Correspondence

Table 1. Associations between maternal age and the risk of non-spontaneous mode of delivery (n = 7784)
Maternal age

< 20 years
(n = 313; ncases = 71)
2024.9 years
(n = 1302; ncases = 319)
2529.9 years
(n = 2121; ncases = 617)
3034.9 years
(n = 2880; ncases = 898)
3539.9 years
(n = 1034; ncases = 295)
40 years
(n = 134; ncases = 43)

Non-spontaneous delivery, odds ratio (95% CI)* (n = 2243)

Model A**

Model B**

Model C**

Model D**

0.65 (0.490.85)

0.42 (0.310.56)

0.80 (0.601.06)

0.44 (0.330.60)

0.72 (0.620.83)

0.54 (0.450.64)

0.83 (0.710.98)

0.56 (0.470.66)

0.91 (0.801.03)

0.78 (0.680.89)

0.97 (0.851.10)

0.79 (0.690.90)

Reference

Reference

Reference

Reference

0.88 (0.751.03)

1.13 (0.961.34)

0.89 (0.761.04)

1.13 (0.951.34)

1.04 (0.721.51)

1.43 (0.962.11)

1.07 (0.731.55)

1.42 (0.962.10)

Ptrend*** < 0.01

Ptrend < 0.01

Ptrend < 0.05

Ptrend < 0.01

*Values are odds ratios (95% CI) that reflect the difference in risk of non-spontaneous delivery between children of mothers in different age
groups compared with children of mothers in the 3034.9-year age group. Estimates are pooled estimated from multiple imputed datasets.
**Model A (Basic model) is adjusted fetal sex. Model B (Basic and socio-demographic model) is adjusted for fetal sex and maternal height, weight,
educational level, ethnicity and parity. Model C (Basic and lifestyle-related model) is adjusted for fetal sex and maternal alcohol consumption,
smoking habits, caffeine intake, folic acid supplement use and daily energy intake. Model D (Cumulative model) is adjusted for fetal sex and
maternal height, weight, educational level, ethnicity, parity, alcohol consumption, smoking habits, caffeine intake, folic acid supplement use and
daily energy intake.
***P-values for trend were based on multiple nonlinear logistic regression models; birthweight = maternal age + (maternal age)2 + covariates per
model.

P < 0.05; P < 0.01.

References
1 Mehta S, Tran K, Stewart L, Nauta M, Yoong W. Explaining differences in birth outcomes in relation to maternal age: the Generation R
Study. BJOG 2011;118:11467.
2 Bakker R, Steegers EAP, Biharie AA, Mackenbach JP, Hofman A, Jaddoe VWV. Explaining differences in birth outcomes in relation to
maternal age: the Generation R Study. BJOG 2011;118:5009.
3 Troe EJ, Raat H, Jaddoe VWV, Hofman A, Looman CW, Moll HA,
et al. Explaining differences in birth weight between ethnic populations: the Generation R Study. BJOG 2007;114:155765.
4 Fuentes-Afflick E, Hessol NA, Perez-Stable EJ. Maternal birthplace,
ethnicity, and low birth weight in California. Arch Pediatr Adolesc
Med 1998;152:110512.
5 Callaway LK, Lust K, McIntyre HD. Pregnancy outcomes in women of
very advanced maternal age. Aust N Z J Obstet Gynaecol 2005;45:
126.

R Bakker,a,b EAP Steegers,c AA Biharie,a,b

JP Mackenbach,d A Hofmanb & VWV Jaddoea,b,e
a

The Generation R Study Group bDepartment of Epidemiology

Department of Obstetrics and Gynaecology dDepartment of Public
Health and eDepartment of Paediatrics of the Erasmus Medical
Center, Rotterdam, the Netherlands
c

Comparing medical versus surgical termination of

pregnancy at 1320 weeks of gestation: a randomised
controlled trial1

Sir,
Six months ago, Kelly et al.1,* published a prospective
randomised trial in BJOG demonstrating womens preference for surgical abortion over medical methods between
13 and 20 weeks of gestation. This is in keeping with the
limited but consistent body of evidence already available
regarding womens preferences on this issue. In addition,
the authors showed that the methods were comparable in
safety, but with fewer unplanned hospital stays in the surgical abortion group, which agrees with a Cochrane review
showing that surgical methods at this gestation are at least
as safe and probably safer when compared with medical
methods, including modern regimens using mifepristone
and misoprostol.2
Despite these data, the most recent available figures show
that 79% of NHS hospitals providing abortion care for

Accepted 28 April 2011.

*The authors of the original article were invited to respond but did not

DOI: 10.1111/j.1471-0528.2011.03034.x

consider this to be necessary.

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2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology 2011 RCOG

Correspondence

women over 13 weeks of gestation only offer medical abortion.3 Remarkably, in a draft of its recent guidance on the
Care of Women Requesting Induced Abortion, the Royal
College of Obstetricians and Gynaecologists states only that
for those lacking the necessary expertise and caseload [to
perform second trimester surgical abortion] medical abortion using mifepristone and a prostaglandin is appropriate.4 No mention is made of the discordance between
evidence and practice in second-trimester abortion care in
the UK public sector.
As Kelly et al. correctly state, women should be offered a
choice of abortion methods. However, this goal can only
be achieved if the profession acknowledges the barriers preventing its realisation.

Disclosure of interest
I have previously worked for the British Pregnancy Advisory Service, a charitable independent-sector UK abortion
provider. j

References
1 Kelly T, Suddes J, Howel D, Hewison J, Robson S. Comparing medical
versus surgical termination of pregnancy at 1320 weeks of gestation: a randomised controlled trial. BJOG 2010;117:151220.
2 Lohr PA, Hayes JL, Gemzell-Danielsson K. Surgical versus medical
methods for second trimester induced abortion. Cochrane Database
Syst Rev 2008;1:CD006714.
3 RCOG. National Audit of Induced Abortion 2000. Audit. London:
Royal College of Obstetricians and Gynaecologists, 2001.
4 RCOG. Published for peer-review 22 January 2011. [www.rcog.
org.uk/files/rcog-corp/TheCareOfWomenRequestingInducedAbortion_
PeerReviewDraft_Jan2011.pdf]. Last accessed 31 March 2011.

R Lyus
Royal Free Hospital, London, UK
Accepted 28 April 2011.
DOI: 10.1111/j.1471-0528.2011.03035.x

2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology 2011 RCOG

1149