Pregnancy Outcomes After Second Trimester Pregnancy Loss and Termination for Medical Reasons Before 24 Weeks: A Historical Cohort Study [PASTeL-2]

Andrea M.F. Woolner; Konstantin Shestopaloff; Alexander E.P. Heazell

doi:10.1111/1471-0528.70161

Pregnancy Outcomes After Second Trimester Pregnancy Loss and Termination for Medical Reasons Before 24 Weeks: A Historical Cohort Study [PASTeL-2]

Andrea M.F. Woolner^*
, Konstantin Shestopaloff
, Alexander E.P. Heazell

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To investigate if second trimester pregnancy loss (second trimester miscarriage [STM] or termination for medical reasons [TFMR]) was associated with subsequent adverse pregnancy outcomes. Design: Retrospective cohort study. Setting: Conducted using the Aberdeen Maternity and Neonatal Databank [AMND] in Aberdeen, United Kingdom. Population: Women with and without a history of STM or TFMR (between 13 + 0 and 23 + 6 weeks' gestation). Methods: Logistic and linear regression were used to determine associations between exposed (prior STM or TFMR) and unexposed women (women with prior livebirth). Main Outcome Measures: The primary outcome was subsequent spontaneous preterm birth, defined as spontaneous onset of labour and birth between 24 + 0 and 36 + 6 weeks' gestation. Results: The study included 65 592 women with first and second pregnancies recorded from 1950 to 2017. Women who had a STM in their first pregnancy (n = 935) were at significantly greater risk of spontaneous preterm birth in the next pregnancy (4.3% vs. 1.5%; adjusted Odds Ratio [aOR] 2.55 (95% CI 1.81 to 3.50); p < 0.01). Women with STM in their first pregnancy were two-fold more likely to have a repeat second trimester miscarriage (3.7% vs. 1.1%; aOR 2.25 (95% CI 1.53 to 3.19); p < 0.01). Women who had a first TFMR (n = 177) were significantly more likely to have a repeat TFMR (adjusted OR [aOR] 6.59 (3.4% vs. 0.3%, 95% CI 2.54 to 13.99); p < 0.01). There was no observed increased risk of spontaneous preterm birth after TFMR detected in this sample (aOR 1.06 (95% CI 0.39 to 2.87); p = 0.91) though the sample size was too small to be conclusive. Conclusions: Women with a history of second trimester pregnancy loss have an increased risk of adverse pregnancy outcomes in a subsequent pregnancy. Consequently, antenatal care surveillance and counselling may need to be increased for women with a prior STM, who are at risk of spontaneous preterm birth and other adverse obstetric outcomes including pre-eclampsia. Women after TFMR can be reassured by our findings; however, larger cohorts are needed to confirm these results.

Original language	English
Pages (from-to)	1200-1212
Number of pages	12
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	133
Issue number	6
Early online date	25 Jan 2026
DOIs	https://doi.org/10.1111/1471-0528.70161
Publication status	E-pub ahead of print - 25 Jan 2026

Bibliographical note

Open access via the Wiley OA Agreement

We wish to acknowledge the significant contribution of our late colleague Dr. Sohinee Bhattacharya to the planning of this study. We also wish to thank the University of Aberdeen data management team, in particular, Adrian Martin.

A.M.F.W. and A.E.P.H. conceived the idea for the study and designed the study. A.M.F.W. applied for approvals. A.M.F.W., K.S., and A.E.P.H. designed and planned the statistical analyses. K.S. analysed data. A.M.F.W. wrote the first draft of the paper and edited subsequent drafts. A.E.P.H. and K.S. edited each draft of the paper and commented on the final draft.

Data Availability Statement

Research data available by application to the Aberdeen Maternity and Neonatal Databank Steering Committee (www.abdn.ac.uk/amnd).

Funding

This research was funded by Tommy's UK, the baby and pregnancy loss charity. K.S. has no conflicts of interest to declare. A.M.F.W. holds research grants from Chief Scientist Office Scotland, NIHR EME, and Tommy's charity. A.E.P.H. has research grants from NIHR RfPB and Tommy's Charity.

Funders
The Queen's Medical Research Institute, University of Edinburgh
Chief Scientist Office
Nottingham NIHR BRC
NIHR RfPB

Keywords

late miscarriage
late spontaneous abortion
midtrimester miscarriage
spontaneous preterm birth
termination for fetal anomalies
termination for medical reason

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Pregnancy Outcomes After Second Trimester Pregnancy Loss and Termination for Medical Reasons Before 24 Weeks: A Historical Cohort Study [PASTeL-2]. / Woolner, Andrea M.F.; Shestopaloff, Konstantin; Heazell, Alexander E.P.
In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 133, No. 6, 05.2026, p. 1200-1212.

