion during the first trimester(P<0.05), while pregnant women with history of induce abortion had significantly higher SAS score than those with no history of abortion and those with history of miscarriage during the second trimester (P<0.05). With respect to CES-D score, there was significantly difference between women with induce abortion and controls during the first trimester(P<0.05), however there was on difference between neither group.A positive and linear correlation was observed between the SAS score and induced abortion rate during the first trimester with a correlation coefficient of 0.62 (P=0.019). A positive and linear correlation was also observed between the CES-D score and induced abortion rate during the first trimester with a correlation coefficient of 0.58(P=0.029). While the correlation between miscarriage rate and SAS score and CES-D score was no significant difference(P>0.05). In the Binary logistic regression model, as compared with pregnant women with no history of induced abortion, the women with history of induced abortion for less than 1 year(odds ratio 1.96,95% confidence interval 0.97 to 3.96)and more than 1 year(odds ratio 2.14,95% confidence interval 1.29 to 3.56)was associated with an increased anxiety symptom during the first trimester, after adjusted for maternal education, income, place of residence and BMI yielded similar result. With history of induced abortion for more than 1 year was significantly associated with depression symptom during the first trimester(odds ratio1.54,95% confidence interval 1.05 to 2.25). An interesting finding, pregnant women with history of induced abortion for less than 1 year reported significant more cases of depression than those had no during the second trimester(odds ratio 1.66,95% confidence interval 1.01 to 2.73), after control for confounding variable produced similar result.Among 2 479 pregnant women in this cohort, 1 359 ( 54.82% ) had no history of abortion, 910(36.71% )had a previous induced abortion , 132(5.32%)had a previous miscarriage and 78(3.15%)had both. There were 106 preterm births(4.27%), 96 small for gestational age ( 3.87% ) and 72 low birth weight(2.90%)among the respondents. After adjustment for maternal age, maternal education, income, place of residence, BMI and previous induced abortion, previous miscarriage was not associated with a significantly increased risk of preterm birth(odds ratio 0.85,95% confidence interval 0.38 to 1.89), low birth weigh(todds ratio 0.47, 95% confidence interval 0.15 to 1.54), small for gestational age (odds ratio 0.53,95% confidence interval 0.21 to 1.32). In the Linear regression model, a positive and linear correlation was observed between previous miscarriage and height and chest measurement, regression coefficient were 0.21(P<0.1)and 0.22 respectively(P<0.1), After adjustment for maternal age, maternal education, income, place of residence , BMI and previous induced abortion regression coefficient changed to 0.19(P<0.1)and 0.21(P>0.1). Furthermore, a negative correlation was observed between previous miscarriage and 5 min Apgar score with regression coefficient equal to -0.07(P<0.05), after adjusted for maternal age, maternal education, income, place of residence , BMI and previous induced abortion produced different result. However, a history of induced abortion was the risk factor of cesarean section, urged to perform cesarean section, transverse presentation, after adjusted for maternal age, maternal education, income, place of residence , BMI and previous miscarriage, the adjusted OR was estimated at 1.19(95%CI=0.99～1.41,P<0.1), 1.48(95%CI=1.10～1.97,P<0.05)and 0.23(0.05～1.04,P<0.1)respectively。Conclusions: These results suggest that women who have experienced a previous pregnancy loss have omnipresent anxiety and depression symptom during a subsequent pregnancy, the odds ration was different by interval between abortion and subsequent preganacy and pregnancy weeks. However, we found no evidence that a previous induced abortion and miscarriage, as compared with the one had no history of abortion, increased the risk of low birth weight, preterm birth and small for gestational-age, but previous induced abortion may increase the likelihood of performing cesarean delivery.
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