Research output: Contribution to journal › Article › peer-review

@article{0e4564161adb4cc4b90bf9bf9e344676,

title = "Pregnancy Outcomes After Second Trimester Pregnancy Loss and Termination for Medical Reasons Before 24 Weeks: A Historical Cohort Study [PASTeL-2]",

abstract = "Objective: To investigate if second trimester pregnancy loss (second trimester miscarriage [STM] or termination for medical reasons [TFMR]) was associated with subsequent adverse pregnancy outcomes. Design: Retrospective cohort study. Setting: Conducted using the Aberdeen Maternity and Neonatal Databank [AMND] in Aberdeen, United Kingdom. Population: Women with and without a history of STM or TFMR (between 13 + 0 and 23 + 6 weeks' gestation). Methods: Logistic and linear regression were used to determine associations between exposed (prior STM or TFMR) and unexposed women (women with prior livebirth). Main Outcome Measures: The primary outcome was subsequent spontaneous preterm birth, defined as spontaneous onset of labour and birth between 24 + 0 and 36 + 6 weeks' gestation. Results: The study included 65 592 women with first and second pregnancies recorded from 1950 to 2017. Women who had a STM in their first pregnancy (n = 935) were at significantly greater risk of spontaneous preterm birth in the next pregnancy (4.3\% vs. 1.5\%; adjusted Odds Ratio [aOR] 2.55 (95\% CI 1.81 to 3.50); p < 0.01). Women with STM in their first pregnancy were two-fold more likely to have a repeat second trimester miscarriage (3.7\% vs. 1.1\%; aOR 2.25 (95\% CI 1.53 to 3.19); p < 0.01). Women who had a first TFMR (n = 177) were significantly more likely to have a repeat TFMR (adjusted OR [aOR] 6.59 (3.4\% vs. 0.3\%, 95\% CI 2.54 to 13.99); p < 0.01). There was no observed increased risk of spontaneous preterm birth after TFMR detected in this sample (aOR 1.06 (95\% CI 0.39 to 2.87); p = 0.91) though the sample size was too small to be conclusive. Conclusions: Women with a history of second trimester pregnancy loss have an increased risk of adverse pregnancy outcomes in a subsequent pregnancy. Consequently, antenatal care surveillance and counselling may need to be increased for women with a prior STM, who are at risk of spontaneous preterm birth and other adverse obstetric outcomes including pre-eclampsia. Women after TFMR can be reassured by our findings; however, larger cohorts are needed to confirm these results.",

keywords = "late miscarriage, late spontaneous abortion, midtrimester miscarriage, spontaneous preterm birth, termination for fetal anomalies, termination for medical reason",

author = "Woolner, \{Andrea M.F.\} and Konstantin Shestopaloff and Heazell, \{Alexander E.P.\}",

note = "Open access via the Wiley OA Agreement We wish to acknowledge the significant contribution of our late colleague Dr. Sohinee Bhattacharya to the planning of this study. We also wish to thank the University of Aberdeen data management team, in particular, Adrian Martin. A.M.F.W. and A.E.P.H. conceived the idea for the study and designed the study. A.M.F.W. applied for approvals. A.M.F.W., K.S., and A.E.P.H. designed and planned the statistical analyses. K.S. analysed data. A.M.F.W. wrote the first draft of the paper and edited subsequent drafts. A.E.P.H. and K.S. edited each draft of the paper and commented on the final draft. ",

year = "2026",

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doi = "10.1111/1471-0528.70161",

language = "English",

volume = "133",

pages = "1200--1212",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

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T1 - Pregnancy Outcomes After Second Trimester Pregnancy Loss and Termination for Medical Reasons Before 24 Weeks

T2 - A Historical Cohort Study [PASTeL-2]

AU - Woolner, Andrea M.F.

AU - Shestopaloff, Konstantin

AU - Heazell, Alexander E.P.

N1 - Open access via the Wiley OA Agreement We wish to acknowledge the significant contribution of our late colleague Dr. Sohinee Bhattacharya to the planning of this study. We also wish to thank the University of Aberdeen data management team, in particular, Adrian Martin. A.M.F.W. and A.E.P.H. conceived the idea for the study and designed the study. A.M.F.W. applied for approvals. A.M.F.W., K.S., and A.E.P.H. designed and planned the statistical analyses. K.S. analysed data. A.M.F.W. wrote the first draft of the paper and edited subsequent drafts. A.E.P.H. and K.S. edited each draft of the paper and commented on the final draft.

PY - 2026/1/25

Y1 - 2026/1/25

N2 - Objective: To investigate if second trimester pregnancy loss (second trimester miscarriage [STM] or termination for medical reasons [TFMR]) was associated with subsequent adverse pregnancy outcomes. Design: Retrospective cohort study. Setting: Conducted using the Aberdeen Maternity and Neonatal Databank [AMND] in Aberdeen, United Kingdom. Population: Women with and without a history of STM or TFMR (between 13 + 0 and 23 + 6 weeks' gestation). Methods: Logistic and linear regression were used to determine associations between exposed (prior STM or TFMR) and unexposed women (women with prior livebirth). Main Outcome Measures: The primary outcome was subsequent spontaneous preterm birth, defined as spontaneous onset of labour and birth between 24 + 0 and 36 + 6 weeks' gestation. Results: The study included 65 592 women with first and second pregnancies recorded from 1950 to 2017. Women who had a STM in their first pregnancy (n = 935) were at significantly greater risk of spontaneous preterm birth in the next pregnancy (4.3% vs. 1.5%; adjusted Odds Ratio [aOR] 2.55 (95% CI 1.81 to 3.50); p < 0.01). Women with STM in their first pregnancy were two-fold more likely to have a repeat second trimester miscarriage (3.7% vs. 1.1%; aOR 2.25 (95% CI 1.53 to 3.19); p < 0.01). Women who had a first TFMR (n = 177) were significantly more likely to have a repeat TFMR (adjusted OR [aOR] 6.59 (3.4% vs. 0.3%, 95% CI 2.54 to 13.99); p < 0.01). There was no observed increased risk of spontaneous preterm birth after TFMR detected in this sample (aOR 1.06 (95% CI 0.39 to 2.87); p = 0.91) though the sample size was too small to be conclusive. Conclusions: Women with a history of second trimester pregnancy loss have an increased risk of adverse pregnancy outcomes in a subsequent pregnancy. Consequently, antenatal care surveillance and counselling may need to be increased for women with a prior STM, who are at risk of spontaneous preterm birth and other adverse obstetric outcomes including pre-eclampsia. Women after TFMR can be reassured by our findings; however, larger cohorts are needed to confirm these results.

AB - Objective: To investigate if second trimester pregnancy loss (second trimester miscarriage [STM] or termination for medical reasons [TFMR]) was associated with subsequent adverse pregnancy outcomes. Design: Retrospective cohort study. Setting: Conducted using the Aberdeen Maternity and Neonatal Databank [AMND] in Aberdeen, United Kingdom. Population: Women with and without a history of STM or TFMR (between 13 + 0 and 23 + 6 weeks' gestation). Methods: Logistic and linear regression were used to determine associations between exposed (prior STM or TFMR) and unexposed women (women with prior livebirth). Main Outcome Measures: The primary outcome was subsequent spontaneous preterm birth, defined as spontaneous onset of labour and birth between 24 + 0 and 36 + 6 weeks' gestation. Results: The study included 65 592 women with first and second pregnancies recorded from 1950 to 2017. Women who had a STM in their first pregnancy (n = 935) were at significantly greater risk of spontaneous preterm birth in the next pregnancy (4.3% vs. 1.5%; adjusted Odds Ratio [aOR] 2.55 (95% CI 1.81 to 3.50); p < 0.01). Women with STM in their first pregnancy were two-fold more likely to have a repeat second trimester miscarriage (3.7% vs. 1.1%; aOR 2.25 (95% CI 1.53 to 3.19); p < 0.01). Women who had a first TFMR (n = 177) were significantly more likely to have a repeat TFMR (adjusted OR [aOR] 6.59 (3.4% vs. 0.3%, 95% CI 2.54 to 13.99); p < 0.01). There was no observed increased risk of spontaneous preterm birth after TFMR detected in this sample (aOR 1.06 (95% CI 0.39 to 2.87); p = 0.91) though the sample size was too small to be conclusive. Conclusions: Women with a history of second trimester pregnancy loss have an increased risk of adverse pregnancy outcomes in a subsequent pregnancy. Consequently, antenatal care surveillance and counselling may need to be increased for women with a prior STM, who are at risk of spontaneous preterm birth and other adverse obstetric outcomes including pre-eclampsia. Women after TFMR can be reassured by our findings; however, larger cohorts are needed to confirm these results.

KW - late miscarriage

KW - late spontaneous abortion

KW - midtrimester miscarriage

KW - spontaneous preterm birth

KW - termination for fetal anomalies

KW - termination for medical reason

U2 - 10.1111/1471-0528.70161

DO - 10.1111/1471-0528.70161

M3 - Article

AN - SCOPUS:105028397494

SN - 1470-0328

VL - 133

SP - 1200

EP - 1212

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - 6

ER -

Pregnancy Outcomes After Second Trimester Pregnancy Loss and Termination for Medical Reasons Before 24 Weeks: A Historical Cohort Study [PASTeL-2]

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

Access to Document

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